Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil.
Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil.
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DOI：
10.1136/bmjopen-2021-049251
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发表时间：
2022-01-11
期刊：
影响因子：
2.9
通讯作者：
Rasella D
中科院分区：
文献类型：
--
作者：
Basu S;Hone T;Villela D;Saraceni V;Trajman A;Durovni B;Millett C;Rasella D
随着中等收入国家努力实现可持续发展目标，扩大初级保健覆盖面能在多大程度上帮助实现这些目标并减少国内死亡率的不平等，目前尚不清楚。我们的目标是评估初级保健扩大对巴西15个最大城市特定原因死亡率的潜在影响。微观仿真模型。巴西人口规模最大的15个城市。模拟种群。我们进行了生存分析，以从国家行政数据库中估计按死因和人口群体划分的死亡比，该数据库与里约热内卢120万 居民(2010年至2016年)的家庭健康战略(FHS)电子健康和死亡记录相关联。我们将人力资源纳入一个微观模拟，以评估巴西人口规模最大的15个城市初级保健覆盖率变化的影响。按原因划分的粗略和年龄标准化死亡率、婴儿死亡率和5岁以下儿童死亡率。扩大医疗保险覆盖面有望减少城市之间的死亡率不平等(最高死亡率城市和最低死亡率城市之间的死亡率从2.8‰降至2.4‰，考虑到覆盖率增加了40个 百分点)，福利接受者与不领取福利者之间的不平等(从1.3‰降至1.0‰)，以及种族/族裔群体之间的不平等(巴西黑人和白人之间的死亡率从1.0‰降至0.8‰)。然而，即使将覆盖率提高40个 百分点，也不足以单独实现可持续发展目标，因为预计将把非传染性疾病的过早死亡率降低20%(与33%的目标相比)，将传染病的过早死亡率降低15%(与100%相比)。FHS初级保健覆盖范围可能对减少国内卫生不平等至关重要，但实现可持续发展目标可能需要初级保健和其他部门之间的协调。
As middle-income countries strive to achieve the Sustainable Development Goals (SDGs), it remains unclear to what degree expanding primary care coverage can help achieve those goals and reduce within-country inequalities in mortality. Our objective was to estimate the potential impact of primary care expansion on cause-specific mortality in the 15 largest Brazilian cities. Microsimulation model. 15 largest cities by population size in Brazil. Simulated populations. We performed survival analysis to estimate HRs of death by cause and by demographic group, from a national administrative database linked to the Estratégia de Saúde da Família (Family Health Strategy, FHS) electronic health and death records among 1.2 million residents of Rio de Janeiro (2010–2016). We incorporated the HRs into a microsimulation to estimate the impact of changing primary care coverage in the 15 largest cities by population size in Brazil. Crude and age-standardised mortality by cause, infant mortality and under-5 mortality. Increased FHS coverage would be expected to reduce inequalities in mortality among cities (from 2.8 to 2.4 deaths per 1000 between the highest-mortality and lowest-mortality city, given a 40 percentage point increase in coverage), between welfare recipients and non-recipients (from 1.3 to 1.0 deaths per 1,000), and among race/ethnic groups (between Black and White Brazilians from 1.0 to 0.8 deaths per 1,000). Even a 40 percentage point increase in coverage, however, would be insufficient to reach SDG targets alone, as it would be expected to reduce premature mortality from non-communicable diseases by 20% (vs the target of 33%), and communicable diseases by 15% (vs 100%). FHS primary care coverage may be critically beneficial to reducing within-country health inequalities, but reaching SDG targets will likely require coordination between primary care and other sectors.
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影响因子：
2.8
作者：
Hone, Thomas;Powell-Jackson, Timothy;Millett, Christopher
通讯作者：
Millett, Christopher
影响因子：
15.8
作者：
Hone T;Saraceni V;Medina Coeli C;Trajman A;Rasella D;Millett C;Durovni B
通讯作者：
Durovni B
DOI：
10.26633/rpsp.2020.31
发表时间：
2020-01-01
影响因子：
2.6
作者：
Francesconi, Gabriel Vivas;Tasca, Renato;Rasella, Davide
通讯作者：
Rasella, Davide
影响因子：
5.4
作者：
Shi, LY;Macinko, J;Xu, JH
通讯作者：
Xu, JH
DOI：
10.1136/bmj.g4014
发表时间：
2014-07-03
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Rasella D;Harhay MO;Pamponet ML;Aquino R;Barreto ML
通讯作者：
Barreto ML