Desigualdades sociales en indicadores de uso de servicios de salud por adolescentes de Campinas, São Paulo, Brasil

Lemos, Vivian Castro; Barros, Marilisa Berti de Azevedo; Lima, Margareth Guimarães

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ARTICLE • Cad. Saúde Pública 40 (4) • 2024 • https://doi.org/10.1590/0102-311XEN146523 copiar

Desigualdades sociales en indicadores de uso de servicios de salud por adolescentes de Campinas, São Paulo, Brasil

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen:

El objetivo de este estudio fue estimar la prevalencia de los indicadores de uso de servicios de salud según el sexo, ingresos y etnia/color de la piel entre adolescentes (10 a 19 años) basado en los datos de la Encuesta de Salud de la Ciudad de Campinas (ISACamp), realizada entre 2014 y 2015 en Campinas, São Paulo, Brasil. Se utilizó la prueba de chi-cuadrado para evaluar las diferencias entre las variables de resultado (indicadores de uso de servicios de salud) y sexo, ingresos y etnia/color de la piel. Se estimaron las razones de prevalencia (RP) ajustadas a través de modelos de regresión múltiple de Poisson. La demanda de atención médica fue alta en el último año de la entrevista (el 79,2%), mayoritariamente asistidos por el Sistema Único de Salud (el 65,2%), con las consultas de rutina más frecuentes para el sexo femenino (RP = 1,17; IC95%: 1,01-1,34) y la atención por lesiones más frecuentes para la población masculina (RP = 0,47; IC95%: 0,26-0,84). Se encontraron diferencias económicas y raciales en la evaluación de la última consulta médica, con mayor prevalencia de peor atención entre aquellos con menores ingresos (RP = 1,46; IC95%: 1,14-1,87) y personas negras (RP = 1,27; IC95%: 1,01-1,61). Las desigualdades persistieron en términos de retraso o no realización de exámenes (RP = 1,64; IC95%: 1,02-2,64) y peor calidad de la atención odontológica (RP = 2,10; IC95%: 1,38-3,21) en aquellos con menores ingresos. Y las personas negras fueron las que menos consultaron los servicios de dentistas (RP = 0,90; IC95%: 0,82-0,99).

Palabras-clave:
Desigualdades Sociales; Atención Médica; Servicios de Salud del Adolescente; Encuesta de Salud

OUTCOME VARIABLE	QUESTION ASKED	ANSWER
Medical appointment in previous year (G101)	When was the last time you had an appointment with a physician?	(0) The last appointment was more than one year ago (1) The last appointment was in the previous year
Main reason for the appointment (G103)	What was the main reason you had to schedule your last appointment with a physician?	(0) Disease/Health problem (1) Injury (2) Routine checkup
Assessment of attendance of the last appointment as fair/poor/very poor (G117)	How do you assess the care received at the last medical appointment?	(0) Good, very good (1) Fair, poor, very poor
Coverage of appointment through the SUS (G108)	Who covered or complemented the cost of this appointment?	(0) Company plan, individual health insurance plan, other (1) SUS
Felt well oriented to take care of problem (G118)	Did you feel well oriented and informed about how to take care of your problem?	(0) No (1) Yes
Had health problem for which was unable to obtain an appointment in previous year (G119A)	Have you had any health problem for which you were unable to obtain an appointment in the last year?	(0) No (1) Yes
There was delay or non-performance of exams requested during medical appointment (G120A and G121A)	Was any exam requested during a medical appointment in the last year that took a long time for you to get the results? Was any exam requested during a medical appointment in the last year that was not performed? These two questions were combined for the outcome YES	(0) No (1) Yes
There was delay or was not able to schedule an appointment with a specialist physician (G122A and G123A)	Was any referral to a specialist or other health professional requested during any medical appointment in the last year that took a long time to be scheduled? Was any referral to a specialist or other health professional requestion during any medical appointment in the last year that you were unable to schedule? These two questions were united for the outcome YES	(0) No (1) Yes
Dental appointment in previous year	When was the last time you visited a dentist?	(0) Last appointment was more than one year before (1) Last appointment was in the previous year
Assessment of dental appointment as fair/poor/very poor	How do you assess the dental care that you received?	(0) Good, very good (1) Fair, poor, very poor
Has been vaccinated against hepatitis B	Have you ever had a vaccine against hepatitis B?	(0) No (1) Yes
EXPOSURE VARIABLES		ANSWER
Sex		(0) Male (1) Female
Monthly family income per capita		(0) < monthly minimum wage (1) ≥ monthly minimum wage
Race/Skin color		(0) White (1) Black (black/brown)

Variables	Total [% (n)]	Male * [% (95%CI)]	Female [% (95%CI)]	PR (95% CI) **
Medical appointment in the previous year	79.2 (803)	76.4 (71.9-80.3)	82.1 (78.5-85.2)	1.08 (1.01-1.15)
Main reason for last appointment
Disease/Health problem	45.1 (458)	46.6 (41.1-52.2)	43.5 (38.2-48.8)	0.93 (0.81-1.06)
Routine checkup	43.4 (438)	40.2 (34.5-46.1)	46.7 (40.9-52.5)	1.17 (1.01-1.34)
Injury	5.3 (52)	7.1 (5.3-9.5)	3.3 (2.1-5.4)	0.47 (0.26-0.84)
Assessment of attendance of the last appointment as fair/poor/very poor	21.3 (219)	19.4 (16.2-23.1)	23.2 (19.4-27.5)	1.19 (0.99-1.43)
Coverage of appointment through the SUS	65.2 (654)	65.0 (58.9-70.6)	65.3 (58.9-71.3)	1.00 (0.92-1.09)
Felt well oriented to take care of problem	85.2 (856)	86.2 (82.5-89.2)	84.1 (80.0-87.5)	0.98 (0.93-1.02)
Problem for which was unable to obtain an appointment in previous year	8.1 (84)	6.1 (4.4-8.6)	10.1 (7.8-13.0)	1.65 (1.11-2.45)
There was delay or non-performance of exams requested during medical appointment	7.2 (77)	5.1 (3.4-7.7)	9.4 (6.8-12.9)	1.81 (1.04-3.15)
There was delay or was not able to schedule an appointment with specialist physician	8.9 (87)	7.1 (5.1-9.9)	10.9 (8.1-14.4)	1.54 (1.07-2.22)
Dental appointment in previous year	66.9 (678)	67.4 (62.0-72.4)	66.3 (59.6-72.4)	0.98 (0.89-1.09)
Assessment of dental appointment as fair/poor/very poor	11.7 (111)	9.5 (7.2-12.5)	13.9 (10.1-18.8)	1.45 (1.01-2.11)
Has been vaccinated against hepatitis B	97.3 (925)	96.7 (94.1-98.2)	97.8 (95.0-99.1)	1.01 (0.99-1.03)

Variables	n	Income *		PR (95%CI) **	PR (95%CI) ***
Variables	n	≥ Monthly minimum wage [% (95%CI)]	< Monthly minimum wage ^# [% (95%CI)]	PR (95%CI) **	PR (95%CI) ***
Medical appointment in the previous year	800	82.6 (78.8-85.9)	76.7 (72.8-80.3)	0.92 (0.86-0.98)	0.92 (0.85-0.98)
Main reason for last appointment
Disease/Health problem	457	41.5 (34.9-48.4)	47.6 (43.0-52.2)	1.16 (0.99-1.36)	1.16 (0.98-1.36)
Routine checkup	437	48.2 (40.8-55.8)	40.1 (36.0-44.3)	0.81 (0.71-0.93)	0.82 (0.73-0.94)
Injury	52	4.7 (3.2-6.8)	5.7 (4.1-7.9)	1.26 (0.76-2.08)	1.32 (0.79-2.20)
Assessment of attendance of the last appointment as fair/poor/very poor	219	16.5 (13.4-20.3)	24.7 (20.7-29.0)	1.51 (1.19-1.93)	1.46 (1.14-1.87)
Coverage of appointment through the SUS	654	46.3 (39.8-52.9)	77.9 (72.8-82.3)	1.69 (1.46-1.95)	1.59 (1.38-1.82)
Felt well oriented to take care of problem	854	88.1 (84.2-87.9)	83.3 (79.5-86.5)	0.94 (0.89-0.99)	0.94 (0.90-0.99)
Problem for which was unable to obtain an appointment in previous year	84	6.4 (4.6-8.8)	9.3 (7.0-12.1)	1.42 (0.93-2.16)	1.31 (0.82-2.09)
There was delay or non-performance of exams requested during medical appointment	77	4.9 (3.1-7.6)	8.9 (7.0-11.3)	1.84 (1.16-2.92)	1.64 (1.02-2.64)
There was delay or was not able to schedule an appointment with specialist physician	86	7.1 (4.6-10.7)	10.0 (7.4-13.5)	1.38 (0.85-2.24)	1.45 (085-2.47)
Dental appointment in previous year	675	76.7 (71.6-81.2)	59.9 (53.9-65.7)	0.78 (0.69-0.87)	0.79 (0.71-0.89)
Assessment of dental appointment as fair/poor/very poor	111	6.8 (4.8-9.5)	15.4 (11.8-19.8)	2.25 (1.51-3.36)	2.10 (1.38-3.21)
Has been vaccinated against hepatitis B	923	96.3 (92.8-98.1)	97.9 (95.7-99.0)	1.01 (0.99-1.04)	1.01 (0.98-1.04)

Variables	n	Race/Skin color		PR (95%CI) *	PR (95%CI) **
Variables	n	White *** [% (95%CI)]	Black [% (95%CI)]	PR (95%CI) *	PR (95%CI) **
Medical appointment in the previous year	791	78.3 (74.7-81.5)	79.9 (75.4-83.7)	1.02 (0.96-1.09)	1.04(0.97-1.12)
Main reason for last appointment
Disease/Health problem	452	43.9 (38.4-49.6)	46.5 (41.0-52.1)	1.05 (0.91-1.22)	1.03 (0.89-1.19)
Routine checkup	433	45.9 (39.5-52.5)	40.2 (35.2-45.4)	0.88 (0.75-1.03)	0.91 (0.77-1.07)
Injury	51	5.0 (3.5-7.2)	5.5 (3.8-7.8)	1.05 (0.63-1.75)	0.99 (0.59-1.66)
Assessment of attendance of the last appointment as fair/poor/very poor	215	18.3 (14.9-22.3)	25.0 (21.1-29.3)	1.38 (1.10-1.73)	1.27 (1.01-1.61)
Coverage of appointment through the SUS	646	55.5 (48.9-62.0)	77.8 (73.0-82.0)	1.40 (1.25-1.57)	1.27 (1.14-1.42)
Felt well oriented to take care of problem	844	85.3 (81.1-88.7)	84.7 (80.6-88.0)	0.99 (0.94-1.05)	1.01 (0.94-1.06)
Problem for which was unable to obtain an appointment in previous year	83	6.8 (5.0-9.3)	9.7 (7.2-13.0)	1.46 (0.94-2.25)	1.37 (0.85-2.2)
There was delay or non-performance of exams requested during medical appointment	76	5.5 (3.8-7.9)	9.5 (7.0-12.7)	1.76 (1.10-2.83)	1.60 (0.99-2.58)
There was delay or was not able to schedule an appointment with specialist physician	87	9.8 (7.3-12.9)	8.2 (5.4-12.2)	0.85 (0.53-1.36)	0.81 (0.48-1.35)
Dental appointment in previous year	673	71.7 (66.0-76.8)	61.6 (56.1-66.9)	0.86 (0.78-0.94)	0.90 (0.82-0.99)
Assessment of dental appointment as fair/poor/very poor	110	9.7 (7.1-13.2)	14.3 (11.3-18.1)	1.50 (1.10-2.06)	1.31 (0.92-1.86)
Has been vaccinated against hepatitis B	914	97.1 (94.0-98.6)	97.8 (95.5-99.0)	1.01 (0.98-1.03)	1.01 (0.98-1.03)

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[1] Correspondence
V. C. Lemos Rua Monsenhor Faria 5, Carmo do Rio Claro, MG 37150-000, Brasil. vivicalemos@yahoo.com.br