Intermunicipal inequities in access and use of secondary health services in the metropolitan area of Curitiba

Aguilera, Sandra; França, Beatriz Helena Sottile; Moysés, Simone Tetü; Moysés, Samuel Jorge

doi:10.1590/1809-4503201400030007

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…Measured distances between households and health facilities have previously been associated with dengue occurrence [ 28 ], as well as with poorer colorectal cancer survival [ 60 ], lower clinic attendance and a higher degree of dehydration due to diarrhea [ 61 ], and decreased use of antenatal healthcare [ 62 ], among others. Geographic accessibility to health care is usually observed on a broader scale, especially in developing countries where greater inequalities in health care access are observed in smaller towns distant to large urban centers [ 63 , 64 ]. Our study demonstrates that this phenomenon may also be present at finer geographic scales, such as within urban communities.…”

Section: Discussionmentioning

confidence: 99%

Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk

et al. 2015

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BackgroundFew studies of dengue have shown group-level associations between demographic, socioeconomic, or geographic characteristics and the spatial distribution of dengue within small urban areas. This study aimed to examine whether specific characteristics of an urban slum community were associated with the risk of dengue disease.Methodology/Principal FindingsFrom 01/2009 to 12/2010, we conducted enhanced, community-based surveillance in the only public emergency unit in a slum in Salvador, Brazil to identify acute febrile illness (AFI) patients with laboratory evidence of dengue infection. Patient households were geocoded within census tracts (CTs). Demographic, socioeconomic, and geographical data were obtained from the 2010 national census. Associations between CTs characteristics and the spatial risk of both dengue and non-dengue AFI were assessed by Poisson log-normal and conditional auto-regressive models (CAR). We identified 651 (22.0%) dengue cases among 2,962 AFI patients. Estimated risk of symptomatic dengue was 21.3 and 70.2 cases per 10,000 inhabitants in 2009 and 2010, respectively. All the four dengue serotypes were identified, but DENV2 predominated (DENV1: 8.1%; DENV2: 90.7%; DENV3: 0.4%; DENV4: 0.8%). Multivariable CAR regression analysis showed increased dengue risk in CTs with poorer inhabitants (RR: 1.02 for each percent increase in the frequency of families earning ≤1 times the minimum wage; 95% CI: 1.01-1.04), and decreased risk in CTs located farther from the health unit (RR: 0.87 for each 100 meter increase; 95% CI: 0.80-0.94). The same CTs characteristics were also associated with non-dengue AFI risk.Conclusions/SignificanceThis study highlights the large burden of symptomatic dengue on individuals living in urban slums in Brazil. Lower neighborhood socioeconomic status was independently associated with increased risk of dengue, indicating that within slum communities with high levels of absolute poverty, factors associated with the social gradient influence dengue transmission. In addition, poor geographic access to health services may be a barrier to identifying both dengue and non-dengue AFI cases. Therefore, further spatial studies should account for this potential source of bias.

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Section: Discussionmentioning

confidence: 99%

Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk

et al. 2015

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“…Several studies have addressed the use of oral health services for populations in various locations in the world [ 2 – 11 ]. In the Brazilian context, the following areas have been investigated: the use of health services in general [ 12 – 14 ], the use of dental care for the elderly [ 15 – 17 ], the regular use of dental services [ 15 , 18 – 20 ], the use of dental services motivated by pain [ 21 ], the use of secondary care in oral health [ 22 , 23 ] and the characterization of the use of dental services [ 24 – 26 ]. Only three Brazilian studies were identified that investigated the type of service as an outcome of interest in the adult population [ 27 – 29 ].…”

Section: Introductionmentioning

confidence: 99%

Use of Public Oral Health Services by the Adult Population: A Multilevel Analysis

et al. 2016

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BackgroundIt is important to assess context to explain inequalities in oral health, particularly with regard to the type of service used; thus, this study aimed to identify the social determinants of public dental service use by adults and to assess whether, beyond the level individual, existing inequalities are also expressed in the context in which individuals are embedded.MethodsA multilevel analysis with three levels of aggregation of variables was performed. The individual variables were derived from the database of the SB Minas Gerais project—a survey of oral health status of the population of Minas Gerais, a state of the Brazilian Southeast region. The variable at the neighborhood level came from the Census of 2010. The variables at the municipal level were obtained from available public databases relating to oral health services. At the municipal level, the Human Development Index (HDI) variable was chosen to represent quality of life in the municipalities.ResultsIn the final model, the following individual variables were associated with greater use of public dental services: lower income (PR = 1.98, 95% CI = 1.53; 2.58), higher number of residents at home (PR = 1.37, 95% CI = 1.11; 1.68) and higher number of teeth requiring treatment (PR = 1.49, 95% CI = 1.20; 1.84). With regard to context variables, a poorer infrastructure (PR = 0.62, 95% CI = 0.40; 0.96) leads to a lower use of public services.ConclusionThe use of public services is associated with family income, how this income is divided in households, the need for treatment presented by the individual and the organization of the existing oral health service infrastructure in the municipality.

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“…19 Never visiting a doctor or a dentist was two to three times more frequent in people with lower socioeconomic status. Low-income individuals suffer inequities in healthcare usage due to the long distance to the hub municipality 20 and inability of the healthcare system to adequately respond to the population's health demands and needs, 21 besides other social and economic vulnerabilities. Although income-related inequalities in health and dental care access seem to have decreased in Brazil in the past decades, the rate of change has not been enough to offer universal care to all citizens.…”

Section: Discussionmentioning

confidence: 99%

Inequity in utilizing health services in the Brazilian Amazon: A population‐based survey, 2015

Galvão

Tiguman

Caicedo-Roa

et al. 2019

Health Planning & Management

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Summary Background Although Brazil has a public and universal healthcare system, utilization of health services is marked by social and regional discrepancies. Objective To assess the prevalence and factors associated with underutilization of healthcare services in the Brazilian Amazon. Method Cross‐sectional, population‐based study. Adults aged over 18 years old were selected through probabilistic sampling. Underutilization of healthcare services was defined as never seeing a physician or a dentist. Poisson regression with robust variance was performed to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). A complex sample design was considered. Results A total of 4001 individuals were included, of which 419 (10.4%; 95% CI, 9.5‐11.4%) never visited a physician or a dentist. In the adjusted analysis, underutilization was higher among poorer people (PR = 3.32; 95% CI, 2.16‐5.11), men (PR = 1.34; 95% CI, 1.10‐1.65), people with brown skin color (Brazilian mixed race; PR = 1.34; 95% CI, 1.02‐1.76), and people who are separated (PR = 1.40; 95% CI, 1.01‐1.94) and widowed (PR = 1.55; 95% CI, 1.02‐2.37), when compared with the reference categories. Individuals with informal jobs, those who are retired, students/housewives, and unemployed people were more vulnerable to underutilization than formal workers (P < .04). Conclusion Underutilization of healthcare services occurs in one‐tenth of adults in Manaus Metropolitan Region and is associated with social and economic inequities.

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Intermunicipal inequities in access and use of secondary health services in the metropolitan area of Curitiba

Cited by 8 publications

References 16 publications

Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk

Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk

Use of Public Oral Health Services by the Adult Population: A Multilevel Analysis

Inequity in utilizing health services in the Brazilian Amazon: A population‐based survey, 2015

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