Inequity in utilizing health services in the Brazilian Amazon: A population‐based survey, 2015

Abstract

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.

Consumption and Lack of Access to Medicines and Associated Factors in the Brazilian Amazon: A Cross-Sectional Study, 2019

“…Consumption of medicines was negatively associated with lower social class, similar to a previous national survey with 41,433 people, which observed that the lowest prevalence of medicine consumption occurred in poorer individuals and in the North region of Brazil – where Manaus is located ( Bertoldi et al., 2016 ). Indeed, previous analyses conducted in this region showed that socioeconomic inequalities play an important role in the access and use of health care services among adults ( Araujo et al., 2017 ; Galvao et al., 2019 ). In a previous 2015 survey of 4,001 adults from Manaus and surrounding cities, the prevalence of medicine consumption was 29%, which was not associated with higher social status as observed in the present research ( Lima et al.…”

“…Nearly one-fourth of the medicines were used by self-medication or indication by a family member/neighbor, which is higher than the prevalence found in a previous national cross-sectional study of 16.1% ( Arrais et al., 2016 ). These findings may be explained by the significant inequities in the access to health care services ( Araujo et al., 2017 ; Galvao et al., 2019 ) and the long waiting times for medical consultations in the region ( Galvao et al., 2020 ), as high health care costs and long waiting times can be predictors of self-medication behavior ( Shaghaghi et al., 2014 ).…”

Deciphering Multifactorial Correlations of COVID-19 Incidence and Mortality in the Brazilian Amazon Basin

“…Galvão et al [42] previously mentioned that the crisis experienced in Manaus and its nearby cities with the COVID-19 pandemic might be a consequence of this region's limited health structure and social vulnerability. However, high mortality rates have been reported in cities of high-income countries [42].…”

Explosão da mortalidade no epicentro amazônico da epidemia de COVID-19

“…A fragilidade da rede de atenção à saúde em Manaus e em municípios vizinhos 4 , somada à marcante desigualdade social 3 , ajudam a entender a crítica situação da epidemia de COVID-19. O excesso de mortalidade não está restrito aos países de baixa e média rendas, tendo sido também observado em Nova York, Estados Unidos, e nas províncias de Bérgamo e Bréscia, no norte da Itália 9,12,13 .…”

“…No caso do Estado do Amazonas, situado na Amazônia brasileira, região que ocupa aproximadamente 60% do território do nacional, cuja população tem sido historicamente submetida a condições de pobreza e desigualdade social 3 . Um estudo sobre a Região Metropolitana de Manaus constatou elevada desigualdade no acesso aos serviços de saúde 4 . Essa é uma realidade comum para populações vivendo em regiões de acesso remoto e terras indígenas 5 , cuja vulnerabilidade social e econômica restringe sua mobilidade espacial no território, tornando-as mais susceptíveis à dramática disseminação da COVID-19, em especial de suas formas graves.…”