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Inequity in utilizing health services in the Brazilian Amazon: A population‐based survey, 2015
Author(s) -
Galvao Tais Freire,
Tiguman Gustavo Magno Baldin,
Caicedo Roa Mónica,
Silva Marcus Tolentino
Publication year - 2019
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.2902
Subject(s) - poisson regression , confidence interval , metropolitan area , demography , amazon rainforest , population , medicine , health care , public health , gerontology , environmental health , nursing , ecology , pathology , sociology , economics , biology , economic growth
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.