The variation of the burden of hypertension and diabetes in two large districts of the city of São Paulo, Brazil, based on primary health care routinely-collected data

Abstract

BackgroundNoncommunicable diseases (NCDs) were responsible for 72.3% of global deaths in 2016, with cardiovascular diseases accounting for almost half of those deaths and low- and middle-income countries carrying the biggest burden. As a result, the prevention and control of NCDs is recognized as urgent, while better surveillance at the country level could result in more effective policies. Hence, the objective of this study was to obtain more detailed information on the distribution of the prevalence of hypertension and diabetes among the population of two large districts of the city of São Paulo in Brazil, and to compare these findings to the results of a citywide health survey.Methods and findingsThis cross-sectional study used primary health care (PHC) routinely-collected data. The study population included 187,110 individuals 20 years of age or older registered in 13 public PHC facilities at two districts of the city of São Paulo in 2015. Data extracted from SIAB, a primary care database, was used to calculate age and sex directly standardized prevalences for diabetes and hypertension for each PHC facility. The prevalence of hypertension among women was significantly higher than the prevalence among men in the entire study population, and in every PHC facility. There was great variation among PHC facilities that was more pronounced among women. The prevalence of diabetes among women was significantly higher than the prevalence among men in the entire study population, and in every PHC facility, but there was little variation among PHC facilities.ConclusionsThis study provided information that could help with policy planning and allocation of resources, and demonstrated the use of PHC routinely-collected data to generate important insights that if replicated could have a substantial impact given the broad coverage of the national public PHC program in Brazil.

Prevalência de pré-diabetes e hiperglicemia intermediária em adultos e fatores associados, Pesquisa Nacional de Saúde

“…Although the prevalence of self-reported DM in different surveys [11][12][13][14] and measured by the PNS, when considering HbA1c ≥ 6.5% 10 , is higher among women, this study found no differences in the frequency of prediabetes/intermediate hyperglycemia by gender, in agreement with the results of the IDF 6 . On the other hand, the pattern observed increased prevalence according to the population's age, with a risk gradient given by low schooling, obesity, and comorbidities such as arterial hypertension, besides physical inactivity, is per the occurrence of diabetes itself [10][11][12] .…”

Deconstructing design thinking as a tool for the implementation of a population health initiative

“…The decision to engage with Brazil was based on several criteria: first, the characteristics of the healthcare system-Brazil has a public health system [31] that recognizes health as a universal constitutional right, provides access to medicines [32] and vests the responsibility to execute primary care delivery at the municipal level. Second, the burden of hypertension in São Paulo is high and is increasing [33], and the health system faces burgeoning pressures in the face of urbanization, a double disease burden where NCDs overtake communicable diseases, and political interference. It is understood that there remains ample opportunity to make greater use of known evidence-based practices for reducing hypertension in resource-constrained settings [29], despite documented improvements in hypertension diagnosis and management across several geographies [34].…”