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. 2021 May;111(5):927-936.
doi: 10.2105/AJPH.2020.306146. Epub 2021 Mar 18.

Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil

Marciane Kessler  1 , Elaine Thumé  1 , Michael Marmot  1 , James Macinko  1 , Luiz Augusto Facchini  1 , Fúlvio Borges Nedel  1 , Louriele Soares Wachs  1 , Pâmela Moraes Volz  1 , Cesar de Oliveira  1
Affiliations

Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil

Marciane Kessler et al. Am J Public Health. 2021 May.

Abstract

Objectives. To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period.Methods. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth.Results. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85).Conclusions. FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity.

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Figures

FIGURE 1—
FIGURE 1—
All-Cause Mortality by Primary Health Care Coverage in Age Group 60–64 Years, Adjusted for Gender, Age, and Wealth: The SIGa-Bagé Cohort Study, Bagé, Rio Grande do Sul, Brazil, 2008–2017 Note. FHS = Family Health Strategy; TPHC = traditional primary health care. The sample size was 309 observations and 83 failures.
FIGURE 2—
FIGURE 2—
Avoidable Mortality by Primary Health Care Coverage in Age Group 60–64 Years, Adjusted for Gender, Age, and Wealth: The SIGa-Bagé Cohort Study, Bagé, Rio Grande do Sul, Brazil, 2008–2017 Note. FHS = Family Health Strategy; TPHC = traditional primary health care. The sample size was 309 observations and 55 failures.
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