Socioeconomic inequalities related to noncommunicable diseases and their limitations: National Health Survey, 2019

Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Lima, Margareth Guimaraes; Silva, Alanna Gomes da; Szwarcwald, Célia Landmann; Barros, Marilisa Berti de Azevedo

doi:10.1590/1980-549720210011.supl.2

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. Epidemiol. 24 (suppl 2) • 2021 • https://doi.org/10.1590/1980-549720210011.supl.2 copy

Socioeconomic inequalities related to noncommunicable diseases and their limitations: National Health Survey, 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze socioeconomic inequalities in the self-reported prevalence of NonCommunicable Diseases (NCDs) and their disabilities in the Brazilian adult population.

Methods:

Cross-sectional study with data from the National Health Survey carried out in 2019. The self-reported prevalences of individuals with some noncommunicable diseases were calculated, according to sociodemographic characteristics; and the prevalence and prevalence ratio of these diseases and degrees of disability, according to education and possession of a private health plan.

Results:

47.6% of the population reported having at least one noncommunicable diseases. Noncommunicable diseases increased progressively with age and were more prevalent in women (PR 1.13; 95%CI 1.1–1.15), in black (PR 1.04; 95%CI 1.01–1, 06) or brown individuals (PR 1.05; 95%CI 1.01–1.09), illiterate or with incomplete elementary education (PR 1.12; 95%CI 1.08–1.16), in the Southeast (PR 1.10; 95%CI 1.05–1.14) and the South (PR 1.07; 95%CI 1.03–1.12) and among individuals who do not have private health insurance (PR 1.02; 95%CI 1.0–1.05). For the majority of noncommunicable diseases investigated, the highest reports of disabilities were among those with low education and without health insurance.

Conclusion:

adults with less education and without private health plans have a higher prevalence of noncommunicable diseases and a higher degree of disability. Thus, it is important to analyze health indicators in the face of different populations and disparities, in order to understand and monitor health inequalities.

Keywords:
Chronic disease; Disabled persons; Health status disparities; Socioeconomic factors

		P	95%CI	PR_crude	95%CI	PR_adj	95%CI
	Total	47.63
Gender	Male	43.73	42.84–44.62	1.00		1.00
Gender	Female	51.06	50.21–51.91	1.17	1.14–1.20	1.13	1.1–1.15
Age (years)	18–24	20.62	18.98–22.25	1.00		1.00
	25–34	25.28	24.01–26.54	1.23	1.12–1.34	1.22	1.12–1.34
	35–44	38.51	37.25–39.76	1.87	1.72–2.03	1.86	1.71–2.02
	45–54	55.21	53.55–56.87	2.68	2.46–2.91	2.66	2.44–2.89
	55–64	69.91	68.58–71.24	3.39	3.13–3.67	3.36	3.10–3.64
	65 and more	80.73	79.74–81.72	3.92	3.62–4.24	3.86	3.56–4.18
Race/Color	White	49.42	48.45–50.38	1.00		1.00
	Black	45.85	44.94–46.75	0.93	0.90–0.95	1.04	1.01–1.06
	Brown	47.66	45.99–49.33	0.96	0.93–1.00	1.05	1.01–1.09
	Others	47.97	42.66–53.28	0.97	0.87–1.09	0.99	0.91–1.07
Education	Complete Higher degree	44.11	42.63–45.60	1.00		1.00
	High School/Incomplete Higher Degree	37.37	36.29–38.46	0.85	0.81–0.88	1.00	0.96–1.03
	Elementary/Middle School/Incomplete High School	42.73	41.17–44.30	0.97	0.92–1.02	1.07	1.02–1.12
	Illiterate/ Incomplete Elementary/Middle School	61.58	60.56–62.60	1.40	1.34–1.45	1.12	1.08–1.16
Region	North	40.98	39.46–42.50	1.00		1.00
	Northeast	45.87	44.86–46.87	1.12	1.07–1.17	1.04	1.00–1.90
	Southeast	50.09	48.87–51.31	1.22	1.17–1.28	1.10	1.05–1.14
	South	49.10	47.65–50.55	1.20	1.14–1.26	1.07	1.03–1.12
	Centro-Oeste	43.69	42.20–45.18	1.07	0.03–1.12	1.06	0.03–1.12
Health insurance	Yes	46.52	45.79–47.25	1.00		1.00
Health insurance	No	50.62	49.37–51.87	1.09	1.06–1.12	1.02	1.00–1.05

NCD	Measures	a	b	c	d
Hypertension	P	36.55	20.38	15.44	18.17
Hypertension	PR* (95%CI)	1.38 (1.29–1.46)	1.30 (1.21–1.41)	1.13 (1.06–1.22)	1.00
Diabetes	P	12.89	6.26	4.58	4.65
Diabetes	PR* (95%CI)	1.77 (1.56–2.02)	1.55 (1.31–1.82)	1.34 (1.16–1.54)	1.00
Heart disease	P	7.83	4.78	3.47	4.25
Heart disease	PR* (95%CI)	1.27 (1.10–1.47)	1.25 (1.04–1.51)	1.05 (0.89–1.23)	1.00
Stroke	P	3.77	1.65	0.80	0.82
Stroke	PR* (95%CI)	2.71 (2.06–3.57)	2.21 (1.53–3.19)	1.27 (0.93–1.73)	1.00
Asthma	P	4.44	5.58	5.32	6.69
Asthma	PR* (95%CI)	0.75 (0.64–0.88)	0.82 (0.68–0.98)	0.75 (0.65–0.88)	1.00
Rheumatism	P	11.65	6.15	4.91	5.78
Rheumatism	PR* (95%CI)	1.35 (1.18–1.55)	1.25 (1.07–1.45)	1.15 (1.02–1.31)	1.00
Spine/back problem	P	29.16	18.18	16.79	18.63
Spine/back problem	PR* (95%CI)	1.37 (1.28–1.48)	1.09 (0.99–1.19)	1.04 (0.96–1.13)	1.00
WMSD	P	2.39	2.36	2.52	2.89
WMSD	PR* (95%CI)	0.94 (0.73–1.21)	1.04 (0.77–1.41)	1.12 (0.91–1.38)	1.00
Lung disease	P	2.18	1.67	1.32	1.30
Lung disease	PR* (95%CI)	1.61 (1.16–2.23)	1.40 (0.98–2.01)	1.15 (0.81–1.64)	1.00
Cancer	P	3.28	1.93	1.77	3.28
Cancer	PR* (95%CI)	0.64 (0.54–0.77)	0.68 (0.52–0.90)	0.76 (0.63–0.91)	1.00
Kidney disease	P	1.98	1.72	1.08	0.98
Kidney disease	PR* (95%CI)	1.68 (1.21–2.34)	1.87 (1.28–2.74)	1.27 (0.9–1.78)	1.00

NCD	Measures	Total	a	b	c	d
Hypertension	P	3.01	4.08	2.96	1.59	0.98
	PR*		2.30	3.01	1.57	1.00
	95%CI		(2.30–8.41)	(1.45–6.22)	(0.78–3.16)
Diabetes	P	5.83	7.31	4.02	4.51	1.97
	PR*		4.01	2.16	2.30	1.00
	PR*		1.72–9.36	0.87–5.34	0.92–5.74
Heart disease	95%CI	11.90	16.33	11.54	6.53	4.01
	PR*		3.93	3.08	1.79	1.00
	95%CI		1.87–8.23	1.39–6.85	0.83–3.86
Stroke	P	20.88	24.55	11.13	16.12	11.99
	PR*		1.96	1.03	1.44	1.00
	95%CI		1.10–3.51	0.48–2.2	0.74–2.80
Asthma	P	6.39	10.89	6.33	4.40	3.34
	PR*		3.22	1.98	1.39	1.00
	95%CI		(1.73–5.97)	(0.97–4.06)	(0.74–2.63)
Rheumatism	P	20.00	25.81	18.55	12.14	10.41
	PR*		2.47	1.80	1.21	1.00
	95%CI		(1.82–3.37)	(1.24–2.61)	(0.85–1.72)
Spine/back problem	P	16.09	20.86	16.36	11.58	8.44
	PR*		2.36	2.07	1.50	1.00
	95%CI		(1.91–2.92)	(1.62–2.66)	(1.17–1.91)
WMSD	P	17.59	28.25	20.78	11.06	8.41
	PR*		2.83	2.63	1.41	1.00
	95%CI		(1.67–4.80)	(1.45–4.77)	(0.82–2.41)
Lung disease	P	14.00	20.28	12.10	8.53	5.46
	PR*		2.95	2.09	1.54	1.00
	95%CI		(1.32–6.59)	(0.77–5.66)	(0.64–3.68)
Cancer	P	11.09	12.17	16.44	13.49	3.08
	PR*		4.67	6.32	4.49	1.00
	95%CI		(2.17–10.04)	(2.40–16.6)	(1.95–10.31)
Kidney disease	P	12.17	15.54	13.93	8.17	4.09
	PR*		4.14	2.90	1.86	1.00
	95%CI		(1.50–11.45)	(0.95–8.86)	(0.60–5.79)

NCD	Measures	Health insurance		Limitation (P)	Health insurance
NCD	Measures	No	Yes	Limitation (P)	Yes	No
Hypertension	P	23.77	24.34	3.01	1.79	3.47
Hypertension	PR* (95%CI)	1.85 (1.34–2.57)	1.00		1.00	1.85 (1.34–2.57)
Diabetes	P	7.67	7.88	5.83	3.65	6.67
Diabetes	PR* (95%CI)	1.88 (1.22–2.89)	1.00		1.00	1.88 (1.22–2.89)
Heart disease	P	2.14	1.46	11.90	6.90	14.23
Heart disease	PR* (95%CI)	2.15 (1.55–2.97)	1.00		1.00	2.15 (1.55–2.97)
Stroke	P	7.24	8.45	20.88	15.56	22.22
Stroke	PR* (95%CI)	1.43 (0.97–2.10)	1.00		1.00	1.43 (0.97–2.10)
Asthma	P	4.96	6.23	6.39	3.99	7.53
Asthma	PR* (95%CI)	1.9 (1.24–2.89)	1.00		1.00	1.90 (1.24–2.89)
Rheumatism	P	4.88	6.31	20.00	15.27	22.04
Rheumatism	PR* (95%CI)	1.46 (1.18–1.80)	1.00		1.00	1.46 (1.18–1.80)
Spine/back problem	P	21.34	22.21	16.09	11.34	17.92
Spine/back problem	PR* (95%CI)	1.63 (1.40–1.89)	1.00		1.00	1.63 (1.40–1.89)
WMSD	P	2.14	3.49	17.59	11.50	21.25
WMSD	PR* (95%CI)	1.82 (1.27–2.63)	1.00		1.00	1.82 (1.27–2.63)
Lung disease	P	1.65	1.72	14.00	10.73	15.27
Lung disease	PR* (95%CI)	1.48 (0.90–2.45)	1.00		1.00	1.48 (0.90–2.45)
Cancer	P	2.10	3.78	11.09	6.41	14.26
Cancer	PR* (95%CI)	2.09 (1.30–3.34)	1.00		1.00	2.09 (1.30–3.34)
Kidney disease	P	1.42	1.59	12.17	7.60	14.07
Kidney disease	PR* (95%CI)	1.60 (0.85–3.01)	1.00		1.00	1.60 (0.85–3.01)

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[1] Conflict of interests: nothing to declare