Existe desigualdade socioeconômica na multimorbidade entre adultos brasileiros?
DOI:
https://doi.org/10.11606/s1518-8787.2020054002569Palavras-chave:
Adulto, Fatores Socioeconômicos, Multimorbidade, Estudos transversaisResumo
OBJETIVO: Avaliar a prevalência de multimorbidade e a associação desta com indicadores socioeconômicos entre adultos brasileiros. MÉTODOS: Estudo transversal que utilizou dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil, realizada entre 2013 e 2014. Multimorbidade foi definida como a coexistência, no mesmo indivíduo, de duas ou mais doenças crônicas, e é mensurada a partir de uma lista de 14 morbidades (autorrelato de diagnóstico médico na vida). Classe econômica e escolaridade foram os indicadores socioeconômicos utilizados, sendo as desigualdades avaliadas pelo Slope Index of Inequality (SII) e pelo Concentration Index (CIX), estratificadas por sexo. RESULTADOS: O estudo considerou 23.329 mil adultos (52,8% de mulheres), com média de idade de 37,9 anos. Hipertensão e colesterol alto foram as condições mais prevalentes. A prevalência de multimorbidade foi de 10,9% (IC95% 10,1–11,7), representando, aproximadamente, 11 milhões de indivíduos no Brasil, sendo 14,5% (IC95% 13,5–15,4) entre mulheres e 6,8% (IC95% 5,9–7,8) entre homens. A ocorrência de multimorbidade foi similar segundo os indicadores socioeconômicos. Nas análises de desigualdade, observou-se diferença absoluta e relativa para homens com maior poder aquisitivo (SII = 3,7; IC95% 0,3–7,0) e maior escolaridade (CIX = 7,1; IC95% 0,9–14,7), respectivamente. CONCLUSÕES: A frequência de adultos brasileiros com multimorbidade é alta, principalmente em termos absolutos. Desigualdades socioeconômicas na multimorbidade foram observadas somente entre homens.
Referências
Mercer S, Furler J, Moffat K, Fischbacher-Smith D, Sanci LA. Multimorbidity: technical series on safer primary care. Genebra: World Health Organization; 2016.
Puth M-T, Weckbecker K, Schmid M, Münster E. Prevalence of multimorbidity in Germany: impact of age and educational level in a cross-sectional study on 19,294 adults. BMC Public Health. 2017;17(1):826. http://dx.doi.org/10.1186/s12889-017-4833-3.
Prazeres F, Santiago L. Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study. BMJ Open. 2015;5(9):e009287. http://dx.doi.org/10.1136/bmjopen-2015-009287.
Nunes BP, Chiavegatto Filho ADP, Pati S, Cruz Teixeira DS, Flores TR, Camargo-Figuera FA, et al. Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study. BMJ Open. 2017;7(6):e015885.
http://dx.doi.org/10.1136/bmjopen-2017-015885.
Nunes BP, Camargo-Figuera FA, Guttier M, de Oliveira PD, Munhoz TN, Matijasevich A, et al. Multimorbidity in adults from a southern Brazilian city: occurrence and patterns. Int J Public Health. 2016;61(9):1013-20. http://dx.doi.org/10.1007/s00038-016-0819-7.
Violán C, Foguet-Boreu Q, Roso-Llorach A, Rodriguez-Blanco T, Pons-Vigués M, Pujol-Ribera E, et al. Patrones de multimorbilidad en adultos jóvenes en Cataluña: un análisis de clústeres. Aten Primaria. 2016;48(7):479-92.
http://dx.doi.org/10.1016/j.aprim.2015.10.006.
Taylor AW, Price K, Gill TK, Adams R, Pilkington R, Carrangis N, et al. Multimorbidity, not just an older person’s issue: results from an Australian biomedical study. BMC Public Health. 2010;10(1):718. http://dx.doi.org/10.1186/1471-2458-10-718.
Carvalho JN de, Roncalli ÂG, Cancela M de C, Souza DLB de. Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics. PLoS One. 2017;12(4):e0174322.
http://dx.doi.org/10.1371/journal.pone.0174322. eCollection 2017.
Rzewuska M, de Azevedo-Marques JM, Coxon D, Zanetti ML, Zanetti ACG, Franco LJ, et al. Epidemiology of multimorbidity within the Brazilian adult general population: evidence from the 2013 National Health Survey (PNS 2013).
PLoS One. 2017;12(2):e0171813. http://dx.doi.org/10.1371/journal.pone.0171813.
Roberts KC, Rao DP, Bennett TL, Loukine L, Jayaraman GC. Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada. Health Promot Chronic Dis Prev Can. 2015;35(6):87-94.
http://dx.doi.org/10.24095/hpcdp.35.6.01.
Alimohammadian M, Majidi A, Yaseri M, Ahmadi B, Islami F, Derakhshan M, et al. Multimorbidity as an important issue among women: results of a gender difference investigation in a large population-based cross-sectional study in West Asia. BMJ Open. 2017;7(5):e013548. http://dx.doi.org/10.1136/bmjopen-2016-013548.
Jantsch AG, Alves RFS, Faerstein E. Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis. São Paulo Med J. 2018;136(1):51-8. http://dx.doi.org/10.1590/1516-3180.2017.0209100917.
Pathirana TI, Jackson CA. Socioeconomic status and multimorbidity: a systematic review and meta-analysis. Aust N Z J Public Health. 2018;42(2):186-94. http://dx.doi.org/10.1111/1753-6405.12762.
Nagel G, Peter R, Braig S, Hermann S, Rohrmann S, Linseisen J. The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health. 2008;8(1):384. http://dx.doi.org/10.1186/1471-2458-8-384.
Barros MB de A, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva. 2011;16(9):3755-68.
http://dx.doi.org/10.1590/s1413-81232011001000012.
Mengue SS, Bertoldi AD, Boing AC, Tavares NUL, Pizzol TSD, Oliveira MA, et al. National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM): household survey component methods. Rev Saúde Pública. 2016;50(Suppl 2):4s. http://dx.doi.org/10.1590/S1518-8787.2016050006156.
Fortin M, Stewart M, Poitras M-E, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med. 2012;10(2):142-51. http://dx.doi.org/10.1370/afm.1337.
Barros AJD, Victora CG. Measuring coverage in MNCH: determining and interpreting inequalities in coverage of maternal, newborn, and child health interventions. PLoS Med. 2013;10(5):e1001390. http://dx.doi.org/10.1371/journal.pmed.1001390.
Nguyen H, Manolova G, Daskalopoulou C, Vitoratou S, Prince M, Prina AM. Prevalence of multimorbidity in community settings: a systematic review and meta-analysis of observational studies. J Comorbidity. 2019;9:2235042X1987093.
http://dx.doi.org/10.1177/2235042X19870934.
Araujo MEA, Silva MT, Galvão TF, Nunes BP, Pereira MG. Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study. BMJ Open. 2018;8(11):e023398. http://dx.doi.org/10.1136/bmjopen-2018-023398.
Wang Y-P, Nunes BP, Coêlho BM, Santana GL, Nascimento CF, Viana MC, et al. Multilevel analysis of the patterns of physical-mental multimorbidity in general population of São Paulo Metropolitan Area, Brazil. Sci Rep. 2019;9(1):2390.
http://dx.doi.org/10.1038/s41598-019-39326-8.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43. http://dx.doi.org/10.1016/S0140-6736(12)60240-2.
Afshar S, Roderick PJ, Kowal P, Dimitrov BD, Hill AG. Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys. BMC Public Health. 2015;15(1):776. http://dx.doi.org/10.1186/s12889-015-2008-7.
Mendoza-Sassi R, Béria JU. Utilización de los servicios de salud: una revisión sistemática sobre los factores relacionados. Cad Saúde Pública. 2001;17(4):819-32. http://dx.doi.org/10.1590/s0102-311x2001000400016.
Buttorff C, Ruder T, Bauman M. Multiple chronic conditions in the United States. Santa Monica: Rand; 2017.
Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, Lopez AD, et al. Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012;380(9859):2144-62.
https://doi.org/10.1016/S0140-6736(12)61690-0.
Violan C, Foguet-Boreu Q, Flores-Mateo G, Salisbury C, Blom J, Freitag M, et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLoS One. 2014;9(7):e102149.
http://dx.doi.org/10.1371/journal.pone.0102149.
Lima-Costa MF, Peixoto SV, Firmo JOA, Uchoa E. Validade do diabetes auto-referido e seus determinantes: evidências do projeto Bambuí. Rev Saúde Pública. 2007;41(6):947-53. http://dx.doi.org/10.1590/s0034-89102007000600009.
Leggett LE, Khadaroo RG, Holroyd-Leduc J, Lorenzetti DL, Hanson H, Wagg A, et al. Measuring resource utilization: a systematic review of validated self-reported questionnaires. Medicine (Baltimore). 2016;95(10):e2759.
http://dx.doi.org/10.1097/MD.0000000000002759.
Gonçalves VSS, Andrade KRC, Carvalho KMB, Silva MT, Pereira MG, Galvão TF. Accuracy of self-reported hypertension: a systematic review and meta-analysis. J Hypertens. 2018;36(5):970-8. http://dx.doi.org/10.1097/HJH.0000000000001648.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2020 Revista de Saúde Pública
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.