Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults

Detalhes bibliográficos
Autor(a) principal: HoneI, Thomas
Data de Publicação: 2020
Outros Autores: SaraceniI, Valeria, CoeliI, Claudia Medina, TrajmanI, Anete, RasellaI, Davide, MillettI, Christopher, Durovni, Betina
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/45513
Resumo: UK’s Department for International Development (DFID), the Medical Research Council (MRC), the Economic and Social Research Council (ESRC) and Wellcome Trust’s Health Systems Research Initiative (HSRI). Grant Number MR/P014593/1. All co-authors were co-investigators on the grant. DB and CM were PIs. https://mrc.ukri.org/funding/ browse/hsri-call-7/health-systems-researchinitiative- call-7/
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spelling HoneI, ThomasSaraceniI, ValeriaCoeliI, Claudia MedinaTrajmanI, AneteRasellaI, DavideMillettI, ChristopherDurovni, Betina2021-01-06T16:34:59Z2021-01-06T16:34:59Z2020HONEL, Thomas et al. Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults. Plos Medicine, 2020.1549-1277https://www.arca.fiocruz.br/handle/icict/4551310.1371/journal.pmed.1003357UK’s Department for International Development (DFID), the Medical Research Council (MRC), the Economic and Social Research Council (ESRC) and Wellcome Trust’s Health Systems Research Initiative (HSRI). Grant Number MR/P014593/1. All co-authors were co-investigators on the grant. DB and CM were PIs. https://mrc.ukri.org/funding/ browse/hsri-call-7/health-systems-researchinitiative- call-7/Public Health Policy Evaluation Unit. School of Public Health. Imperial College London. London, United Kingdom.Health Surveillance Branch. Secretaria Municipal de Saúde do Rio de Janeiro. Rio de Janeiro, RJ, Brazil., Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil,Federal University of Rio de Janeiro.Programa de Pós-graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Public Health Policy Evaluation Unit. School of Public Health. Imperial College London. London, United Kingdom. / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Public Health Policy Evaluation Unit. School of Public Health. Imperial College London. London, United Kingdom / University of São Paulo. School of Medicine. Department of Preventive Medicine. São Paulo, SP, Brazil / Fundação Oswaldo Cruz, Instituto Gonçalo Muniz. Centro de Integração de Dados e Conhecimento para Saúde.Salvador, BA, Brasil.Fundação Oswaldo Cruz. Centro de Estudos Estratégicos. Rio de Janeiro, RJ, Brasil.Expanding delivery of primary healthcare to urban poor populations is a priority in many lowand middle-income countries. This remains a key challenge in Brazil despite expansion of the country’s internationally recognized Family Health Strategy (FHS) over the past two decades. This study evaluates the impact of an ambitious program to rapidly expand FHS coverage in the city of Rio de Janeiro, Brazil, since 2008. Methods and findings A cohort of 1,241,351 low-income adults (observed January 2010–December 2016; total person-years 6,498,607) with linked FHS utilization and mortality records was analyzed using flexible parametric survival models. Time-to-death from all-causes and selected causes were estimated for FHS users and nonusers. Models employed inverse probability treatment weighting and regression adjustment (IPTW-RA). The cohort was 61% female (751,895) and had a mean age of 36 years (standard deviation 16.4). Only 18,721 individuals (1.5%) had higher education, whereas 102,899 (8%) had no formal education. Two thirds of individuals (827,250; 67%) were in receipt of conditional cash transfers (Bolsa Famı´lia). A total of 34,091 deaths were analyzed, of which 8,765 (26%) were due to cardiovascular disease; 5,777 (17%) were due to neoplasms; 5,683 (17%) were due to external causes; 3,152 (9%) were due to respiratory diseases; and 3,115 (9%) were due to infectious and parasitic diseases. One third of the cohort (467,155; 37.6%) used FHS services. In IPTW-RA survival analysis, an average FHS user had a 44% lower hazard of all-cause mortality (HR: 0.56, 95% CI 0.54–0.59, p < 0.001) and a 5-year risk reduction of 8.3 per 1,000 (95% CI 7.8–8.9, p < 0.001) compared with a non-FHS user. There were greater reductions in the risk of death for FHS users who were black (HR 0.50, 95% CI 0.46–0.54, p < 0.001) or pardo (HR 0.57, 95% CI 0.54–0.60, p < 0.001) compared with white (HR 0.59, 95% CI 0.56–0.63, p < 0.001); had lower educational attainment (HR 0.50, 95% CI 0.46–0.55, p < 0.001) for those with no education compared to no significant association for those with higher education (p = 0.758); or were in receipt of conditional cash transfers (Bolsa Famı´lia) (HR 0.51, 95% CI 0.49–0.54, p < 0.001) compared with nonrecipients (HR 0.63, 95% CI 0.60–0.67, p < 0.001). Key limitations in this study are potential unobserved confounding through selection into the program and linkage errors, although analytical approaches have minimized the potential for bias. Conclusions FHS utilization in urban poor populations in Brazil was associated with a lower risk of death, with greater reductions among more deprived race/ethnic and socioeconomic groups. Increased investment in primary healthcare is likely to improve health and reduce health inequalities in urban poor populations globally.engPublic Library of ScienceAtenção Primária à SaúdePopulação UrbanaEstratégia Saúde da FamíliaBrasilMortalidadeAssistência à SaúdePrimary Health CareUrban PopulationFamily Health StrategyBrazilMortalityDelivery of Health CarePrimary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adultsinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83097https://www.arca.fiocruz.br/bitstream/icict/45513/1/license.txt36b51ef91c52b5338d9d29ba0cc807bcMD51ORIGINALHone, Thomas Primary...2020.pdfHone, Thomas 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dc.title.pt_BR.fl_str_mv Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
title Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
spellingShingle Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
HoneI, Thomas
Atenção Primária à Saúde
População Urbana
Estratégia Saúde da Família
Brasil
Mortalidade
Assistência à Saúde
Primary Health Care
Urban Population
Family Health Strategy
Brazil
Mortality
Delivery of Health Care
title_short Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
title_full Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
title_fullStr Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
title_full_unstemmed Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
title_sort Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults
author HoneI, Thomas
author_facet HoneI, Thomas
SaraceniI, Valeria
CoeliI, Claudia Medina
TrajmanI, Anete
RasellaI, Davide
MillettI, Christopher
Durovni, Betina
author_role author
author2 SaraceniI, Valeria
CoeliI, Claudia Medina
TrajmanI, Anete
RasellaI, Davide
MillettI, Christopher
Durovni, Betina
author2_role author
author
author
author
author
author
dc.contributor.author.fl_str_mv HoneI, Thomas
SaraceniI, Valeria
CoeliI, Claudia Medina
TrajmanI, Anete
RasellaI, Davide
MillettI, Christopher
Durovni, Betina
dc.subject.other.pt_BR.fl_str_mv Atenção Primária à Saúde
População Urbana
Estratégia Saúde da Família
Brasil
Mortalidade
Assistência à Saúde
topic Atenção Primária à Saúde
População Urbana
Estratégia Saúde da Família
Brasil
Mortalidade
Assistência à Saúde
Primary Health Care
Urban Population
Family Health Strategy
Brazil
Mortality
Delivery of Health Care
dc.subject.en.pt_BR.fl_str_mv Primary Health Care
Urban Population
Family Health Strategy
Brazil
Mortality
Delivery of Health Care
description UK’s Department for International Development (DFID), the Medical Research Council (MRC), the Economic and Social Research Council (ESRC) and Wellcome Trust’s Health Systems Research Initiative (HSRI). Grant Number MR/P014593/1. All co-authors were co-investigators on the grant. DB and CM were PIs. https://mrc.ukri.org/funding/ browse/hsri-call-7/health-systems-researchinitiative- call-7/
publishDate 2020
dc.date.issued.fl_str_mv 2020
dc.date.accessioned.fl_str_mv 2021-01-06T16:34:59Z
dc.date.available.fl_str_mv 2021-01-06T16:34:59Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.citation.fl_str_mv HONEL, Thomas et al. Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults. Plos Medicine, 2020.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/45513
dc.identifier.issn.pt_BR.fl_str_mv 1549-1277
dc.identifier.doi.none.fl_str_mv 10.1371/journal.pmed.1003357
identifier_str_mv HONEL, Thomas et al. Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults. Plos Medicine, 2020.
1549-1277
10.1371/journal.pmed.1003357
url https://www.arca.fiocruz.br/handle/icict/45513
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Public Library of Science
publisher.none.fl_str_mv Public Library of Science
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
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