Male Mortality from Conditions Sensitive to Primary Care Under The Perspective of The National Men's Health Policy

Abstract

Background: To evaluate the trend of male mortality and its relationship with conditions sensitive to primary care (CSPCs), considering the coverage of the Family Health Strategy (FHS) and the implementation of the National Policy for Comprehensive Health Care of the Male (PNAISH).Methods: Ecological study of the time series of male deaths in the age group of 20 to 59 years, according to CSPC from 2009 to 2018 with data extraction from the Mortality Information System. The relationship between death rate due to CSPCs and FHS coverage was quantified by Spearman’s correlation. The trend in the number of deaths was adjusted by univariate quasi-Poisson regression models. Mortality trends were considered stationary (p > 0.05), declining (p < 0.05 and negative regression coefficient), or ascending (p < 0.05 and positive regression coefficient). Values of p < 0.05 were considered statistically significant.Results: CSPCs were responsible for 1,092,070 (19.2%) deaths in the 127 municipalities under study, a with year-on-year variation of -4.89% to 3.06% and showed no significant relationship with mean FHS coverage (r < 0.09; p < 0.160). PNAISH was implemented in 100% of the municipalities, and the FHS coverage showed a significant upward trend [95% CI; 1.03-1.09], with an annual average of 6%. The trend of deaths in the study groups due to CSPCs was generally stable (Exp (β) = 1.01; p > 0.593). Notably, deaths in specific groups increased over time: bacterial pneumonia, asthma, hypertension, epilepsy, kidney and urinary tract infections, and skin and subcutaneous tissue infections. The heart failure group showed a decreasing mortality rate (Exp (β) = 0.92; p = 0.008).Conclusions: The expansion of FHS coverage and the fact that PNAISH was implemented in all municipalities in the state of Goiás did not influence the rate of deaths due to CSPCs in general. The analysis of death trends due to CSPCs in general indicates stability in the investigated period. The present study, the first of its kind in country, allows an evaluation of actions related to PNAISH, confirming the need for urgent investments. It can serve as feedback to researchers and policy-makers on interventions in humans.