Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil
Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil
Data
2022
Autores
Basu, Sanjay
Hone, Thomas
Villela, Daniel
Saraceni, Valeria
Trajman, Anete
Durovni, Betina
Millett, Christopher
Rasella, Davide
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Open
Resumo
Objectives As middle-income countries strive to achieve
the Sustainable Development Goals (SDGs), it remains
unclear to what degree expanding primary care coverage
can help achieve those goals and reduce within-country
inequalities in mortality. Our objective was to estimate
the potential impact of primary care expansion on cause-
specific mortality in the 15 largest Brazilian cities.
Design Microsimulation model.
Setting 15 largest cities by population size in Brazil.
Participants Simulated populations.
Interventions We performed survival analysis to estimate
HRs of death by cause and by demographic group, from a
national administrative database linked to the Estratégia
de Saúde da Família (Family Health Strategy, FHS)
electronic health and death records among 1.2million
residents of Rio de Janeiro (2010–2016). We incorporated
the HRs into a microsimulation to estimate the impact of
changing primary care coverage in the 15 largest cities by
population size in Brazil.
Primary and secondary outcome measures Crude and
age-standardised mortality by cause, infant mortality and
under-5 mortality.
Results Increased FHS coverage would be expected to
reduce inequalities in mortality among cities (from 2.8
to 2.4 deaths per 1000 between the highest-mortality
and lowest-mortality city, given a 40 percentage point
increase in coverage), between welfare recipients and
non-recipients (from 1.3 to 1.0 deaths per 1,000), and
among race/ethnic groups (between Black and White
Brazilians from 1.0 to 0.8 deaths per 1,000). Even a
40 percentage point increase in coverage, however, would
be insufficient to reach SDG targets alone, as it would
be expected to reduce premature mortality from non-
communicable diseases by 20% (vs the target of 33%),
and communicable diseases by 15% (vs 100%).
Conclusions FHS primary care coverage may be critically
beneficial to reducing within-country health inequalities,
but reaching SDG targets will likely require coordination
between primary care and other sectors.
Description
Palavras-chave
General medicine (see internal medicine), primary care, public health.
Citação
Basu S, Hone T, Villela D, Saraceni V, Trajman A, Durovni B, Millett C, Rasella D. Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil. BMJ Open. 2022 Jan 11;12(1):e049251. doi: 10.1136/bmjopen-2021-049251. PMID: 35017236;