Income gaps, doctors, and ncd burden: correlating mortality, hospitalizations, and costs in brazil

Authors

  • Jean Henri Maselli-Schoueri aLaboratório de Epidemiologia e Análise de Dados. Centro Universitário FMABC. Santo André, São Paulo, Brasil.
  • Luis Eduardo Werneck de Carvalho bOncológica do Brasil Ensino e Pesquisa. Belém, Pará, Brasil.
  • Manuela de Almeida Roediger cLaboratório de Epidemiologia e Análise de Dados. Centro Universitário FMABC. Santo André, São Paulo, Brasil
  • Fernando Luiz Affonso Fonseca dLaboratório de Análises Clínicas. Centro Universitário FMABC. Santo André, São Paulo, Brasil.
  • Luiz Vinicius de Alcantara Sousa eLaboratório de Epidemiologia e Análise de Dados. Centro Universitário FMABC. Santo André, São Paulo, Brasil.
  • Laércio da Silva Paiva fLaboratório de Epidemiologia e Análise de Dados. Centro Universitário FMABC. Santo André, São Paulo, Brasil.

DOI:

https://doi.org/10.36311/jhgd.v35.17288

Keywords:

noncommunicable diseases, inequality, Public Health, public health expenditure, Brazilian Amazon

Abstract

Introduction: Chronic Non-Communicable Diseases are a major public health problem in Brazil, with notable social and regional disparities.

Objective: examine the relationship between the number of doctors in the Unified Health System and the number of hospitalizations and mortality rates due to Non-Communicable Diseases, and how income inequality might influence such outcomes.

Methods: ecological study using secondary data from Brazil’s public health system (2016-2018). Mortality rates were age-standardized based on WHO’s population. All rates were standardized per 100,000 inhabitants, and costs were converted to US dollars. Linear regression was performed using backward elimination strategy.

Results: 2,423,251 deaths were recorded, with a total expenditure of US$3.2 billion. Both deaths and costs were higher in men. The Gini index was inversely correlated with total spending (p < 0.05) and hospital admissions for most Non-Communicable Diseases (p < 0.001), except for metabolic diseases. No correlation was found between the Gini index and mortality.

Conclusions: Non-Communicable Diseases accounted for over 2 million deaths in adults during 2016-2018, with a greater impact on men. A negative relationship between income inequality and Non-Communicable Diseases outcomes was found, but no significant association with the number of Unified Health System’s doctors was identified.

 

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References

WHO - World Health Organization. Noncommunicable diseases. Retrieved November 8, 2023. [Internet]. [cited 2024 Dec 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

Razzaghi H, Martin DN, Quesnel-Crooks S, Hong Y, Gregg E, Andall-Brereton G, et al. 10-year trends in noncommunicable disease mortality in the Caribbean region. Revista Panamericana de Salud Pública [Internet]. 2019;43:1–11. Available from: https://iris.paho.org/bitstream/handle/10665.2/50554/v43e372019.pdf?sequence=1&isAllowed=y.

Vigilância das Doenças e Agravos Não Transmissíveis [Internet]. Ministério da Saúde. [cited 2024 Dec 3]. Available from: https://www.gov.br/saude/pt-br/composicao/svsa/vigilancia-de-doencas-cronicas-nao-transmissiveis/vigilancia-das-dant

Brasil. Ministério da Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil 2011–2022. Retrieved November 8, 2023. [cited 2024 Dec 2]; Available from: http://bibliotecadigital.economia.gov.br/handle/123456789/978

Mais Saúde - Direito de Todos. Diretrizes Estratégicas. [Internet]. bvsms.saude.gov.br. Available from: https://bvsms.saude.gov.br/bvs/pacsaude/diretrizes.php

WHO - World Health Organization. International Classification of Diseases (ICD-10). Retrieved November 8, 2019. [Internet]. [cited 2024 Dec 2]. Available from: https://www.who.int/standards/classifications/classification-of-diseases

Cadastro Nacional de Estabelecimentos de Saúde [Internet]. [cited 2024 Dec 2]. Available from: https://cnes.datasus.gov.br/

Ahmad, OB, Boschi-Pinto, C, Lopez, AD, Murray, CJ, Lozano, R., & Inoue, M. Age Standardization Of Rates: A New Who Standard. [Internet]. ResearchGate. [cited 2024 Dec 3]. Available from: https://www.researchgate.net/publication/203609941_Age_Standardization_of_Rates_A_New_WHO_Standard

Banco Central do Brasil. Conversão de moedas [Internet]. [cited 2024 Dec 3]. Available from: https://www.bcb.gov.br/conversao

Maselli-Schoueri JH, Affonso-Kaufman FA, de Melo Sette CV, Dos Santos Figueiredo FW, Adami F. Time trend of breast cancer mortality in BRAZILIAN men: 10-year data analysis from 2005 to 2015. BMC Cancer [Internet]. 2019 Jan 7;19(1):23. Available from: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-5261-1

Fay MP, Tiwari RC, Feuer EJ, Zou Z. Estimating average annual percent change for disease rates without assuming constant change. Biometrics [Internet]. 2006 Sep;62(3):847–54. Available from: https://pubmed.ncbi.nlm.nih.gov/16984328/

Brasil. Ministério da Saúde. Conselho Nacional de Saúde - CNS nº 510, de 07 de abril de 2016. [Internet]. [cited 2024 Dec 3]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2016/res0510_07_04_2016.html

Solt F. The Standardized World Income Inequality Database: Standardized world income inequality database. Soc Sci Q [Internet]. 2016 Nov;97(5):1267–81. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ssqu.12295

Victora CG, Barreto ML, do Carmo Leal M, Monteiro CA, Schmidt MI, Paim J, et al. Health conditions and health-policy innovations in Brazil: the way forward. Lancet [Internet]. 2011 Jun;377(9782):2042–53. Available from: https://pubmed.ncbi.nlm.nih.gov/21561659/

Albuquerque MV de, Viana ALD, Lima LD de, Ferreira MP, Fusaro ER, Iozzi FL. Regional health inequalities: changes observed in Brazil from 2000-2016. Cien Saude Colet [Internet]. 2017 Apr;22(4):1055–64. Available from: https://www.scielo.br/j/csc/a/mnpHNBCXdptWTzt64rx5GSn/?lang=en

Barros AJD, Bertoldi AD. Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil. Int J Epidemiol [Internet]. 2008 Aug;37(4):758–65. Available from: https://pubmed.ncbi.nlm.nih.gov/18411201/

Szwarcwald CL, Souza Júnior PRB de, Marques AP, Almeida W da S de, Montilla DER. Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, 2013. Int J Equity Health [Internet]. 2016 Nov 17;15(1):141. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5112675/

Figueiredo FWDS, Adami F. Income inequality and mortality owing to breast cancer: Evidence from Brazil. Clin Breast Cancer [Internet]. 2018 Aug;18(4):e651–8. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1526820917305268

Schoueri JHM, Kaufman FAA, de Camargo CRS, Sette CV de M, Adami F, Figueiredo FWDS. Time trend and regional variability of mortality rate due to ovarian cancer in Brazil: a 15-year analysis. J Public Health (Oxf) [Internet]. 2018 Dec 1;40(4):e474–81. Available from: https://pubmed.ncbi.nlm.nih.gov/29733385/

Malta DC, Andrade SSC de A, Oliveira TP, Moura L de, Prado RR do, Souza M de FM de. Probabilidade de morte prematura por doenças crônicas não transmissíveis, Brasil e regiões, projeções para 2025. Rev Bras Epidemiol [Internet]. 2019 Apr 1;22(0):e190030. Available from: https://www.scielo.br/j/rbepid/a/r7QkT4hR3HmkWrBwZc6bshG/?format=pdf&lang=en

Ferreira L. Demografia Médica 2018: número de médicos aumenta e persistem desigualdades de distribuição e problemas na assistência [Internet]. Available from: https://amb.org.br/wp-content/uploads/2018/03/DEMOGRAFIA-M%C3%89DICA.pdf

Bonometto, JVB., Sette, CVDM, Santi, PX, Maselli-Schoueri, JH, Giglio, AD, Cubero, DDIG. Critical assessment of resource waste in staging and follow-up of breast cancer [Internet]. ResearchGate. [cited 2024 Dec 3]. Available from: https://www.researchgate.net/publication/375904612_Critical_assessment_of_resource_waste_in_staging_and_follow-up_of_breast_cancer

NCD Countdown 2030 collaborators. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet [Internet]. 2018 Sep 22;392(10152):1072–88. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31992-5/fulltext

Saúde do homem: acompanhamento e prevenção podem reduzir casos de Doenças Crônicas Não Transmissíveis [Internet]. Ministério da Saúde. 2022 [cited 2024 Dec 3]. Available from: https://www.gov.br/saude/pt-br/assuntos/noticias/2022/novembro/saude-do-homem-acompanhamento-e-prevencao-podem-reduzir-casos-de-doencas-cronicas-nao-transmissiveis

Bugge C, Saether EM, Kristiansen IS. Men receive more end-of-life cancer hospital treatment than women: fact or fiction? Acta Oncol [Internet]. 2021 Aug;60(8):984–91. Available from: https://pubmed.ncbi.nlm.nih.gov/33979241/

De 2010 a 2022, população brasileira cresce 6,5% e chega a 203,1 milhões [Internet]. Agência de Notícias - IBGE. 2023 [cited 2024 Dec 3]. Available from: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/37237-de-2010-a-2022-populacao-brasileira-cresce-6-5-e-chega-a-203-1-milhoes

Zhao Q, Coelho MSZS, Li S, Saldiva PHN, Abramson MJ, Huxley RR, et al. Trends in hospital admission rates and associated direct healthcare costs in Brazil: A nationwide retrospective study between 2000 and 2015. Innovation (Camb) [Internet]. 2020 May 21;1(1):100013. Available from: https://pubmed.ncbi.nlm.nih.gov/34557701/

Boudreau DM, Malone DC, Raebel MA, Fishman PA, Nichols GA, Feldstein AC, et al. Health care utilization and costs by metabolic syndrome risk factors. Metab Syndr Relat Disord [Internet]. 2009 Aug;7(4):305–14. Available from: https://pubmed.ncbi.nlm.nih.gov/19558267/

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Published

2025-04-11

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Section

ORIGINAL ARTICLES