Impacto de marcadores inflamatórios e nível da prática de atividade física nos custos com o tratamento ambulatorial de pacientes da atenção básica
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Data
2017-08-21
Autores
Rocha, Ana Paula Rodrigues [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
As doenças crônicas geram impacto substancial nos custos públicos de saúde. A prática de exercício físico tem potencial de redução de concentrações circulantes de diversos biomarcadores inflamatórios, entretanto, não foram encontrados informações sobre o impacto de marcadores inflamatórios nos custos com saúde. Objetivo: Verificar se existe associação entre as concentrações de citocinas pró-inflamatórias e custo com saúde. Metodologia: Estudo transversal, conduzido em Presidente Prudente – SP. A amostra foi composta por homens e mulheres com idade maior que 50 anos, atendidos por Unidades Básicas de Saúde. Os participantes foram submetidos a avaliações que incluem as seguintes variáveis: i) pratica de atividade física habitual, ii) marcadores de inflamação, iii) perfil glicêmico e lipídico, iv) custos com o tratamento ambulatorial, v) excesso de peso e obesidade, vi) pressão arterial, vii) histórico de doença pessoal e familiar, viii) hábito de tabagismo e consumo alcoólico. A estatística descritiva foi composta por valores de média, desvio padrão, mediana, intervalo interquartil. O teste de Mann Whitney estabeleceu comparações entre os grupos formados, e as comparações significativas foram reanalisadas pela análise de covariância (ANCOVA). A significância estatística foi pré-fixada em valores inferiores a 5%, o software utilizado foi o BioEstat. Resultados: Nas comparações entre obesos e não obesos, foi possível identificar significância com valores superiores em obesos de concentrações de insulina (p-valor=0,039), do índice HOMA-IR (p-valor=0,016) e de leptina (p-valor=0,001), mesmo após ajuste. Da mesma forma, esses grupos apresentaram diferença estatisticamente significativa, nos custos com consulta médica (p=0,004), medicamentos (p-valor=0,038), custo total (p-valor=0,026) e custo total adicional (p-valor=0,024), sendo que custo de medicamentos (p-valor=0,007), custo total (p-valor=0,014) e custo total adicional (p-valor =0,017) foram mantidos após ajuste. Nas comparações entre ativos e inativos, foi possível identificar significância estatística com valores superiores para concentrações de glicose (p-valor=0,009) para os inativos e valores superiores para concentrações de TG (p-valor=0,031) para os ativos, no domínio exercício; somente TG (p-valor=0,040) se manteve significativo após o ajuste. Nos custos com saúde, foi possível identificar valores significativamente inferiores, para os participantes considerados ativos no domínio ocupacional, para custos com medicamentos (p=0,001), custo total (p=0,004) e custo total adicional (p-valor=0,008). Na correlação entre marcadores metabólicos e inflamatórios e custos de saúde, pode-se observar relação positiva e significante, ajustado por IMC e AFH, entre concentrações de glicose e custos de exames (r=0,343; p-valor=0,007) e custo total (r=261; p-valor=0,043); índice HOMA-IR e custo de exames (r=0,267; p-valor=0,038); IL-10 e custo com consulta médica (r=0,297; p-valor=0,020). Ajustado por %GC e AFH, custo de exame e concentrações de glicose (r=0,338; p-valor=0,008) e HOMA-IR (r=0,262; pvalor=0,042); custo total e glicose (r=0,295; p-valor=0,021); custo de consulta médica e IL-10 (r=0,297; p-valor=0,020). Conclusão: Com essa pesquisa foi possível concluir que marcadores metabólicos e inflamatórios estão relacionados com custos de consultas e exames, independentemente de IMC, %GC e AFH. Além disso, a obesidade esteve associada à concentração de insulina, HOMA-IR e leptina, bem como concentração de glicose foi menor em praticantes de atividade física.
Chronic diseases have a substantial impact on public health costs. The practice of physical exercise with the potential to reduce circulating concentrations of several inflammatory biomarkers, however, did not find information on the impact of inflammatory markers on health costs. Cross-sectional study, conducted in Presidente Prudente - SP. The sample consisted of men and women over 50 years old, attended by Basic Health Units. The sample consisted of men and women aged over 50, attended by basic health units of Presidente Prudente. Participants underwent evaluations that included the following variables: i) habitual physical activity, ii) markers of inflammation, iii) glycemic and lipid profile, iv) costs of outpatient treatment, v) excess weight, vi) blood pressure, vii) history of personal and family illness, viii) smoking habit and. Statistical analysis: The descriptive statistics were composed of mean values, standard deviation, median, interquartile range. The Mann Whitney test established comparisons between the groups formed, and significant comparisons were reanalysed by covariance analysis (ANCOVA). Statistical significance was set at values lower than 5%, the software used was BioEstat. Results: In the comparisons between obese and non-obese subjects, it was possible to identify higher values in obese subjects with insulin (p-value = 0.039), HOMA-IR (p-value = 0.016) and leptin (p-value = 0.001 ), even after adjustment. In the same way, these groups presented a statistically significant difference in the costs of medical consultation (p = 0.004), medication (p-value = 0.038), total cost (p-value = 0.026) and additional total cost ), with drug costs (p-value = 0.007), total cost (p-value = 0.014) and additional total cost (p-value = 0.017) were maintained after adjustment. In the comparisons between active and inactive, it was possible to identify statistical significance with higher values for glucose concentrations (p-value = 0.009) for the inactive and higher values for TG concentrations (p-value = 0.031) ; only TG (p-value = 0.040) remained significant after adjustment. In the health costs, it was possible to identify significantly lower values for the participants considered active in the occupational domain, for costs with medicines (p = 0.001), total cost (p = 0.004) and additional total cost (p-value = 0.008). In the correlation between metabolic and inflammatory markers and health costs, we can observe a positive and significant relationship, adjusted for BMI and AFH, between glucose concentrations and exam costs (r = 0.343, p-value = 0.007) and total cost r = 261; p-value = 0.043); HOMA-IR index and cost of exams (r = 0.267; p-value = 0.038); IL-10 and cost with medical consultation (r = 0.297; p-value = 0.020). Adjusted for% GC and AFH, examination cost and glucose concentrations (r = 0.338, p-value = 0.008) and HOMAIR (r = 0.262; p-value = 0.042); total cost and glucose (r = 0.295; p-value = 0.021); cost of medical consultation and IL-10 (r = 0.297; p-value = 0.020). Conclusion: This research it was possible to conclude that metabolic and inflammatory markers are related to the costs of consultations and examinations, independently of BMI,% GC and AFH. In addition, obesity was associated with insulin concentration, HOMA-IR and leptin, as well as glucose concentration was lower in physical activity practitioners.
Chronic diseases have a substantial impact on public health costs. The practice of physical exercise with the potential to reduce circulating concentrations of several inflammatory biomarkers, however, did not find information on the impact of inflammatory markers on health costs. Cross-sectional study, conducted in Presidente Prudente - SP. The sample consisted of men and women over 50 years old, attended by Basic Health Units. The sample consisted of men and women aged over 50, attended by basic health units of Presidente Prudente. Participants underwent evaluations that included the following variables: i) habitual physical activity, ii) markers of inflammation, iii) glycemic and lipid profile, iv) costs of outpatient treatment, v) excess weight, vi) blood pressure, vii) history of personal and family illness, viii) smoking habit and. Statistical analysis: The descriptive statistics were composed of mean values, standard deviation, median, interquartile range. The Mann Whitney test established comparisons between the groups formed, and significant comparisons were reanalysed by covariance analysis (ANCOVA). Statistical significance was set at values lower than 5%, the software used was BioEstat. Results: In the comparisons between obese and non-obese subjects, it was possible to identify higher values in obese subjects with insulin (p-value = 0.039), HOMA-IR (p-value = 0.016) and leptin (p-value = 0.001 ), even after adjustment. In the same way, these groups presented a statistically significant difference in the costs of medical consultation (p = 0.004), medication (p-value = 0.038), total cost (p-value = 0.026) and additional total cost ), with drug costs (p-value = 0.007), total cost (p-value = 0.014) and additional total cost (p-value = 0.017) were maintained after adjustment. In the comparisons between active and inactive, it was possible to identify statistical significance with higher values for glucose concentrations (p-value = 0.009) for the inactive and higher values for TG concentrations (p-value = 0.031) ; only TG (p-value = 0.040) remained significant after adjustment. In the health costs, it was possible to identify significantly lower values for the participants considered active in the occupational domain, for costs with medicines (p = 0.001), total cost (p = 0.004) and additional total cost (p-value = 0.008). In the correlation between metabolic and inflammatory markers and health costs, we can observe a positive and significant relationship, adjusted for BMI and AFH, between glucose concentrations and exam costs (r = 0.343, p-value = 0.007) and total cost r = 261; p-value = 0.043); HOMA-IR index and cost of exams (r = 0.267; p-value = 0.038); IL-10 and cost with medical consultation (r = 0.297; p-value = 0.020). Adjusted for% GC and AFH, examination cost and glucose concentrations (r = 0.338, p-value = 0.008) and HOMAIR (r = 0.262; p-value = 0.042); total cost and glucose (r = 0.295; p-value = 0.021); cost of medical consultation and IL-10 (r = 0.297; p-value = 0.020). Conclusion: This research it was possible to conclude that metabolic and inflammatory markers are related to the costs of consultations and examinations, independently of BMI,% GC and AFH. In addition, obesity was associated with insulin concentration, HOMA-IR and leptin, as well as glucose concentration was lower in physical activity practitioners.
Descrição
Palavras-chave
Marcador inflamatório, Atividade física, Obesidade, Custos com saúde, Inflammatory marker, Physical activity, Obesity, Healthcare cost