Zilda Pereira da Silva

Perfil sociodemográfico e padrão de utilização de serviços de saúde para usuários e não-usuários do SUS - PNAD 2003

A utilizacao de servicos de saude e resultante da oferta e das caracteristicas sociodemograficas e do perfil de saude dos usuarios. Os dados da PNAD 2003 permitem analisar as diferencas regionais,do perfil sociodemografico dos usuarios e nao-usuarios do SUS. As variaveis dependentes foram: atendimento em servico de saude (SUS ou sistema privado). Foram utilizadas as variaveis: sexo, idade, cor da pele, anos de estudo, renda familiar e posse de plano de saude, atraves de um modelo de regressao logistica para avaliar a probabilidade de ser atendido pelo SUS. Nos usuarios do SUS ha predominio de mulheres, criancas, pretos e pardos, baixa escolaridade e renda. Ha associacao entre estado de saude regular/ruim e utilizacao dos servicos do SUS, entre o atendimento pelo SUS e usuarios de baixa escolaridade e renda. O padrao de busca de servicos foi semelhante nos usuarios e nao usuarios do SUS. Os resultados apontam para a contribuicao do SUS na universalizacao e equidade de acesso aos servicos de saude. No entanto, os nao atendidos (4%) sao individuos adultos, pretos e pardos e de baixa escolaridade e renda.

Prevalência de doenças crônicas auto-referidas e utilização de serviços de saúde, PNAD/1998, Brasil

Com o envelhecimento da populacao brasileira torna-se cada vez mais importante conhecer a prevalencia das doencas cronicas. Essas doencas constituem-se em forte demanda aos servicos de saude. Foram utilizados os dados da amostra da PNAD/98. Analisou-se o conjunto de doencas cronicas auto-referidas, empregou-se a razao de prevalencia e razao de odds ratios com intervalo de confianca de 95% para verificar a presenca de associacoes. Comprovou-se o aumento da prevalencia das doencas cronicas com o aumento da idade; padronizando-se a idade identificou-se um gradiente de reducao da prevalencia com aumento da escolaridade e da renda. Observou-se maior prevalencia entre mulheres e entre os que nao possuiam plano de saude. A presenca de doenca cronica estava associada a ma avaliacao do estado de saude e de restricao de atividade. A utilizacao dos servicos de saude foi de 1,8 vezes entre os portadores de doencas cronicas; com um consumo significativamente maior do numero medio de consultas. Nao se verificou diferenca significante do numero medio de consultas medicas por estrato de renda. Entre os portadores de doenca cronica nao houve diferenca significativa do numero medio de consultas entre usuarios do SUS e de planos privados de saude.

Perfil sociodemográfico e padrão de utilização dos serviços de saúde do Sistema Único de Saúde (SUS), 2003- 2008

PNAD data was employed to analyze the utilization profile of health services, and this was measured by the proportion of individuals seeking and reporting use of health services in the prior two weeks and those who reported hospitalization in the preceding 12 months. Private health plans covered 25.9% of the Brazilian population. Comparing data from 2003 and 2008 surveys, there was no change in the proportion of individuals seeking health services, as well as the proportion of those attended by these services (96%). The Unified Health System (SUS) was responsible for 56,7% of all healthcare, providing the bulk of medical visits, vaccine activities and hospital admissions, but accounted for only 1/3 of dental care. There was a reduction in SUS health services utilization with the increase of education and income level, in the two surveys. There was also a decrease in utilization of services due to prevention and an increase in dental problems, accidents, injuries and rehabilitation. The pattern of SUS services utilization per region was inversely related to the proportion of individuals with private health insurance coverage.

Inquéritos populacionais: aspectos metodológicos, operacionais e éticos

Eliseu Alves Waldman H. Maria Dutilh Novaes Maria de Fatima Militao de Albuquerque Maria do Rosario Dias de Oliveira Latorre Manoel Carlos Sampaio de Almeida Ribeiro Mauricio Vasconcellos Ricardo Arraes de Alencar Ximenes Rita Barradas Barata Tânia Giacomo do Lago Zilda Pereira da Silva 1 Universidade de Sao Paulo, Faculdade de Saude Publica 2 Faculdade de Medicina da Universidade de Sao Paulo 3 Universidade Federal de Pernambuco, Centro de Ciencias da Saude, Departamento de Medicina Clinica 4 Universidade de Sao Paulo, Faculdade de Saude Publica, Departamento de Epidemiologia 5 Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Departamento de Medicina Social 6 Instituto Brasileiro de Geografia e Estatistica IBGE 7 Universidade Federal de Pernambuco, Centro de Ciencias da Saude, Departamento de Medicina Tropical 8 Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Departamento de Medicina Social 9 Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Departamento de Medicina Social 10 Fundacao Sistema Estadual de Analise de Dados SEADE

Health inequalities based on ethnicity in individuals aged 15 to 64, Brazil, 1998

This study aimed to analyze inequalities in health status and utilization of medical consultations and hospital services by Brazilian young and adult populations according to ethnicity. The survey analyzes a representative sample of the Brazilian population aged 15 to 64 years, except those living in the rural area of the Amazon. The prevalence of fair or poor health status was substantially higher among black men, white women, and black women. The influence of gender and ethnicity remains significant after adjusting for age and socioeconomic conditions (OR = 1.11; 1.49 and 1.86 respectively). Differences between blacks and whites decrease with age, but increase with socioeconomic status. There were 10% more medical consultations among white individuals. The differences were more striking among young people who reported good health status. For individuals with fair or poor health, no differences were observed in frequency of medical consultations between blacks and whites. There were no significant differences in hospitalization rates. With regard to health status, differences between blacks and whites were striking. However, the same was not true for utilization of health services.

Qualidade das informações registradas nas declarações de óbito fetal em São Paulo, SP

OBJETIVO: Avaliar a qualidade da informacao registrada nas declaracoes de obito fetal. METODOS: Estudo documental com 710 obitos fetais em hospitais de Sao Paulo, SP, no primeiro semestre de 2008, registrados na base unificada de obitos da Fundacao Sistema Estadual de Analise de Dados e da Secretaria de Estado da Saude de Sao Paulo. Foi analisada a completitude das variaveis das declaracoes de obito fetal emitidas por hospitais e Servico de Verificacao de Obitos. Os registros das declaracoes de obito de uma amostra de 212 obitos fetais de hospitais do Sistema Unico de Saude foram comparados com os dados dos prontuarios e do registro do Servico de Verificacao de Obitos. RESULTADOS: Dentre as declaracoes de obito, 75% foram emitidas pelo Servico de Verificacao de Obitos, mais frequente nos hospitais do Sistema Unico de Saude (78%). A completitude das variaveis das declaracoes de obito emitidas pelos hospitais foi mais elevada e foi maior nos hospitais nao pertencentes ao Sistema Unico de Saude. Houve maior completitude, concordância e sensibilidade nas declaracoes de obito emitidas pelos hospitais. Houve baixa concordância e elevada especificidade para as variaveis relativas as caracteristicas maternas. Maior registro das variaveis sexo, peso ao nascer e duracao da gestacao foi observada nas declaracoes emitidas no Servico de Verificacao de Obitos. A autopsia nao resultou em aprimoramento da indicacao das causas de morte: a morte fetal nao especificada representou 65,7% e a hipoxia intrauterina, 24,3%, enquanto nas declaracoes emitidas pelos hospitais foi de 18,1% e 41,7%, respectivamente. CONCLUSOES: E necessario aprimorar a completitude e a indicacao das causas de morte dos obitos fetais. A elevada proporcao de autopsias nao melhorou a qualidade da informacao e a indicacao das causas de morte. A qualidade das informacoes geradas de autopsias depende do acesso as informacoes hospitalares.OBJECTIVE To evaluate the quality of information registered on fetal death certificates. METHODS Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public) were compared to medical records and to the records from Coroners Office. RESULTS Among death certificates, 75% were issues by Coroners Office, with a greater frequency in public hospitals (78%). Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroners Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identified as unspecified fetal death as 24.3% as intrauterine hypoxia, while death certificates by hospitals reported 18.1% as unspecified and 41.7% as intrauterine hypoxia. CONCLUSIONS Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.

Early neonatal mortality according to level of hospital complexity in Greater Metropolitan São Paulo, Brazil

The aim of this study was to analyze the profile of newborns, mothers, and early neonatal mortality according to the hospitals complexity and affiliation (or lack thereof) with the Unified National Health System (SUS) in Greater Metropolitan São Paulo, Brazil. The study was based on data for live births, deaths, and hospital registries. Factor and cluster analysis were used to obtain the typology of hospital complexity and user profile. The SUS treats more high-risk newborns and mothers with low schooling, insufficient prenatal care, and teenage mothers. The probability of early neonatal death was 5.6 live births (65% higher in the SUS), with no significant differences by level of hospital complexity, except those with extremely high (SUS) and medium (non-SUS) complexity. The difference in early neonatal mortality between the two systems was smaller in the group of newborns with birth weight < 1,500g (22%), but the rate was 131% higher in the SUS for newborns > 2,500g. There was a concentration of high-risk births in the SUS, but the difference in early neonatal mortality between SUS and non-SUS hospitals was smaller in this group of newborns. New studies are needed to elucidate the high mortality rate among newborns with birth weight > 2,500g in the SUS.

Gender and health inequalities among adolescents and adults in Brazil, 1998

OBJECTIVES To assess the extent of gender inequalities in health status and health services utilization among adolescents and adults in Brazil. METHODS A representative sample of 217,248 individuals from 15 to 64 years of age was obtained from the National Household Sample Survey (Pesquisa Nacional de Amostras por Domicílios, PNAD) conducted in 1998 by the Brazilian Institute of Geography and Statistics and funded by the Ministry of Health. The study focused on three outcome variables (self-assessed health status, medical visits, and hospitalizations (except childbirth)) and five exposure variables (age, gender, ethnicity, income, and education). Unconditional logistic regression and Mantel-Haenszel stratified analysis was employed. Prevalence rate ratios were calculated for each stratum. Confidence intervals were calculated using the Taylor series, with a 95% confidence interval (95% CI). RESULTS Women were more likely to report fair or poor health than men (odds ratio (OR) = 1.33; 95% CI: 1.31-1.35). Gender disparities were significant for all ages, household income brackets, and education levels, and were always unfavorable to women (1.17 < or = OR < or = 1.44). Gender disparities for medical visits were higher for those in good health; tended to fall as age, income, and education increased; and were always favorable for women (1.12 < or = OR < or = 2.06). Gender disparities in hospitalization rates decreased with age, varied according to income and education level in each age group, and were always favorable for women (1.16 < or = OR < or = 1.66). CONCLUSIONS The difference in self-reported health status for men and women became even greater after adjusting for socioeconomic variables, suggesting that poorer women have more pronounced, relative differences than men do. The impact of structural determinants, such as education and income, is considerably smaller than the social construct of gender, although the former are more important predictors. Women use health services more often than men do, which is consistent with their health needs. However, medical visit rates show an inverse relationship to health care needs, suggesting an inequitable access to outpatient care, mainly preventive care.

Maternal and neonatal characteristics and early neonatal mortality in Greater Metropolitan São Paulo, Brazil

The objective was to describe maternal and neonatal characteristics and early neonatal mortality rate according to place of delivery in Greater Metropolitan São Paulo, Brazil. The study linked the databases on live births and early neonatal deaths with the national hospital registry. Place of delivery was identified through certificates of live birth. There were a total of 154,676 live births: 98.7% in-hospital; 0.3% home deliveries, and 1% in other health services. Deliveries in birthing centers and small hospital units were associated with low obstetric risk and a low proportion of preterm and low birth weight infants, and as a result these services showed the lowest early neonatal mortality rate. Compared to hospital maternity ward deliveries, the early neonatal mortality rate was 4.7 times higher for home deliveries and 9.6 higher for emergency room deliveries. There is a high rate of hospital delivery care in São Paulo, but there is still a small portion of accidental home births and deliveries occurring in inappropriate health services, probably as a result of obstetric emergencies and difficulties in accessing hospital services.

Análise espacial dos aglomerados de nascimentos ocorridos em hospitais SUS e não SUS do município de São Paulo, Brasil

The scope of this study is to evaluate the spatial distribution of live births (LB) in the Municipality of São Paulo (MSP), verify if there is spatial dependence, identify possible differences in birth profiles and evaluate the distances between homes and delivery hospitals. LB occurring in high complexity hospitals were studied, namely 4 from the Unified Health System (SUS) and 4 from the private network in MSP in 2008. 46,190 LB were geocoded: 48.8% from SUS hospitals and 51.2% from private hospitals, accounting for 27.9% of total live births in MSP. LB in SUS hospitals formed two clusters, with a high proportion of households with incomes of 1/2 to 2MW and a marked number of shantytowns and high birth rates. LB in private hospitals formed a cluster in the central region of MSP, where there is a high proportion of households with > 10 MW income and a low birth rate. Differences in maternal, pregnancy and childbirth characteristics were statistically significant in SUS and non-SUS hospitals, as well as the frequency of multiple births. There was no difference in the prevalence of low birth weight and pre-term births. The results showed differences in the LB cluster profile reflecting the current inequalities in living conditions.O objetivo deste estudo e avaliar a distribuicao espacial de nascidos vivos (NV) do municipio de Sao Paulo (MSP), verificar se ha dependencia espacial, identificar possiveis diferencas no perfil dos nascimentos e avaliar as distâncias percorridas entre os domicilios e os hospitais do parto. Foram estudados os NV ocorridos em hospitais de alta complexidade, quatro SUS e quatro da rede nao SUS no MSP em 2008. Foram georreferenciados 46.190 NV: 48,8% em hospitais SUS e 51,2% nao SUS, estes representaram 27,9% do total de NV do MSP. Os NV de hospitais SUS formaram dois aglomerados com elevada proporcao de domicilios com renda de 1/2 a 2SM, concentracao de favelas e altas taxas de natalidade. Os NV de hospitais nao SUS formaram um aglomerado na regiao central do MSP, onde ha elevada proporcao de domicilios com renda > 10 SM e baixa natalidade. Foram encontradas diferencas estaticamente significantes das caracteristicas maternas, da gestacao e do parto entre os NV de hospitais SUS e nao SUS e da frequencia de gemelaridade. Nao houve diferenca na prevalencia de baixo peso e pre-termo. Os resultados mostraram existir diferenciais no perfil dos aglomerados de NV, que refletem as desigualdades das condicoes de vida do MSP.The scope of this study is to evaluate the spatial distribution of live births (LB) in the Municipality of Sao Paulo (MSP), verify if there is spatial dependence, identify possible differences in birth profiles and evaluate the distances between homes and delivery hospitals. LB occurring in high complexity hospitals were studied, namely 4 from the Unified Health System (SUS) and 4 from the private network in MSP in 2008. 46,190 LB were geocoded: 48.8% from SUS hospitals and 51.2% from private hospitals, accounting for 27.9% of total live births in MSP. LB in SUS hospitals formed two clusters, with a high proportion of households with incomes of 1/2 to 2MW and a marked number of shantytowns and high birth rates. LB in private hospitals formed a cluster in the central region of MSP, where there is a high proportion of households with > 10 MW income and a low birth rate. Differences in maternal, pregnancy and childbirth characteristics were statistically significant in SUS and non-SUS hospitals, as well as the frequency of multiple births. There was no difference in the prevalence of low birth weight and pre-term births. The results showed differences in the LB cluster profile reflecting the current inequalities in living conditions.