Fatores que predizem uma elevada utilização de serviços de saúde em um coorte de trabalhadores siderúrgicos

Abstract

OBJECTIVE: To investigate factors predisposing individual, context and occupational factors related to health need that predict increased use of health services in 12 months of follow up in a cohort of steel workers in Belo Horizonte, Brazil. METHODS: The cohort was composed of active male workers of a large steel manufacturing plant in Belo Horizonte. All workers were covered by private health insurance tied to employment contract and participated in a health survey conducted at the headquarters unit of the industry in 2006. Survey information was obtained through interview using a structured questionnaire containing socio-demographic, occupational, health behavioral factors, morbidity, previous use of health services and exposure to adverse psychosocial conditions at work, measured by the Job Stress Scale. Data on number of physician visits in the 12 months following the survey were obtained from the health plan. Information on duration of employment, date of resignation or death, date of exclusion from the health plan and type of wage contract during the study period were obtained from the company human resources records. The response variable was defined as the upper quintile of the distribution of the total number of medical visits (both, emergency and elective) during the 12 months of followup. Workers who performed 10 or more visits during the 12 months were compared to all the other employees with respect to all existing information using multiple logistic regression analysis. RESULTS: From 3121 elegible workers, 11.15% had no record of elective or emergency consultations during the monitoring period. The incidence of at least one visit in 12 months was 88.85%. The mean and median numbers of consultations in one year were 5.54 (SE= 5.37) and 4.00, respectively. The risk (OR/95%CI) of making 10 or more visits was higher among workers aged 50 years and above (2.14/1.27-3.61), former smokers (1.51/1.18-1.94), who reported back pain (1.58/1.22-2.05), tendinitis, tenosynovitis or work-related osteomuscular disorders (1.48/1.05-2.08), depression (2.30/1.59-3.34), and who were exposed to high strain at work (1.61/1.17-2.23). The risk of high use increased directly with the number of appointments made in the year preceding the survey (1-2 queries: 2.02/1.04-3.93; 3-4 queries: 3.89/1.98-7.65; 5 or more visits: 5.23/2.61-10.48) and the number of drugs used in 15 days immediately prior to the follow up (a drug: 1.53/1.20-1.95, and two or more14 medications: 2.56/1.90-3.46). Workers who earned more than 10 minimum wages had a lower risk of performing 10 or more medical visits (0.51/0.32-0.83). CONCLUSIONS: The median number of medical consultations in one year of follow-up was high and the cutoff to define major user is much higher than that found among most male active working populations. Most of the predictors of being a major user of consultations indicate increased health needs, as they are more common among older individuals and those who already have some health problem, such as former smokers and those who were already greater users of elective consultations and medicines. The greater risks for employees with musculoskeletal disorders or depression, potentially related to work, and for individuals working under high demand reinforce the role of psychosocial work conditions in health care needs. Family income above 10 minimum wages was a protective factor for greater use of health services, possibly reflecting better health and life quality of this group.