Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data

Abstract

Objectives To evaluate the impact of Brazil's recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil from 2000 to 2009.Design Ecological longitudinal design, evaluating the impact of FHP using negative binomial regression models for panel data with fixed effects specifications.Setting Nationwide analysis of data from Brazilian municipalities covering the period from 2000 to 2009.Data sources 1622 Brazilian municipalities with vital statistics of adequate quality. Main outcome measuresThe annual FHP coverage and the average FHP coverage in previous years were used as main independent variables and classified as none (0%), incipient (<30%), intermediate (30-69%), or consolidated (≥70%). Age standardised mortality rates from causes in the group of cerebrovascular (ICD-10 codes I60-69), ischaemic (ICD-10 I20-25), and other forms of heart diseases (ICD-10 I30-52), which were included in the national list of ambulatory care-sensitive conditions, were calculated for each municipality for each year. They accounted for 40% of all deaths from these groups during the study period.Results FHP coverage was negatively associated with mortality rates from cerebrovascular and heart diseases (ambulatory care-sensitive conditions) in both unadjusted and adjusted models for demographic, social, and economic confounders. The FHP had no effect on the mortality rate for accidents, used as a control. The rate ratio for the effect of consolidated annual FHP coverage on cerebrovascular disease mortality and on heart disease mortality was 0.82 (95% confidence interval 0.79 to 0.86) and 0.79 (0.75 to 0.80) respectively, reaching the value of 0.69 (0.66 to 0.73) and 0.64 (0.59 to 0.68) when the coverage was consolidated during all the previous eight years. Moreover, FHP coverage increased the number of health education activities, domiciliary visits, and medical consultations and reduced hospitalisation rates for cerebrovascular and heart disease. Several complementary analyses showed quantitatively similar results. ConclusionsComprehensive and community based primary health care programmes, such as the FHP in Brazil, acting through cardiovascular disease prevention, care, and follow-up can contribute to decreased cardiovascular disease morbidity and mortality in a developing country such as Brazil.

Tipologia da estrutura das unidades básicas de saúde brasileiras: os 5 R

“…Há evidências de que a expansão da ESF teve impactos positivos sobre a saúde da população, com redução da mortalidade infantil 40 , da mortalidade cardio e cerebrovascular 41 e de internações por condições sensíveis à atenção primária 42 . E esses avanços foram implantados em cenário de carência estrutural, o que nos faz indagar o muito que poderá ser realizado com a reversão dos principais constrangimentos estruturais identificados.…”

Cobertura da avaliação do estado nutricional no Sistema de Vigilância Alimentar e Nutricional brasileiro: 2008 a 2013

“…Programas de atenção primária baseados na família e orientados para a comunidade, como a ESF e os ACS, foram associados à reorientação do processo de trabalho no sentido do trabalho em equipe e da interdisciplinaridade, maior custo-efetividade frente a outras propostas assistenciais, melhora da resolutividade e impacto positivo na saúde da população com a redução da mortalidade infantil, morbimortalidade por doenças cardiovasculares e de internações por doenças preveníveis a partir de cuidados primários 28,29,30,31,32,33 .…”

Decomposition of mortality rates from cardiovascular disease in the adult population: a study for Brazilian micro-regions between 1996 and 2015

“…), or very specific municipalities in Brazil (MANSUR et al, 2002;ISHITANI et al, 2006;MELO et al, 2006;SOUZA et al, 2006;GODOY et al, 2007;ASARIA et al, 2012;NOWBAR et al, 2014;RASELLA et al, 2014;GUIMARÃES et al, 2015). There is an absence and need for studies investigating the variation of cardiovascular disease mortality, taking both time frame and spatial factors into consideration.…”