Associação entre discriminação percebida em serviços de saúde e doenças cardiovasculares autorreferidas em indivíduos brasileiros

Abstract

Introduction: Cardiovascular diseases (CVDs) have a major impact on Brazilian and global public health as they contribute to the significant increase in the number of premature deaths. They have multiple risk factors, such as sociodemographic lifestyle and comorbidities. Recent evidence shows an independent association between the experience of discrimination and CVD. Objective: To estimate the association between perceived discrimination in health services and history of self-reported cardiovascular diseases in Brazilian individuals. Methodology: Cross-sectional study, with data from the 2013 National Health Survey and a nationally representative sample of 59.226 adult individuals (age ≥ 18 years). The perceived discrimination in the health services was evaluated in: discrimination for lack of money; social class; type of disease; sexual preference; race/color; sex; type of occupation; age and others. CVD was considered as: report of infarction, angina, heart failure or other. Multivariate logistic regression models were used to assess the association between the types of perceived discrimination (main exposures) and history of some CVD (outcome), adjusted for sociodemographic variables (gender, age, race/color, and education) and depression. Results: The frequency of CVD was 4,23% and 10,59% of individuals reported having experienced at least one type of discrimination in health services. It was evidenced that the discrimination perceived in all dimensions analyzed almost doubled the chances of CVD compared to individuals who did not report discrimination. The associations remained significant after adjustments for all variables and types of discrimination analyzed, being: Lack of money (OR:1,82; CI95%: 1,38-2,40); Social class (OR:2,16; CI95%: 1,66-2,80); Race/color (OR:2,32; CI95%: 1,30-4,12); Occupation (OR:1,81; CI95%: 1,08-3,04); Disease (OR:2,33; CI95%: 1,48-3,67); Sexual preference (OR:3,65; CI95%: 1,80-7,39); Religion (OR:2,95; CI95%: 1,26-6,90); Sex (OR:3,07; CI95%: 1,13-8,37); Age (OR: 1,60; CI95%: 1,06-2,41); Others (OR:1,88; CI95%: 1,20-2,95). Conclusion: The perceived discrimination in health services was positively associated with a history of self-reported CVD, regardless of sociodemographic factors and depression.