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Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults

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  • Thomas Hone
  • Valeria Saraceni
  • Claudia Medina Coeli
  • Anete Trajman
  • Davide Rasella
  • Christopher Millett
  • Betina Durovni

Abstract

Background: Expanding delivery of primary healthcare to urban poor populations is a priority in many low- and middle-income countries. This remains a key challenge in Brazil despite expansion of the country’s internationally recognized Family Health Strategy (FHS) over the past two decades. This study evaluates the impact of an ambitious program to rapidly expand FHS coverage in the city of Rio de Janeiro, Brazil, since 2008. Methods and findings: A cohort of 1,241,351 low-income adults (observed January 2010–December 2016; total person-years 6,498,607) with linked FHS utilization and mortality records was analyzed using flexible parametric survival models. Time-to-death from all-causes and selected causes were estimated for FHS users and nonusers. Models employed inverse probability treatment weighting and regression adjustment (IPTW-RA). Conclusions: FHS utilization in urban poor populations in Brazil was associated with a lower risk of death, with greater reductions among more deprived race/ethnic and socioeconomic groups. Increased investment in primary healthcare is likely to improve health and reduce health inequalities in urban poor populations globally. Thomas Hone and colleagues explore the Family Health Strategy for primary health care access in a low-income population.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Thomas Hone & Valeria Saraceni & Claudia Medina Coeli & Anete Trajman & Davide Rasella & Christopher Millett & Betina Durovni, 2020. "Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults," PLOS Medicine, Public Library of Science, vol. 17(10), pages 1-20, October.
    • Handle: RePEc:plo:pmed00:1003357
    DOI: 10.1371/journal.pmed.1003357
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    References listed on IDEAS

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    1. Thomas Hone & Davide Rasella & Mauricio L Barreto & Azeem Majeed & Christopher Millett, 2017. "Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis," PLOS Medicine, Public Library of Science, vol. 14(5), pages 1-19, May.
    2. Michele Gragnolati & Magnus Lindelow & Bernard Couttolenc, 2013. "Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde," World Bank Publications - Books, The World Bank Group, number 15801.
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    6. Edson Araujo & Luciana Cavalini & Sabado Girardi & Megan Ireland & Magnus Lindelow, 2014. "Contracting for Primary Health Care in Brazil: The Cases of Bahia and Rio de Janeiro," Health, Nutrition and Population (HNP) Discussion Paper Series 91322, The World Bank.
    7. Kruk, Margaret Elizabeth & Porignon, Denis & Rockers, Peter C. & Van Lerberghe, Wim, 2010. "The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives," Social Science & Medicine, Elsevier, vol. 70(6), pages 904-911, March.
    8. Mayara Lisboa Bastos & Dick Menzies & Thomas Hone & Kianoush Dehghani & Anete Trajman, 2017. "The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-14, August.
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    1. Ferreira-Batista, Natalia N. & Postali, Fernando Antonio Slaibe & Diaz, Maria Dolores Montoya & Teixeira, Adriano Dutra & Moreno-Serra, Rodrigo, 2022. "The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas," Economics & Human Biology, Elsevier, vol. 46(C).

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