Gastos com saúde de pacientes atendidos pelo Sistema Único de Saúde, segundo obesidade e atividade física habitual: coorte de oito anos
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Data
2020-11-16
Autores
Morais, Luana Carolina De
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Universidade Estadual Paulista (Unesp)
Resumo
O Sistema Único de Saúde (SUS) apresenta elevados gastos em saúde nos tratamentos relacionados às doenças crônicas não transmissíveis e aos efeitos deletérios da inatividade física, fator que se agrava ainda mais com a epidemia de obesidade. Desse modo, o objetivo deste trabalho foi analisar os gastos de pacientes atendidos pela atenção primária, segundo a presença de obesidade e atividade física habitual. Para isto, foram avaliados pacientes com idade igual ou acima de 50 anos, atendidos em Unidades Básicas de Saúde do município de Bauru (SP). A tese é decorrente de uma coorte em andamento com 8 anos de acompanhamento. Foram coletadas informações sobre a presença de obesidade, calculada pelo índice de massa corporal (IMC); a condição econômica foi registrada por meio do questionário da Associação Brasileira de Empresas de Pesquisa; o nível de atividade física habitual foi obtido com o questionário de Baecke; o diagnóstico de doenças foi observado por questionário e os dados referentes aos gastos em saúde de cada paciente foram computados pela análise de seus prontuários. Para a análise estatística, foram utilizados os testes de Mann-Whitney, qui-quadrado, correlação Spearman, regressão linear, teste T independente, ANOVA para medidas repetidas e General Structural Equation Model (GSEM), com modelagem latent growth analysis, foram adotados como nível de significância p<0,05 e o software usado foi o Stata 16.0. Como resultados principais, destacam-se, no sexo feminino, a quantidade de vezes que as pacientes foram diagnosticadas com obesidade ao longo de 8 anos, associada inversamente com a idade (p=0,001) e a atividade física habitual (p=0,008) e positivamente com gastos em saúde (p=0,041). Quando comparados os cinco momentos (2010, 2012, 2014, 2016 e 2018) para a avaliação da trajetória das variáveis analisadas, houve diferença estatística ao longo do tempo para IMC (p=0,003), atividade física habitual (p=0,001) e gastos em saúde (p=0,001). E, por fim, a variável IMC na linha de base (2010) afetou a trajetória dos gastos em saúde no decorrer dos oito anos (R$ 8,02 (R$ 1,05; R$ 14,99) p=0,024). Assim, pode se concluir que os principais determinantes que influenciaram a obesidade foram idade, atividade física habitual e gastos em saúde. Também no seguimento dos oito anos, o aumento dos gastos em saúde mostrou ser influenciado pelo IMC, avaliado na linha de base, de pacientes atendidos no SUS do município de Bauru (SP).
The Unified Health System (UHS) has high health expenditures on treatments related to chronic non-communicable diseases and deleterious effects of physical inactivity, a factor that worsens even more with the obesity epidemic. Thus, the objective of this paper was to analyze the expenses of patients treated by primary care, according to the presence of obesity and habitual physical activity. For this, patients aged 50 years or over, treated at Basic Health Units in the city of Bauru, SP, were evaluated. The thesis is the result of an ongoing cohort with 8 years of follow-up. Information on the presence of obesity was collected, calculated by the Body Mass Index (BMI), the economic condition was recorded through the questionnaire of the Brazilian Association of Research Companies, the level of habitual physical activity was obtained through the questionnaire of Baecke, the diagnosis of diseases was observed through a questionnaire and the data referring to the health expenditure of each patient were computed through the analysis of their medical records. Mann-Whitney tests, chi-square, Spearman correlation, linear regression, independent T test, ANOVA for repeated measures and General Structural Equation Model (GSEM) were used for statistical analysis, with latent growth analysis modeling, adopted as the level of significance p <0.05 and the software used was Stata 16.0. As main results, the number of times that women were diagnosed with obesity over 8 years stands out, in women, inversely associated with age (p= 0.001) and habitual physical activity (p = 0.008) and positively health spending (p= 0.041). When comparing the five moments (2010, 2012, 2014, 2016 and 2018) to assess the trajectory of the analyzed variables, there was a statistical difference over time for BMI (p= 0.003), habitual physical activity (p= 0.001) and spending on health (p= 0.001). Finally, the BMI variable in the baseline (2010) affected the trajectory of health expenditures over the eight years (R$ 8.02 (R$ 1.05; R$ 14.99) p= 0.024). Thus, it can be concluded that the main determinants that influenced obesity were age, habitual physical activity and health expenses. Also, over the eight-year follow-up, the increase in health expenditures was shown to be influenced by the BMI, assessed at the baseline, of patients treated at SUS in the city of Bauru, SP.
The Unified Health System (UHS) has high health expenditures on treatments related to chronic non-communicable diseases and deleterious effects of physical inactivity, a factor that worsens even more with the obesity epidemic. Thus, the objective of this paper was to analyze the expenses of patients treated by primary care, according to the presence of obesity and habitual physical activity. For this, patients aged 50 years or over, treated at Basic Health Units in the city of Bauru, SP, were evaluated. The thesis is the result of an ongoing cohort with 8 years of follow-up. Information on the presence of obesity was collected, calculated by the Body Mass Index (BMI), the economic condition was recorded through the questionnaire of the Brazilian Association of Research Companies, the level of habitual physical activity was obtained through the questionnaire of Baecke, the diagnosis of diseases was observed through a questionnaire and the data referring to the health expenditure of each patient were computed through the analysis of their medical records. Mann-Whitney tests, chi-square, Spearman correlation, linear regression, independent T test, ANOVA for repeated measures and General Structural Equation Model (GSEM) were used for statistical analysis, with latent growth analysis modeling, adopted as the level of significance p <0.05 and the software used was Stata 16.0. As main results, the number of times that women were diagnosed with obesity over 8 years stands out, in women, inversely associated with age (p= 0.001) and habitual physical activity (p = 0.008) and positively health spending (p= 0.041). When comparing the five moments (2010, 2012, 2014, 2016 and 2018) to assess the trajectory of the analyzed variables, there was a statistical difference over time for BMI (p= 0.003), habitual physical activity (p= 0.001) and spending on health (p= 0.001). Finally, the BMI variable in the baseline (2010) affected the trajectory of health expenditures over the eight years (R$ 8.02 (R$ 1.05; R$ 14.99) p= 0.024). Thus, it can be concluded that the main determinants that influenced obesity were age, habitual physical activity and health expenses. Also, over the eight-year follow-up, the increase in health expenditures was shown to be influenced by the BMI, assessed at the baseline, of patients treated at SUS in the city of Bauru, SP.
Descrição
Palavras-chave
Gastos em saúde, Atividade física, Obesidade, Healthcare expenditures, Physical activity, Obesity