Impacto da inatividade física e obesidade abdominal sobre custos com saúde entre hipertensos atendidos na Atenção Primária do SUS
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Data
2018-07-06
Autores
Bortolatto, Carolina Rodrigues [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Hipertensão arterial (HA) é importante problema de saúde pública devido à sua cronicidade e aos altos custos com assistência a saúde. O aumento da prevalência de HA é atribuído principalmente à inatividade física e à obesidade. Dessa forma, o objetivo do presente artigo foi analisar o efeito isolado e combinado da inatividade física (IF) e obesidade abdominal (AO) sobre os custos com saúde em hipertensos na atenção primária ao longo de 24 meses de seguimento. Os custos com saúde foram avaliados através de prontuários médicos. HA, IF e OA foram verificados por meio de avaliações. Estatística descritiva foi expressa por valores de média, desvio padrão e intervalo de confiança de 95%, foi utilizada análise da covariância, com teste post hoc de Bonferroni, o tamanho do efeito foi expresso pelo eta-square (ES-r). O nível de significância foi definido em p-valor <0,05. No baseline, a amostra foi composta por 354 pacientes, com idade acima de 50 anos. Após 24 meses, a amostra acompanhada consistiu em 167 pacientes, composta por 51 homens e 116 mulheres, com média de idade de 61,6 anos, 63,5% (n=106) dos pacientes eram hipertensos e apresentaram custo total mediano de R$ 70,30. Quando comparada com o grupo perda amostral houve diferença significativa apenas no valor de pressão arterial sistólica com p = 0.023 e condição econômica p = 0.003. Identificou-se incidência e prevalência de HA, respectivamente, de 1,8% e 65,3% ao longo de 24 meses. Modificações no nível de inatividade física e obesidade abdominal não apresentaram variância significativa nos resultados. Quanto ao efeito combinado do nível de IF e OA sobre os custos em hipertensos, o grupo obeso e inativo apresentou custos estatisticamente maiores (pvalor=0,018) quando comparado ao grupo ativo com peso normal e ao grupo obeso e inativo. Resultados levam a acreditar que apenas o efeito combinado da IF e AO aumentam os custos com saúde em pacientes hipertensos e independente do efeito isolado ou combinado da OA e IF sobre a hipertensão, ocorre à influência de outros fatores (condição econômica, sexo, idade e comorbidades), verificada na ausência de diferença significativa após os ajustes.
Arterial hypertension (AH) is an important public health problem because of its chronicity and the high costs to health. The increase in the prevalence of AH is attributed mainly to physical inactivity (PI) and obesity. Thus, the objective of this study was to analyze the isolated and combined effect of PI and abdominal obesity (AO) on health costs among patients with AH in primary care during 24 months of follow-up. Health costs were assessed through medical records. AH, PI and AO were assessed through questionnaires and measurements. Descriptive statistics were expressed as mean, standard deviation, and 95% confidence intervals. Analysis of covariance with Bonferroni post hoc test were used and the size of the effect was expressed by eta-square (ES-r). The level of significance was set at p-value <0.05. At baseline the sample was composed of 354 patients (age > 50 years) and, after 24 months of follow-up, the sample consisted of 167 patients (51 men and 116 women, mean age of 61.6 years). 63.5% (n = 106) of the patients had AH and presented total median cost of R$ 70.30. When compared to the dropout sample, there were significant differences for systolic blood pressure (p = 0.023) and economic condition (p = 0.003). Incidence and prevalence of AH were respectively 1.8% and 65.3% at the end of follow-up period. Changes in PI and AO presented no significant variance in the results. Regarding the combined effect of PI and AO on costs, the group with PI and AO presented higher costs when compared to the AO or PI group and Active and no AO group (p = 0.018). These results suggest that only the combined effect of PI and AO increases health costs among patients with AH.
Arterial hypertension (AH) is an important public health problem because of its chronicity and the high costs to health. The increase in the prevalence of AH is attributed mainly to physical inactivity (PI) and obesity. Thus, the objective of this study was to analyze the isolated and combined effect of PI and abdominal obesity (AO) on health costs among patients with AH in primary care during 24 months of follow-up. Health costs were assessed through medical records. AH, PI and AO were assessed through questionnaires and measurements. Descriptive statistics were expressed as mean, standard deviation, and 95% confidence intervals. Analysis of covariance with Bonferroni post hoc test were used and the size of the effect was expressed by eta-square (ES-r). The level of significance was set at p-value <0.05. At baseline the sample was composed of 354 patients (age > 50 years) and, after 24 months of follow-up, the sample consisted of 167 patients (51 men and 116 women, mean age of 61.6 years). 63.5% (n = 106) of the patients had AH and presented total median cost of R$ 70.30. When compared to the dropout sample, there were significant differences for systolic blood pressure (p = 0.023) and economic condition (p = 0.003). Incidence and prevalence of AH were respectively 1.8% and 65.3% at the end of follow-up period. Changes in PI and AO presented no significant variance in the results. Regarding the combined effect of PI and AO on costs, the group with PI and AO presented higher costs when compared to the AO or PI group and Active and no AO group (p = 0.018). These results suggest that only the combined effect of PI and AO increases health costs among patients with AH.
Descrição
Palavras-chave
Custos com saúde, Sistema Único de Saúde, Economia da saúde, Health costs, Public health, Health economics