Custos de procedimentos de saúde e associação com nível de atividade física e estado nutricional de idosos hipertensos e diabéticos: análise do Estudo SABE - Saúde, Bem-estar e Envelhecimento, 2010
Background- The insufficient physical activity level (PAL) as well the inadequate nutritional status (NS) increases the risk of hypertension and the development of diabetes, and difficult the control of theses diaseases. Thus, we can infer that the costs spent by the public health system to the management of hypertension and diabetes in the population would shows an inverse relationship with physical activity level, including engagement in walking, and nutritional status. However,
... ever, epidemiological studies describing these costs and analyzing these associations among elderly population are non-existent in Brazil, which makes difficult the implementation of public policies for the economy of resource. Aim -To describe the health care costs among hypertensive and diabetic elderly people and to analyze the associations with PAL and NS according to sex and age groups. Methods -The sample consisted of elderly people with self-reported hypertension and/or diabetes (≥ 60 years-old) living in São Paulo-SP, participants of the three cohorts SABE Study (Health, Wellbeing and Aging), in 2010. The dependent variable (total annual cost -in Reais, R$) was estimated based on self-reported use of medication, use of outpatient services and hospital admissions, retroactive to one year of data collection. The explanatory variables: i) PAL was estimated from interview using the International Physical Activity Questionnaire (IPAQ, short version), classifying the elderly accorind to the time performing in moderate physical activity (≥ 150 minutes / week) and insufficiently active (< 150 minutes / week). ii) Engagement in walking, categorized according to the weekly frequency: a) ≥ 4 days / week; b) 1 to 3 days / week; c) does not walk. a) BMI < 28 kg/m 2 ; b) BMI ≥ 28 kg / m² (overweight); the control variables were sex and age groups: a) ≥ 70 years; b) 65-69 years; c) 60 to 64 years. The description of the costs according to the PAL and NS was represented by mean values and 95%, median and P25 -P75, minimum and maximum values. Multiple logistic regression models were emplyed to analyze associations. The level of significance was set at 5% and all analyzes were performed considering complex samples, using the Stata software, 10.0. Results -The average of total annual cost was R$ 732.54 and the sum of costs on 12 months was R$ 609,587.20, always higher for elderly with excess weight, insufficient PAL and the elderly who do not engage in walking. The group of elderly with excess weight showed a 50% chance of 11 being in the highest annual total cost group (OR 1:49, 95% 1:01 to 2:18) and 70% higher for the costs with medicine use (OR 1.71,). The absence of walking had higher chance for highest costs with medication (OR 1.63, 95% CI 1:06 to 2:51) and total costs (OR 1.82, 95% CI 1.17 -2.81). All analyzes adjusted for sex and age. The PAL was not associated to the total costs and cost with medication. Conclusion-The costs related to the control of hypertension and diabetes in the elderly are high and were inversely associated to the engagement in walking and nutritional status, especially in relation to the costs with the use of antihypertensive and hypoglycemic medication.