Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil

• Published in: American journal of public health (1971) 2021-05, Vol.111 (5), p.927-936
• Main Authors: Kessler, Marciane, Thumé, Elaine, Marmot, Michael, Macinko, James, Facchini, Luiz Augusto, Nedel, Fúlvio Borges, Wachs, Louriele Soares, Volz, Pâmela Moraes, de Oliveira, Cesar
• Format: Article
• Language: English
• Subjects: Adults; Age Factors; Aged; Aging; Brazil - epidemiology; Cohort analysis; Community Health; Community health care; Comorbidity; Confidence intervals; Epidemiology; Fairness; Family Health; Family roles; Female; Health care; Health disparities; Health education; Health Policy; Health promotion; Health services; Health Services Accessibility - statistics & numerical data; Health Status; Health Status Disparities; Home health care; Households; Humans; Longitudinal studies; Male; Middle Aged; Mortality; Mortality - trends; Multidisciplinary teams; National Health Programs - organization & administration; National Health Programs - statistics & numerical data; Older people; Patient Acceptance of Health Care; Population; Population studies; Poverty - statistics & numerical data; Primary care; Primary Health Care - statistics & numerical data; Public health; Public Health Practice; Research & Analysis; Social inequality; Socioeconomic Factors; Statistical analysis; Wealth
• ISSN: 0090-0036; 1541-0048; 1541-0048
• DOI: 10.2105/AJPH.2020.306146

To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85). FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity.