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Objectives: The Brazilian Family Health Strategy (FHS) is strongly associated with better health system performance, but there are no nationally-representative data examining individual-level primary care experiences in the country. Here, we examine reports of primary care experiences among adults with different forms of healthcare coverage (FHS, "traditional" public health posts, and private health plans). Methods: Data are from the 2019 National Health Survey that included a shortened version of the Primary Care Assessment Tool (PCAT). PCAT questions were administered to a subsample of randomly-selected adults who had a doctor visit within the past 6 months and sought care in a primary care setting (9677 respondents). We used linear regression to examine the association between type of healthcare coverage and PCAT scores adjusted for sex, age, socioeconomic status, health status, geographic region and state of residence. Results: Primary care experiences in the sample of Brazilians who had a doctor visit 6 months prior to the survey averaged a modest PCAT score of 57 out of 100. Regression models show that users of the FHS had superior primary care experiences, but with large variations across Brazilian regions and states. Individuals selected to respond to the PCAT questions were more likely to be female, older, and poorer, and to be in worse health than the general population. Conclusions: Brazil's FHS is associated with modest, but higher-reported primary care experiences than both traditional public health posts and those who have a private health plan. Future iterations of the PCAT module could enhance generalizability by including individuals who had a doctor visit in the past 12 (instead of 6) months. [ABSTRACT FROM AUTHOR]

Background: This study examined the variation in city-level amenable mortality, i.e. mortality due to conditions that can be mitigated in the presence of timely and effective healthcare, in 363 Latin American cities and measured associations between amenable-mortality rates and urban metrics.Methods: We used death records from 363 cities with populations of >100 000 people in nine Latin American countries from 2010 to 2016. We calculated sex-specific age-adjusted amenable-mortality rates per 100 000. We fitted multilevel linear models with cities nested within countries and estimated associations between amenable mortality and urban metrics, including population size and growth, fragmentation of urban development and socio-economic status.Results: Cities in Mexico, Colombia and Brazil had the highest rates of amenable mortality. Overall, >70% of the variability in amenable mortality was due to between-country heterogeneity. But for preventable amenable mortality, those for which the healthcare system can prevent new cases, most of the variability in rates occurred between cities within countries. Population size and fragmentation of urban development were associated with amenable mortality. Higher fragmentation of urban development was associated with lower amenable mortality in small cities and higher amenable mortality in large cities. Population growth and higher city-level socio-economic status were associated with lower amenable mortality.Conclusions: Most of the variability in amenable mortality in Latin American cities was due to between-county heterogeneity. However, urban metrics such as population size and growth, fragmentation of urban development and city-level socio-economic status may have a role in the distribution of amenable mortality across cities within countries. [ABSTRACT FROM AUTHOR]

This study assesses changes in the prevalence and distribution of noncommunicable diseases (NCDs) and related risk factors among Brazilian adults from the 2013 and 2019 Brazilian National Health Surveys (PNS). It is based on the hypothesis that deteriorating socioeconomic conditions over this period would lead to increased NCDs among the least advantaged populations. We estimated adjusted prevalence ratios by education category and three inequality measures - the slope index of inequality (SII), the relative index of inequality (RII), and population attributable fraction (PAF) - for obesity, hypertension, arthritis, asthma, cancer, depression, diabetes, heart disease, having any chronic condition, and multimorbidity by survey year. We also estimated the 27 Brazilian Federative Units RII and prevalence rates for diabetes and multimorbidity per year and plotted the RII against prevalence by year. Results showed that all NCDs increased over the period observed, ranging from an 8% increase in the adjusted prevalence of arthritis to a 24% increase in the adjusted prevalence of obesity. Measures of inequality showed that most conditions exhibited significant educational inequities in both 2013 and 2019. However, on average, education-based inequities did not significantly change between the two periods. Considering the deterioration of the socioeconomic conditions of most Brazilians, the erosion of social protections, and the continuing economic, political, and health crises occurring in the nation, we observed an urgent need for discussion about the best way to adopt equity-promoting health policies and programs and action to reduce socioeconomic and geographic inequalities in NCDs throughout the country.