Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data.
Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data.
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DOI：
10.1136/bmj.g4014
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发表时间：
2014-07-03
期刊：
影响因子：
--
通讯作者：
Barreto ML
中科院分区：
文献类型：
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作者：
Rasella D;Harhay MO;Pamponet ML;Aquino R;Barreto ML
目标 评估巴西最近实施的家庭健康计划 (FHP)（世界上最大的初级卫生保健计划）对 2000 年至 2009 年巴西全国心脑血管疾病死亡率的影响。设计生态纵向设计，使用具有固定效应规范的面板数据的负二项式回归模型评估 FHP 的影响。对 2000 年至 2009 年期间巴西城市的全国数据进行分析。数据来源 1622 个巴西城市，拥有足够质量的生命统计数据。主要结果指标 以年度 FHP 覆盖率和前几年的平均 FHP 覆盖率作为主要自变量，分为无（0%）、初期（<30%）、中间（30-69%）或巩固（≥70%）。每年计算每个城市的年龄标准化死亡率，包括脑血管疾病（ICD-10 代码 I60-69）、缺血性疾病（ICD-10 I20-25）和其他形式的心脏病（ICD-10 I30-52），这些疾病均包含在国家门诊护理敏感疾病清单中。研究期间，他们占这些群体所有死亡人数的 40%。结果 在人口、社会和经济混杂因素的未调整和调整模型中，FHP 覆盖率与脑血管和心脏病（门诊护理敏感疾病）的死亡率呈负相关。作为对照，FHP 对事故死亡率没有影响。合并年度 FHP 覆盖对脑血管疾病死亡率和心脏病死亡率的影响率比分别为 0.82（95% 置信区间 0.79 至 0.86）和 0.79（0.75 至 0.80），当覆盖范围在之前所有期间合并时达到 0.69（0.66 至 0.73）和 0.64（0.59 至 0.68）。八年。此外，家庭健康计划的覆盖增加了健康教育活动、上门拜访和医疗咨询的次数，降低了脑血管和心脏病的住院率。几项补充分析显示出定量相似的结果。结论 以社区为基础的综合初级卫生保健计划，例如巴西的 FHP，通过心血管疾病的预防、护理和随访，有助于降低巴西等发展中国家的心血管疾病发病率和死亡率。
Objectives To evaluate the impact of Brazil’s recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil from 2000 to 2009. Design Ecological longitudinal design, evaluating the impact of FHP using negative binomial regression models for panel data with fixed effects specifications. Setting Nationwide analysis of data from Brazilian municipalities covering the period from 2000 to 2009. Data sources 1622 Brazilian municipalities with vital statistics of adequate quality. Main outcome measures The annual FHP coverage and the average FHP coverage in previous years were used as main independent variables and classified as none (0%), incipient (<30%), intermediate (30-69%), or consolidated (≥70%). Age standardised mortality rates from causes in the group of cerebrovascular (ICD-10 codes I60-69), ischaemic (ICD-10 I20-25), and other forms of heart diseases (ICD-10 I30-52), which were included in the national list of ambulatory care-sensitive conditions, were calculated for each municipality for each year. They accounted for 40% of all deaths from these groups during the study period. Results FHP coverage was negatively associated with mortality rates from cerebrovascular and heart diseases (ambulatory care-sensitive conditions) in both unadjusted and adjusted models for demographic, social, and economic confounders. The FHP had no effect on the mortality rate for accidents, used as a control. The rate ratio for the effect of consolidated annual FHP coverage on cerebrovascular disease mortality and on heart disease mortality was 0.82 (95% confidence interval 0.79 to 0.86) and 0.79 (0.75 to 0.80) respectively, reaching the value of 0.69 (0.66 to 0.73) and 0.64 (0.59 to 0.68) when the coverage was consolidated during all the previous eight years. Moreover, FHP coverage increased the number of health education activities, domiciliary visits, and medical consultations and reduced hospitalisation rates for cerebrovascular and heart disease. Several complementary analyses showed quantitatively similar results. Conclusions Comprehensive and community based primary health care programmes, such as the FHP in Brazil, acting through cardiovascular disease prevention, care, and follow-up can contribute to decreased cardiovascular disease morbidity and mortality in a developing country such as Brazil.