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Intraurban Differences in the Use of Ambulatory Health Services in a Large Brazilian City

Journal of Urban Health volume 87, pages 994–1006 (2010)Cite this article

Abstract

A major goal of health systems is to reduce inequities in access to services, that is, to ensure that health care is provided based on health needs rather than social or economic factors. This study aims to identify the determinants of health services utilization among adults in a large Brazilian city and intraurban disparities in health care use. We combine household survey data with census-derived classification of social vulnerability of each household’s census tract. The dependent variable was utilization of physician services in the prior 12 months, and the independent variables included predisposing factors, health needs, enabling factors, and context. Prevalence ratios and 95% confidence intervals were estimated by the Hurdle regression model, which combined Poisson regression analysis of factors associated with any doctor visits (dichotomous variable) and zero-truncated negative binomial regression for the analysis of factors associated with the number of visits among those who had at least one. Results indicate that the use of health services was greater among women and increased with age, and was determined primarily by health needs and whether the individual had a regular doctor, even among those living in areas of the city with the worst socio-environmental indicators. The experience of Belo Horizonte may have implications for other world cities, particularly in the development and use of a comprehensive index to identify populations at risk and in order to guide expansion of primary health care services as a means of enhancing equity in health.

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Acknowledgements

This study was partially funded by the Departamento de Atenção Básica, Ministério da Saúde, Brasil (Department of Primary Care of the Secretariat for Healthcare of the Ministry of Health, Brazil). The authors thank Maria Cristina of Mattos Almeida for her inestimable help in the risk stratification of the residential areas where study participants live.

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Affiliations

  1. Graduate Program in Public Health, Federal University-Minas Gerais, Belo Horizonte, MG, Brazil

    Maria Aparecida Turci, Maria Fernanda Lima-Costa, Fernando Augusto Proietti & Cibele C. Cesar

  2. Aging and Public Health Study Group, Oswaldo Cruz Foundation and Federal University-Minas Gerais, Belo Horizonte, MG, Brazil

    Maria Fernanda Lima-Costa & Cibele C. Cesar

  3. Department of Statistics, Federal University-Minas Gerais, Belo Horizonte, MG, Brazil

    Cibele C. Cesar

  4. Department of Nutrition, Food Studies & Public Health, New York University, New York, NY, USA

    James Macinko

  5. Instituto René Rachou da Fundação Oswaldo Cruz Laboratório of Epidemiologia e Antropologia Médica, Avenida Augusto de Lima 1715, Belo Horizonte, MG 30190-002, Brazil

    Maria Aparecida Turci & Maria Fernanda Lima-Costa

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  1. Maria Aparecida Turci
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  2. Maria Fernanda Lima-Costa
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  3. Fernando Augusto Proietti
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  4. Cibele C. Cesar
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  5. James Macinko
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Correspondence to Maria Aparecida Turci.

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All of the authors participated equally in the study design, data analysis, and preparation and critical review of the manuscript.

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Turci, M.A., Lima-Costa, M.F., Proietti, F.A. et al. Intraurban Differences in the Use of Ambulatory Health Services in a Large Brazilian City. J Urban Health 87, 994–1006 (2010). https://doi.org/10.1007/s11524-010-9499-4

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  • DOI: https://doi.org/10.1007/s11524-010-9499-4

Keywords

  • Health services
  • Health care utilization
  • Brazil
  • Health equity