Gender and education inequalities in dynapenia-free life expectancy: ELSI-Brazil.

OBJECTIVE: To estimate the dynapenia-free life expectancy among community-dwelling older Brazilian adults and evaluate gender-related and educational differences. METHODS: This is a cross-sectional study. The data were obtained from the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil - Brazilian Longitudinal Study of Aging), conducted from 2015 to 2016 in Brazil. Dynapenia is defined as low muscle strength (< 27kg for men and < 16kg for women), measured with a handgrip dynamometer. The dynapenia-free life expectancy was estimated using the Sullivan method based on the standard period life table and dynapenia prevalence, stratified by age groups, gender, and schooling. RESULTS: A total of 8,827 participants, aged 50 and over (53.3% women), were investigated. The prevalence of dynapenia was 17.7% among men and 18.5% among women. The women live longer and with more years free of dynapenia than men. Those in the higher education category (four or more years) presented an advantage in the dynapenia-free life expectancy estimates. CONCLUSIONS: The results of this study suggest the substantial impact of dynapenia on longer dynapenia-free life expectancy among older people. Understanding dynapenia prevalence and dynapenia-free life expectancy could assist in predicting care needs, as well as targeting efforts to delay the onset of complications related to it at older ages. Without the implementation of policy regarding dynapenia prevention, inequalities in health due to gender and socioeconomic status may continue to increase.

[Factors associated with undiagnosed hypertension among elderly adults in Brazil - ELSI-Brazil]. / Fatores associados à hipertensão não diagnosticada entre adultos mais velhos no Brasil - ELSI-Brasil.

This article aims to identify factors associated with undiagnosed systemic arterial hypertension (SAH) among elderly adults in Brazil. A total of 5,416 hypertensive participants in the Longitudinal Study of the Health of Elderly Brazilians (ELSI-BRAZIL) were evaluated. Undiagnosed SAH was identified by mean blood pressure (BP) ≥140/90 mmHg without previous SAH diagnosis. Logistic regression was used to verify factors associated with undiagnosed SAH. In this study, 19.8% of the hypertensive patients evaluated did not report a previous diagnosis of SAH. Age between 60 to 69 (OR: 0.68, 95%CI 0.55-0.85) and 70 to79 (OR: 0.67, 95%CI 0.51-0.89), being black (OR: 0.67, 95%CI 0.49-0.91), obese (OR: 0.51, 95%CI 0.40-0.65), having one chronic disease (OR: 0.54, 95%CI 0.44-0.66) or more (OR: 0.32, 95%CI 0.25-0.42) and medical consultations in the last year (OR: 0.47, 95%CI 0.38-0.58) were factors associated with lower chances of undiagnosed SAH, while being male (OR: 1.27, 95%CI 1,05-1,54), presenting low body weight (OR: 1.33, 95%CI 1,00-1,78) and alcohol consumption (OR: 1.36, 95%CI 1,09-1,68) increased the chances of having the undiagnosed condition. The characteristics identified in this study needs to be observed in health services, expanding early diagnosis and preventing the progression of BP and its future consequences.

O objetivo deste artigo é identificar fatores associados à hipertensão arterial sistêmica (HAS) não diagnosticada entre adultos mais velhos no Brasil. Foram avaliados 5.416 participantes hipertensos do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). HAS não diagnosticada foi definida como a presença de pressão arterial (PA) ≥140/90 mmHg sem diagnóstico prévio. Regressão logística foi utilizada para verificar fatores associados à HAS não diagnosticada. No estudo, 19,8% dos hipertensos avaliados não relataram diagnóstico prévio de HAS. Ter entre 60 e 69 anos (OR: 0,68, IC95% 0,55-0,85) e 70 e 79 (OR: 0,67, IC95% 0,51-0,89), cor preta (OR: 0,67, IC95% 0,49-0,91), ser obeso (OR: 0,51, IC95% 0,40-0,65), ter uma doença crônica (OR: 0,54, IC95% 0,44-0,66) ou mais (OR: 0,32, IC95% 0,25-0,42) e consultas no último ano (OR: 0,47, IC95% 0,38-0,58) foram fatores associados a menores chances de HAS não diagnosticada, enquanto sexo masculino (OR: 1,27, IC95% 1,05-1,54), baixo peso (OR: 1,33, IC95% 1,00-1,78) e consumo de álcool (OR: 1,36, IC95% 1,09-1,68) elevaram as chances para apresentar a doença não diagnosticada. As características identificadas nesse estudo devem ser observadas em serviços de saúde, ampliando o diagnóstico precoce e prevenindo a progressão da PA e suas futuras consequências.

[Prevalence rates and inequalities in access to medicines by users of the Brazilian Unified National Health System in 2013 and 2019]. / Prevalências e desigualdades no acesso aos medicamentos por usuários do Sistema Único de Saúde no Brasil em 2013 e 2019.

The study aimed to analyze and compare the prevalence of access to medicines and associated factors among users of the Brazilian Unified National Health System (SUS). The authors analyzed data from the 2013 and 2019 editions of the Brazilian National Health Survey, a nationwide health study, representative of the Brazilian population. The outcomes were: (1) obtaining from the SUS all the medicines prescribed during care received in the SUS itself in the two weeks prior to the interview (2) and obtaining all the medicines, regardless of the source. Demographic and socioeconomic characteristics were included as independent variables. In 2019, 29.7% of the interviewees obtained all the prescribed medicines from the SUS, 81.8% obtained all the medicines in general (considering all sources), and 56.4% paid some amount for the medicines. The proportion who did obtain any medicine from the SUS and that made some out-of-pocket payment increased from 2013 to 2019. The likelihood of obtaining all the medicines in the SUS was higher among the poorest, and that of obtaining the medicines regardless of source was higher among the wealthiest. Approximately two out of three persons that were unable to access all the medicines reported difficulties obtaining them in services funded by the public sector. There was an increase in out-of-pocket expenditure on medicines in Brazil and a reduction in access through the SUS, among users of the system.

O objetivo do estudo foi analisar e comparar a prevalência, a forma de obtenção e os fatores associados ao acesso a medicamentos entre usuários do Sistema Único de Saúde (SUS) no Brasil. Foram analisados os dados das edições 2013 e 2019 da Pesquisa Nacional de Saúde, estudo de abrangência nacional e representativo da população brasileira. Os desfechos foram: (1) a obtenção total, por meio do SUS, dos medicamentos prescritos em atendimentos em saúde realizados no próprio SUS nas duas semanas anteriores à entrevista, e (2) a obtenção total dos medicamentos independentemente da fonte. Características demográficas e socioeconômicas foram incluídas como variáveis independentes. Em 2019, observou-se que 29,7% dos entrevistados obtiveram no SUS todos os medicamentos prescritos, que 81,8% tiveram acesso total aos medicamentos quando consideradas todas as fontes de obtenção e que 56,4% pagaram algum valor pelos medicamentos. A proporção de pessoas que não obtiveram nenhum medicamento no SUS e que efetuaram algum desembolso direto aumentou entre 2013 e 2019. A probabilidade de obter todos os medicamentos no SUS foi maior entre os mais pobres, e de consegui-los, independentemente da fonte, foi maior entre os mais ricos. Dentre as pessoas que não conseguiram acesso a todos os medicamentos, aproximadamente duas em cada três indicaram como principal motivo dificuldades de obtenção encontradas em serviços financiados pelo setor público. Verificou-se ampliação do desembolso direto para compra de medicamentos no Brasil e redução de acesso pelo SUS entre usuários do sistema.

El objetivo de este estudio fue analizar y comparar la prevalencia, la forma de obtención y los factores asociados al acceso a los medicamentos entre los usuarios del Sistema Único de Salud (SUS) en Brasil. Se analizaron los datos de las ediciones 2013 y 2019 de la Encuesta Nacional de Salud, un estudio de cobertura nacional y representativo de la población brasileña. Los resultados fueron: (1) la obtención total, a través del SUS, de los medicamentos prescritos en los servicios de salud realizados en el propio SUS en las dos semanas anteriores a la entrevista, y (2) la obtención total de los medicamentos independientemente de la fuente. Las características demográficas y socioeconómicas se incluyeron como variables independientes. En 2019 se observó que el 29,7% de los entrevistados obtuvo todos los medicamentos prescritos en el SUS, que el 81,8% tuvo acceso total a los medicamentos al considerar todas las fuentes de obtención y que el 56,4% pagó por los medicamentos. La proporción de personas que no obtuvieron ningún medicamento en el SUS y que realizaron algún gasto directo aumentó entre 2013 y 2019. Entre los pobres, la probabilidad de obtener todos los medicamentos del SUS fue mayor, y entre los más ricos también fue mayor esta obtención independientemente de la fuente. Entre las personas que no pudieron acceder a todos los medicamentos, aproximadamente dos de cada tres indicaron como razón principal las dificultades que se encuentran en los servicios financiados con fondos públicos. Hubo un aumento del gasto directo para la compra de medicamentos en Brasil y una reducción del acceso a través del SUS entre los usuarios del sistema.

[Catastrophic health expenditures: analysis of the association with socioeconomic conditions in Minas Gerais, Brazil]. / Gastos catastróficos em saúde: análise da associação com condições socioeconômicas em Minas Gerais, Brasil.

This study aimed to assess catastrophic health expenditures (CHE) and its association with socioeconomic conditions in 2009, 2011 and 2013 in Minas Gerais, Brazil. A cross-sectional study was carried out with data from the Household Sample Survey. The dependent variable was the CHE in each year of the survey. Expenditures that exceeded 10% and 25% of household income were considered catastrophic. The association between catastrophic health expenditure and independent variables was tested by the Poisson regression. The prevalence of CHE ranged from 9.0% to 11.3% and 18.9% to 24.4% within the limits of 10% and 25%, and 2011 recorded the lowest values. The largest proportion of health expenditure (94%) was related to the acquisition of medicines. The prevalence of CHE was lower among those responsible for the household with 12 or more years of study than those with no formal education. Households with a higher wealth score had, in both limits, lower prevalence of CHE than those of the first quintile. We concluded that health expenditures significantly affected the budget of households in Minas Gerais and the purchase of medicines was the main component of spending. The findings reinforce the role of the Brazilian Unified Health System (SUS) in minimizing CHE and reducing socioeconomic inequalities.

O objetivo deste estudo foi avaliar os gastos catastróficos em saúde (GCS) e sua associação com condições socioeconômicas nos anos de 2009, 2011 e 2013 em Minas Gerais. Realizou-se um estudo transversal com dados da Pesquisa por Amostra de Domicílios. A variável dependente foi o GCS, em cada ano da pesquisa. Foram considerados catastróficos os gastos que ultrapassaram os limites de 10% e 25% da renda familiar. A associação entre o gasto catastrófico e as variáveis independentes foi testada por meio de regressão de Poisson. As prevalências de GCS variaram de 9,0% a 11,3% e 18,9% a 24,4% nos limites de 10% e 25%, sendo que o ano de 2011 apresentou os menores valores. A maior proporção dos gastos com saúde (94%) foi relativa aos gastos com medicamentos. A prevalência de CGS foi menor entre responsáveis pelo domicílio com maior escolaridade quando comparados àqueles sem estudo nos limites de 10% e 25%. Famílias com maior escore de riqueza apresentaram, nos dois limites, prevalência de GCS menores do que aquelas do primeiro quintil. Concluiu-se que os gastos com saúde afetaram significativamente o orçamento das famílias em Minas Gerais, sendo o gasto com medicamentos o principal componente dos gastos. Os achados reforçam o papel do SUS para minimizar o GCS e reduzir as desigualdades socioeconômicas.

[Socioeconomic inequalities in the prevalence of excess weight and sedentary behavior among Brazilian adolescents]. / Desigualdades socioeconômicas associadas ao excesso de peso e sedentarismo em adolescentes brasileiros.

The scope of this study was to estimate the prevalence of excess weight and a sedentary lifestyle among Brazilian students between 13 and 17 years of age and investigate the magnitude of the socioeconomic inequalities related to these outcomes. A cross-sectional study was carried out based on data from the National School Health Survey (PeNSE) conducted in 2015. Inequalities were evaluated using the Absolute and Relative Index of Inequality. The prevalence of excess weight in Brazil was 24.2%, ranging from 20.7% in the Northeast Region to 27.8% in the Southern Region. The prevalence of a sedentary lifestyle in Brazil was 67.8%, ranging from 61.8 % in the North Region to 70.3% in the Southeast Region. The direct and positive association between better socioeconomic conditions and the prevalence of excess weight and a sedentary lifestyle indicate health inequities in Brazil. The results of this study point to the need to restructure and reinforce public policies directed at adolescents, which should have as guidelines the promotion of a healthy lifestyle and the reduction of health inequities.

O objetivo deste estudo foi estimar a prevalência de excesso de peso e sedentarismo em escolares brasileiros na faixa etária de 13 a 17 anos, e investigar a magnitude das desigualdades socioeconômicas relacionadas a esses desfechos. Realizou-se um estudo transversal com base nos dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) do ano 2015. As desigualdades foram avaliadas por meio dos Índices Absoluto e Relativo de Desigualdade. A prevalência de excesso de peso no Brasil foi 24,2%, variou de 20,7% na região Nordeste a 27,8% na região Sul. Já a prevalência de sedentarismo no Brasil foi 67,8%, variou de 61,8% na região Norte a 70,3% na região Sudeste. A associação direta e positiva entre melhores condições socioeconômicas e as prevalências de excesso de peso e sedentarismo indicam iniquidades em saúde existentes no Brasil. Os resultados do presente estudo apontam a necessidade de reestruturação e fortalecimento das políticas públicas voltadas aos adolescentes, que devem ter como diretrizes a promoção de estilos de vida saudáveis e a redução das iniquidades em saúde.

[Predisposition to severe forms of COVID-19 and adherence to preventive measures: the role of social support]. / Predisposição a formas graves de COVID-19 e adesão às medidas de prevenção: o papel do apoio social.

This study sought to assess the adherence to preventive measures among the elderly more prone to severe forms of COVID-19, and the association and interaction with social support. It is a cross-sectional study conducted with a sample of 3,477 participants of the telephone survey of the Brazilian Longitudinal Study of Aging (ELSI-COVID-19 initiative), who reported going out of the home in the past week. The adherence was based on the frequency of leaving the house, the need to venture outside the home, use of masks, and sanitization of hands. Statistical analysis was based on the Poisson model with robust variance. Predisposing factors for severe forms of COVID-19 included age ≥65 years, hypertension, diabetes, and obesity. Social support included living arrangements and social distancing during the pandemic. Approximately 46% of the participants showed higher adherence, which was positively associated with the number of predisposing factors for severe forms of COVID-19. Social support was not associated with adherence, nor was this association modified after adjustments. The conclusion drawn is that higher adherence is concentrated among the elderly with greater predisposition to severe forms of COVID-19, irrespective of social support, albeit preventive measures should be adopted by all.

Objetivou-se verificar a adesão às medidas de prevenção em idosos com maior predisposição a formas graves de COVID-19 e sua associação e interação com o apoio social. Trata-se de um estudo transversal realizado em amostra de 3.477 participantes do inquérito telefônico do Estudo Longitudinal da Saúde dos Idosos Brasileiros (iniciativa ELSI-COVID-19), que informaram ter saído de casa na semana anterior à realização do inquérito. A adesão foi aferida pela frequência com que saiu de casa, necessidade de sair de casa, uso de máscara e higienização das mãos. As análises basearam-se no modelo Poisson com variância robusta. Idade ≥ 65 anos, hipertensão, diabetes e obesidade foram considerados fatores predisponentes para formas graves de COVID-19. O apoio social incluiu o arranjo domiciliar e a conexão social na pandemia. Aproximadamente 46% apresentaram melhor adesão, que foi associada positivamente ao número de fatores predisponentes para formas graves. O apoio social não foi associado à adesão e não modificou essa associação, após ajustamentos. Conclui-se que a adesão às medidas de prevenção, que deveria ser estendida a todos, está concentrada nos idosos com maior predisposição a formas graves de COVID-19, independentemente do apoio social.

[Frailty in elderly individuals and perception of problems in indicators of attributes of primary healthcare: results of the ELSI-Brasil]. / Fragilidade entre idosos e percepção de problemas em indicadores de atributos da atenção primária à saúde: resultados do ELSI-Brasil.

This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness.

O presente trabalho objetivou examinar a associação entre a síndrome de fragilidade e a percepção de problemas em indicadores de atributos da atenção primária à saúde (APS) entre idosos brasileiros. É um estudo transversal envolvendo 5.432 participantes, com 60 anos ou mais, da primeira onda do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), realizado entre 2015 e 2016. A fragilidade, variável independente, foi definida com base no marco teórico do fenótipo de fragilidade, e os indicadores de problemas em atributos da APS, variáveis dependentes, foram obtidos baseando-se em perguntas relacionadas ao uso de serviços de saúde. Acesso, longitudinalidade, coordenação, integralidade, orientação familiar e adequação cultural foram os atributos avaliados. Utilizou-se modelos de regressão logística ajustados por fatores predisponentes, facilitadores e de necessidade de uso de serviços de saúde para a análise dos dados. Entre os participantes, 55,1% eram do sexo feminino, 57,9% tinham entre 60 e 69 anos e 51,8% referiram multimorbidade. Idosos frágeis e pré-frágeis representaram 13,4% e 54,5% da amostra, respectivamente. Resultados da análise multivariada mostraram que os idosos frágeis em comparação com os robustos apresentaram mais chances de apontar problemas de acesso (OR = 1,45; IC95%: 1,08-1,93), longitudinalidade (OR = 1,54; IC95%: 1,19-2,00) e integralidade (OR = 1,45; IC95%: 1,14-1,85), além de maior número de problemas em atributos da APS (OR = 1,38; IC95%: 1,05-1,82, para 5 ou mais). O estudo sugere a ocorrência de iniquidades na assistência prestada pela APS brasileira aos idosos frágeis, particularmente no âmbito dos atributos acesso, longitudinalidade e integralidade.

El objetivo de este trabajo fue examinar la asociación entre el síndrome de fragilidad y la percepción de problemas en indicadores de atributos de la atención primaria a la salud (APS) entre ancianos brasileños. Se trata de un estudio transversal implicando a 5.432 participantes, con 60 años o más, del primer grupo del Estudio Longitudinal de la Salud entre Ancianos Brasileños (ELSI-Brasil), realizado entre 2015 y 2016. La fragilidad -variable independiente- fue definida a partir del marco teórico del fenotipo de fragilidad, y los indicadores de problemas en atributos de la APS, variables dependientes, se obtuvieron a partir de preguntas relacionadas con el uso de servicios de salud. Acceso, longitudinalidad, coordinación, integralidad, orientación familiar y adecuación cultural fueron los atributos evaluados. Se utilizaron modelos de regresión logística ajustados por factores predisponentes, facilitadores, y de necesidad de uso de servicios de salud para análisis de datos. Entre los participantes, un 55,1% eran de sexo femenino, un 57,9% tenían entre 60 y 69 años y un 51,8% informaron de multimorbilidad. Los ancianos frágiles y prefrágiles representaron un 13,4% y un 54,5% de la muestra, respectivamente. Los resultados del análisis multivariado mostraron que los ancianos frágiles, en comparación con los fuertes, tuvieron más oportunidades de apuntar problemas de acceso (OR = 1,45; IC95%: 1,08-1,93), longitudinalidad (OR = 1,54; IC95%: 1,19-2,00) e integralidad (OR = 1,45; IC95%: 1,14-1,85), además de un mayor número de problemas en atributos de la APS (OR = 1,38; IC95%: 1,05-1,82, para 5 o más). El estudio sugiere la ocurrencia de inequidades en la asistencia prestada por la APS brasileña a ancianos frágiles, particularmente en el ámbito de los atributos acceso, longitudinalidad e integralidad.

[Tendency of extreme attitudes in relation to weight in adolescents and their relationship with family support and body image]. / Tendência de atitudes extremas em relação ao peso em adolescentes e sua relação com suporte familiar e imagem corporal.

The scope of this study was to evaluate the tendency of extreme attitudes in relation to body weight among adolescents in Brazilian capitals and to verify its relationship with measures of family support and perception of body image. A cross-sectional study was conducted based on data from the National School Health Survey (PeNSE) for the years 2009, 2012 and 2015. There was an increase in the prevalence of extreme attitudes during the period evaluated. In the final model, higher age, perception of body image as being fat and male gender were associated with a higher incidence of extreme attitudes. However, higher level of schooling of the mother and the variables associated with family support (living with parents, informed parents, eating with parents) were associated with a lower incidence of extreme attitudes. The results of this study revealed that the family and social context is a fundamental issue to be investigated with families, adolescents and schools, as a preventive measure for possible health problems. The need to restructure public policies on health and education for adolescents, which should have the encouragement of family support as a guideline, is suggested.

Factors related to the dissatisfaction of users of specialized dental care centers in Brazil in 2014: a cross-sectional study. / Fatores associados à insatisfação dos usuários dos centros de especialidades odontológicas do Brasil em 2014: estudo transversal.

OBJECTIVE: to evaluate factors related to the dissatisfaction of users of the specialized dental care centers (CEO) in Brazil. METHODS: this was a cross-sectional study with data from the Dental Specialty Center Access and Quality Improvement Program; the study was conducted in 2014 and included a non-probabilistic sample of users; those who answered that the service received was regular, poor or very poor were classified as dissatisfied. RESULTS: a total of 8,730 users were included, 4.8% reported dissatisfaction; longer time taken to get to the service (OR=1.38 - 95%CI1.10;1.74), and longer waiting time until treatment (OR=1.37 - 95%CI1.07;1.75), were positively associated with dissatisfaction, whereas negative association was found with attention received (OR=0.12 - 95%CI0.09;0.16), the possibility of asking questions about treatment (OR=0.37 - 95%CI0.24;0.58), and receiving advice during treatment (OR=0.33 - 95%CI0.25;0.44). CONCLUSION: prevalence of user dissatisfaction was low and was associated with factors related to service organization and receipt of information and support.

An evaluation of non-adherence to pharmacotherapy for chronic diseases and socioeconomic inequalities in Brazil. / Avaliação da não adesão à farmacoterapia de doenças crônicas e desigualdades socioeconômicas no Brasil.

OBJECTIVE: To evaluate non-adherence to pharmacotherapy for chronic diseases and to investigate the existence of socioeconomic inequalities related to this outcome in Brazil. METHODS: This was a cross-sectional study based on data from the National Survey on Access, Use and Promotion of the Rational Use of Medicines (PNAUM). The study population corresponded to individuals aged 18 years or older with a medical diagnosis of at least one chronic disease and an indication for pharmacological treatment. The dependent variable was non-adherence to chronic disease pharmacotherapy measured by less than 80% adherence to drug therapy. Socioeconomic inequality related to non-adherence was assessed by absolute (SII) and relative (RII) inequality indices, calculated by logistic regression analyses. RESULTS: The prevalence of non-adherence to pharmacotherapy in Brazil was 20.2%, ranging from 17.0 to 27.8% between regions. Furthermore, this study revealed absolute and relative socioeconomic inequalities in non-adherence to pharmacotherapy of chronic diseases in Brazil (SII = -7.4; RII = 0.69) and the Northeast (SII = -14.0; RII = 0.59) and Center West (SII = -20.8; RII = 0.38) regions. The probability of non-adherence to pharmacotherapy in Brazil was higher among individuals with worse socioeconomic status. CONCLUSION: The findings of the present study indicate the need for the restructuring and strengthening of public policies aimed at reducing socioeconomic inequalities, in order to promote equity in adherence to the pharmacotherapy associated with chronic diseases.

Metabolic syndrome: physical inactivity and socioeconomic inequalities among non-institutionalized Brazilian elderly. / Síndrome metabólica: inatividade física e desigualdades socioeconômicas entre idosos brasileiros não institucionalizados.

OBJECTIVE: Evaluate the association between Metabolic Syndrome (MetS), physical activity and socioeconomic conditions among non-institutionalized elderly individuals. METHODOLOGY: Cross-sectional study with, elderly individuals (≥ 60) living in the city of São Paulo. MetS was evaluated by means of the National Cholesterol Education Program criteria, the Adult Treatment Panel III. Descriptive and bivariate analyses were performed, followed by multiple logistic regression with a 5% significance level. An attributable fraction (AF) and a proportional attributable fraction (PAF) were calculated in relation to physical activity. The magnitude of the socioeconomic inequalities was evaluated using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: The prevalence of MetS was 40.1%, and 23.3% of the individuals had at least one MetS' component. Physically inactive elderly had higher chances of having MetS. The prevalence of MetS was higher among those with lower education levels in both absolute and relative terms. AF and PAF were significant among the inactive individuals and for the total population. CONCLUSION: This study demonstrated that physical activity and schooling are significantly associated with MetS, highlighting the importance of these factors for the control of this syndrome.

A nationwide study on prevalence and factors associated with dynapenia in older adults: ELSI-Brazil.

This study aimed to assess the prevalence and factors associated with dynapenia in a nationally representative sample of Brazilians aged 50 years and older. A cross-sectional study was performed with baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Dynapenia was defined as low muscle strength (< 27kg for men and < 16kg for women). Explanatory variables were sociodemographic characteristics, health conditions, health behaviors and physical performance. Analyses were based on multivariate logistic regression and population attributable fractions. Among the 8,396 participants, the prevalence of dynapenia was 17.2% (16.6% among men and 17.7% among women); for those aged 65 years and older, the prevalence was 28.2% (29.1% and 27.5% among men and women, respectively). Dynapenia was positively associated with age, low gait speed, limitations in performing two or more basic daily activities, falls and self-reported chronic diseases; and negatively associated with education level, physical activity and body mass index (overweight/obese, OR = 0.26). Prevalence of dynapenia is high in Brazilian older adults. Educational skills and physical activity improvement present greater potential to reduce dynapenia in this population.

[Trends in performance indicators and production monitoring in Specialized Dental Clinics in Brazil]. / Tendências nos indicadores de desempenho e monitoramento de produção dos Centros de Especialidades Odontológicas do Brasil.

This study aimed to assess time trends in production and performance indicators in secondary dental care services in the Brazilian Unified National Health System (SUS) from 2008 to 2018. A time series study was conducted, based on production data from the Specialized Dental Clinics (CEOs in Portuguese) obtained from the Ambulatory Information System of the SUS. The monitoring indicator was assessed as the proportion of clinics that met the monthly target set for each specialty (primary care, endodontics, surgery, periodontics). Dental services' performance was defined as poor for those that met only one or no targets in the four dental specialties. The time series were analyzed by the decomposition method, considering the components trend, seasonal variation, and random variation. All the analyses were performed for Brazil as a whole and for each of the country's five major geographic regions. A decline was seen in Brazil as a whole in the proportion of clinics that met the primary care targets. There were upward trends in the proportion of compliance with the targets for surgery and periodontics in Brazil as a whole. Important differences were seen between the regions of Brazil in the proportion of compliance with the targets, with the worst performance for the clinics in the North and Northeast regions. Time trends showed an improvement in the services for Brazil as a whole, while emphasizing the importance of assessing the country's regions and the need for constant monitoring of these indicators.

Este trabalho teve o objetivo de avaliar a tendência temporal dos indicadores de monitoramento de produção e desempenho dos serviços de atenção secundária em saúde bucal do Sistema Único de Saúde (SUS), no período de 2008 a 2018. Realizou-se um estudo de séries temporais com base nos dados de produção dos Centros de Especialidades Odontológicas (CEOs) obtidos junto ao Sistema de Informações Ambulatoriais do SUS. O indicador de monitoramento foi avaliado segundo a proporção de CEOs que cumpriram a meta mensal estabelecida para cada especialidade (atenção básica, endodontia, cirurgia, periodontia). O desempenho dos serviços foi definido como ruim para aqueles que não cumpriram nenhuma ou apenas uma das metas estipuladas para as quatro especialidades odontológicas. As séries temporais construídas foram analisadas pelo método da decomposição, considerando os componentes de tendência, variação sazonal e variação aleatória. Todas as análises foram feitas para o Brasil e cada uma das cinco macrorregiões. Verificou-se o declínio da proporção de CEOs que cumpriram as metas da atenção básica no país como um todo. As tendências da proporção de cumprimento de metas para a área de cirurgia e periodontia foram crescentes para o Brasil. Observou-se diferenças importantes na proporção de cumprimento de metas entre as regiões brasileiras, com o pior desempenho dos CEOs nas regiões Norte e Nordeste. As tendências temporais demostraram uma melhora dos serviços para o Brasil como um todo, mas destacam a importância de avaliação das regiões do país e necessidade de monitoramento constante desses indicadores.

El objetivo de este estudio fue evaluar la tendencia temporal de los indicadores de monitoreo de producción y desempeño de los servicios de atención secundaria en salud bucal del Sistema Único de Salud (SUS), durante el período de 2008 a 2018. Se realizó un estudio de series temporales, basado en los datos de producción de los Centros de Especialidades Odontológicas (CEOs), obtenidos mediante el Sistema de Información Ambulatoria del SUS. El indicador de monitoreo se evaluó según la proporción de CEOs que cumplieron la meta mensual establecida para cada especialidad (atención básica, endodoncia, cirugía, periodoncia). El desempeño de los servicios se definió como malo para aquellos que no cumplieron ninguna o solo una de las metas estipuladas para las cuatro especialidades odontológicas. Las series temporales construidas se analizaron mediante el método de descomposición, considerando los componentes de tendencia, variación estacional y variación aleatoria. Todos los análisis fueron realizados respecto a Brasil y cada una de sus cinco macrorregiones. Se verificó un decremento en la proporción de CEOs que cumplieron las metas de la atención básica en todo el país. Las tendencias de la proporción de cumplimiento de metas para el área de cirugía y periodoncia fueron crecientes en el caso de Brasil. Se observaron diferencias importantes en la proporción de cumplimiento de metas entre las regiones brasileñas, con un peor desempeño de los CEOs en las regiones Norte y Nordeste. Las tendencias temporales demostraron una mejora de los servicios para todo Brasil, pero destacan la importancia de la evaluación de las regiones del país y la necesidad de un monitoreo constante de estos indicadores.

Vaccine coverage and factors associated with influenza vaccination in the elderly in the city of São Paulo, Brazil: SABE Study 2015. / Cobertura vacinal e fatores associados à vacinação contra influenza em pessoas idosas do Município de São Paulo, Brasil: Estudo SABE 2015.

This study evaluated influenza vaccine coverage among elderly individuals (≥ 60 years) living in the city of São Paulo, Brazil, in 2015, and analyzed associated factors. This was a cross-sectional population-based study of data from the SABE Study (Health, Well-Being, and Aging). The dependent variable was influenza vaccination in the 12 months prior to the interview, and the independent variables were sociodemographic and behavioral characteristics, self-reported health status, and use of health services. Data analysis considered the complex study sample, respecting the sampling weight. Poisson's regression was used, with significance set at 5%. Vaccine coverage was 79.7% (95%CI: 76.8-82.5). Influenza vaccination was associated with marital status (PR single/without partner = 0.84; 95%CI: 0.77-0.93), physical activity (PR yes = 1.08; 95%CI: 1.01-1.17), and medical appointment in the previous 12 months (PR yes = 1.22; 95%CI: 1.07-1.39). There were no differences between sociodemographic strata. Influenza vaccination in the elderly had already reached the target for universal coverage in the city of São Paulo. The results are relevant for planning the immunization program, pointing to priority groups to motivate for vaccination and valuing interaction between the elderly and health services.

Catastrophic health expenditure and multimorbidity among older adults in Brazil.

OBJECTIVE: To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older. METHODS: This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI - Brazilian Longitudinal Study of Aging) conducted in 2015-2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression. RESULTS: The prevalence of CHE was 17.9% and 7.5%, for expenditures corresponding to 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67-2.28, and OR = 1.40, 95%CI 1.11-1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores. CONCLUSIONS: The results draw attention to the need for an integrated approach of multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions.

Prevalence and characteristics of Brazilians aged 50 and over that received a doctor's diagnosis of COVID-19: the ELSI-COVID-19 initiative.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused over half a million deaths worldwide. Brazil has been particularly impacted, registering more than 1.3 million infections and 57,000 deaths by late June 2020. Aggregate numbers of cases are essential in modeling the epidemic and planning responses; however, more detailed analysis of risk factors associated with SARS-CoV-2 infection are needed. Our study provides an initial examination of characteristics associated with receiving a doctor's diagnosis of COVID-19 among a nationally representative sample of Brazilians aged 50 and over. Data are derived from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey to ELSI-Brazil participants, known as the ELSI-COVID-19 initiative. The telephone survey was conducted between 26 May and 8 June 2020. Results show that about 2.4% (n = 70) of the sample reported being told by a doctor they had COVID-19, however, only about half of these individuals (n = 37) reported receiving a diagnostic confirmation from viral testing (RT-PCR). Demographic factors (aged 50-60 years), socioeconomic factors (lower household income), health-related factors (obesity, three or more chronic conditions), and geography (living in the Northern region of the country) were positively associated with reporting a COVID-19 diagnosis. Despite the descriptive and preliminary nature of these findings, results reported here suggest the need for more targeted approaches to enhance personal protection and provide greater viral testing options, especially for older, sicker and more vulnerable adults in Brazil.

[Determinants of paid work among older Brazilians using structural equation modeling: evidence from the ELSI-Brazil study]. / Determinantes do trabalho remunerado entre brasileiros mais velhos usando modelagem de equações estruturais: evidências do ELSI-Brasil.

This study aimed to develop a conceptual model and to explore direct and indirect associations between paid work and life-course factors in a representative national sample of the Brazilian population 50 years and older. The analysis was based on 8,903 participants in the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The exposure variables were sociodemographic, health, work, and social interaction variables. Based on a structural equation model, paid work showed total association with lifetime social status in women (standardized coefficient - SC = 0.489) and direct association with capacity for work in men (SC = 0.527). For women alone, an indirect and negative association was observed with lifetime intense physical effort at work, via retirement (SC = -0.156). Men with paid work were more prone to social participation, measured by belonging to groups or associations (SC = 0.209). Among women, this participation was through interaction with family and friends (SC = 0.047), via capacity for work. For both men and women, lifetime health status showed an indirect and positive association (SC = 0.298 men; SC = 0.142 women) with paid work, via capacity for work. All the above-mentioned factors showed a significant association with paid work. The study's results showed that participation in the work market occurs by different mechanisms for men and women, principally considering the factors related to work and social interaction.

O objetivo do estudo foi desenvolver um modelo conceitual e explorar associações diretas e indiretas entre trabalho remunerado e fatores que operam ao longo da vida em amostra nacional representativa da população brasileira com 50 anos e mais. A análise foi baseada em 8.903 participantes da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). Os fatores de exposição foram sociodemográficos, de saúde, trabalho e interação social. Utilizando modelo de equações estruturais, observou-se que o trabalho remunerado apresentou associação total com a condição social ao longo da vida entre mulheres (coeficiente de padronização - CP = 0,489) e associação direta com a capacidade para o trabalho entre homens (CP = 0,527). Apenas para as mulheres, associação indireta e negativa foi observada com o esforço físico intenso no trabalho ao longo da vida, via aposentadoria (CP = -0,156). Homens com trabalho remunerado foram mais propensos à participação social, aferida pelo pertencimento a grupos ou associações (CP = 0,209). Entre as mulheres, essa participação ocorreu por meio de interações com família e amigos (CP = 0,047), via capacidade para o trabalho. Tanto entre homens quanto entre mulheres, a condição de saúde ao longo da vida mostrou associação indireta e positiva (CP = 0,298 homens; CP = 0,142 mulheres) com o trabalho remunerado, via capacidade para o trabalho. Todos os fatores mencionados apresentaram associação significativa com o trabalho remunerado. Os resultados do estudo mostraram que a participação de homens e mulheres mais velhos no mercado de trabalho ocorre por mecanismos diferentes, principalmente ao considerar os fatores relacionados ao trabalho e interação.

El objetivo de este estudio fue desarrollar un modelo conceptual y explorar asociaciones directas e indirectas entre trabajo remunerado y factores que operan a lo largo de la vida, en una muestra nacional representativa de población brasileña con 50 años y más. El análisis se basó en 8.903 participantes procedentes del Estudio Brasileño Longitudinal del Envejecimiento (ELSI-Brasil). Los factores de exposición fueron: sociodemográficos, de salud, trabajo e interacción social. Utilizando un modelo de ecuaciones estructurales, se observó que el trabajo remunerado presentó una asociación total con la condición social a lo largo de la vida entre mujeres (coeficiente de estandarización- CP = 0,489) y asociación directa con la capacidad para el trabajo entre hombres (CP = 0,527). Solamente para las mujeres, la asociación indirecta y negativa se observó con el esfuerzo físico intenso en el trabajo a lo largo de la vida, vía jubilación (CP = -0,156). Hombres con trabajo remunerado fueron más propensos a la participación social, medida por la pertenencia a grupos o asociaciones (CP = 0,209). Entre mujeres, esta participación se produjo mediante interacciones con la familia y amigos (CP = 0,047), vía capacidad para el trabajo. Tanto entre hombres como entre mujeres, la condición de salud a lo largo de la vida mostró una asociación indirecta y positiva (CP = 0,298 hombres; CP = 0,142 mujeres) con el trabajo remunerado, vía capacidad para el trabajo. Todos los factores mencionados presentaron una asociación significativa con el trabajo remunerado. Los resultados del estudio mostraron que la participación en el mercado de trabajo de hombres y mujeres mayores se produce por mecanismos diferentes, principalmente al considerar los factores relacionados con el trabajo e interacción social.

Health care seeking due to COVID-19 related symptoms and health care cancellations among older Brazilian adults: the ELSI-COVID-19 initiative.

The continent of the Americas has the greatest number of people infected and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the world. Brazil occupies the 2nd position in numbers of infected cases and deaths, preceded only by the United States. Older adults and those with pre-existing chronic illnesses are more vulnerable to the consequences of the virus. The SARS-CoV-2 epidemic has serious consequences for health services. Therefore, an assessment of the pandemic's effect on the older Brazilian population is urgently needed. The study examines the prevalence of COVID-19 related symptoms, care-seeking, and cancellation of surgery or other scheduled medical care among a nationally representative sample of Brazilians aged 50 and over derived from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey (the ELSI-COVID-19 initiative) between late May and early June 2020. About 10.4% of older adults reported any fever, dry cough or difficulty breathing in the 30 days prior to the interview, with the highest prevalence in the North region (50%). Among individuals with symptoms, only 33.6% sought care. Individuals living in the South or Southeast regions were significantly less likely to seek care for COVID-19 related symptoms. Nearly one in six participants had to cancel scheduled surgery or other medical care; this proportion was higher among women, those with more education, and people with multiple chronic conditions. This paper is among the first to investigate the effect of COVID-19 on health care use in Brazil among older adults. Results highlight the need to adapt health care delivery (such as through telemedicine) to ensure the continuity of care as well as the urgent need for wide dissemination of information to guide the population on disease prevention measures and how to obtain healthcare when needed.

Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: the ELSI-COVID-19 initiative. / Distanciamento social, uso de máscaras e higienização das mãos entre participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros: iniciativa ELSI-COVID-19.

The aim of the study was to examine the prevalence of social distancing, the use of face masks and hand washing when leaving home among Brazilian adults aged 50 or over. Data from 6,149 telephone interviews were used, conducted between May 26 and June 8, 2020 among participants in the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Social distancing was defined by not having left home in the last seven days. Only 32.8% of study participants did not leave home during the period considered, 36.3% left between one and two times, 15.2% between three and five times and 15.7% left every day. The main reasons for leaving home were to buy medicine or food (74.2%), to work (25.1%), to pay bills (24.5%), for health care (10.5%), to exercise (6.2%), and to meet family or friends (8.8%). Among those who left home, 97.3% always wore face masks and 97.3% always performed hand washing. Women left home less often than men. Men left home more often to work and exercise while women left home more often to seek healthcare. Men (odds ratio - OR = 1.84), those with higher education (OR = 1.48 and 1.95 for 5-8 and 9 years, respectively) and urban residents (OR = 1.54) left home more frequently to perform essential activities, regardless of age or other characteristics. Results show low adherence to social distancing, but high prevalence in the reported use of face masks and hand washing.

O objetivo do estudo foi examinar a prevalência do distanciamento social, do uso de máscaras e da higienização das mãos ao sair de casa entre adultos brasileiros com 50 anos ou mais de idade. Foram utilizados dados de 6.149 entrevistas telefônicas, conduzidas entre 26 de maio e 8 junho de 2020 dentre os participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). O distanciamento social foi definido por não ter saído de casa nos últimos 7 dias. Somente 32,8% dos participantes do estudo não saíram de casa no período considerado, 36,3% saíram entre 1 e 2 vezes, 15,2% entre 3 a 5 vezes e 15,7% saíram todos os dias. As principais razões para sair de casa foram comprar remédios ou alimentos (74,2%), trabalhar (25,1%), pagar contas (24,5%), atendimento dem saúde (10,5%), fazer exercícios (6,2%) e encontrar familiares ou amigos (8,8%). Entre os que saíram de casa, 97,3% usaram sempre máscaras faciais e 97,3% sempre higienizaram as mãos. As mulheres saíram menos de casa que os homens. Esses saíram com mais frequência para trabalhar e fazer exercícios. Elas saíram mais para atendimento em saúde. Os homens (odds ratio - OR =1,84) aqueles com escolaridade mais alta (OR = 1,48 e 1,95 para 5-8 e 9 anos, respectivamente) e os residentes em áreas urbanas (OR = 1,54) saíram mais para realizar atividades essenciais, independentemente da idade e de outros fatores relevantes. Os resultados mostram baixa adesão ao distanciamento social, mas altas prevalências nos usos de máscaras e higienização das mãos.

El objetivo del estudio fue examinar la prevalencia del distanciamiento social, uso de mascarillas e higienización de las manos al salir de casa entre adultos brasileños con 50 años o más de edad. Se utilizaron datos de 6.149 entrevistas telefónicas, realizadas entre el 26 de mayo y el 8 junio de 2020 entre los participantes del Estudio Brasileño Longitudinal del Envejecimiento (ELSI-Brasil por sus siglas en portugués). El distanciamiento social fue definido por no haber salido de casa en los últimos 7 días. Solamente un 32,8% de los participantes del estudio no salieron de casa en el período considerado, 36,3% salieron entre 1 y 2 veces, 15,2% entre 3 a 5 veces y 15,7% salieron todos los días. Las principales razones para salir de casa fueron comprar medicamentos o alimentos (74,2%), trabajar (25,1%), pagar cuentas (24,5%), atención en salud (10,5%), hacer ejercicios (6,2%) y encontrar con familiares o amigos (8,8%). Entre los que salieron de casa, un 97,3% usaron siempre mascarillas faciales y un 97,3% higienizaron siempre las manos. Las mujeres salieron menos de casa que los hombres. Estos salieron con más frecuencia para trabajar y para hacer ejercicio. Ellas salieron más para la atención en salud. Los hombres (odds ratio - OR = 1,84), los con escolaridad más alta (OR = 1,48 y 1,95 para 5-8 y 9 años) y los residentes en áreas urbanas (OR = 1,54) salieron más para realizar actividades esenciales, independientemente de la edad y de otros factores relevantes. Los resultados muestran una baja adhesión al distanciamiento social, pero altas prevalencias en el uso de mascarillas e higienización de las manos.

Life expectancy with negative physical oral health impact on quality of life in older adults.

Oral impairments can affect overall health and life expectancy in older adults. Our study evaluates the life expectancy with negative physical oral health impact on quality of life (POHIQoL) among older adults. Life expectancy with negative POHIQoL was estimated by the Sullivan method, using the prevalence of POHIQoL - obtained in the Health, Well-being and Ageing (SABE Study); and official mortality data for adults aged 60 years or older living in São Paulo, Brazil. Between 2000 and 2010, negative POHIQoL increased from 23.4% (95%CI: 20.2-26.9) to 30.4% (95%CI: 27.0-34.3) among older adults; total life expectancy increased from 22 and 17.5 to 23.7 and 19.4 years among 60-year-old women and men, respectively; and the proportion of remaining years to be lived with negative POHIQoL increased from 25.1% to 32.1% for the same age group. In both years, individuals aged 60 years with lower education level were expected to live more years with negative POHIQoL when compared with the most schooled ones (2000: 15.9 [95%CI: 15.0-16.8] vs. 14.3 [95%CI: 13.7-14.8]; 2010: 16.3 [95%CI: 15.1-17.4] vs. 14.1 [95%CI: 13.2-15.1]). Similarly, women were expected to live more years with negative POHIQoL than men. Within ten years, life expectancy with negative POHIQoL increased, as well as the existence of inequalities in sex and education level among Brazilian older adults. Expansion in coverage and focus on equity in dental care are still necessary to overcome persistent dental-related problems and inequalities and, therefore, contribute to healthy ageing.