Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross- sectional analysis of three million individuals
Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross- sectional analysis of three million individuals
Data
2021
Autores
Hone, Thomas
Stokes, Jonathan
Trajman, Anete
Saraceni, Valeria
Coeli, Claudia Medina
Rasella, Davide
Durovni, Betina
Millett, Christopher
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Resumo
Background: Evidence is limited on racial/ethnic group disparities in multimorbidity and associated health
outcomes in low- and middle-income countries hampering effective policies and clinical interventions to address
health inequalities.
Methods: This study assessed race/ethnic and socioeconomic disparities in the prevalence of multimorbidity and
associated healthcare utilisation, costs and death in Rio de Janeiro, Brazil. A cross-sectional analysis was carried out
of 3,027,335 individuals registered with primary healthcare (PHC) services. Records included linked data to
hospitalisation, mortality, and welfare-claimant (Bolsa Família) records between 1 Jan 2012 and 31 Dec 2016.
Logistic and Poisson regression models were carried out to assess the likelihood of multimorbidity (two or more
diagnoses out of 53 chronic conditions), PHC use, hospital admissions and mortality from any cause. Interactions
were used to assess disparities.
Results: In total 13,509,633 healthcare visits were analysed identifying 389,829 multimorbid individuals (13%). In
adjusted regression models, multimorbidity was associated with lower education (Adjusted Odds Ratio (AOR): 1.26;
95%CI: 1.23,1.29; compared to higher education), Bolsa Família receipt (AOR: 1.14; 95%CI: 1.13,1.15; compared to
non-recipients); and black race/ethnicity (AOR: 1.05; 95%CI: 1.03,1.06; compared to white). Multimorbidity was
associated with more hospitalisations (Adjusted Rate Ratio (ARR): 2.75; 95%CI: 2.69,2.81), more PHC visits (ARR: 3.46;
95%CI: 3.44,3.47), and higher likelihood of death (AOR: 1.33; 95%CI: 1.29,1.36). These associations were greater for
multimorbid individuals with lower educational attainment (five year probability of death 1.67% (95%CI: 1.61,1.74%)
compared to 1.13% (95%CI: 1.02,1.23%) for higher education), individuals of black race/ethnicity (1.48% (95%CI: 1.41,
1.55%) compared to 1.35% (95%CI: 1.31,1.40%) for white) and individuals in receipt of welfare (1.89% (95%CI: 1.77,
2.00%) compared to 1.35% (95%CI: 1.31,1.38%) for non-recipients).
Conclusions: The prevalence of multimorbidity and associated hospital admissions and mortality are greater in
individuals with black race/ethnicity and other deprived socioeconomic groups in Rio de Janeiro. Interventions to
better prevent and manage multimorbidity and underlying disparities in low- and middle-income country settings
are needed.
Description
Palavras-chave
Multimorbidity, Chronic conditions, Mortality, Utilisation, Hospitalisations, Middle-income country, Brazil.
Citação
Hone T, Stokes J, Trajman A, Saraceni V, Coeli CM, Rasella D, Durovni B, Millett C. Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals. BMC Public Health. 2021 Jul 1;21(1):1287. doi: 10.1186/s12889-021-11328-0.