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. 2019 Oct;34(4):e1846-e1853.
doi: 10.1002/hpm.2902. Epub 2019 Sep 12.

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

Tais Freire Galvao  1 , Gustavo Magno Baldin Tiguman  2 , Mónica Caicedo Roa  3 , Marcus Tolentino Silva  4
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Inequity in utilizing health services in the Brazilian Amazon: A population-based survey, 2015

Tais Freire Galvao et al. Int J Health Plann Manage. 2019 Oct.

Abstract

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.

Keywords: Brazil; Cross-sectional studies; health equity; health services accessibility; healthcare disparities.

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