Autoavaliação do estado de saúde: associação com fatores sociodemográficos, hábitos de vida, morbidade e experiência de discriminação racial em inquérito populacional no Brasil

Abstract

Self-rated health (SRH) is a health indicator widely used in surveys and affected by many factors. There is increasing evidence showing that racial discrimination is an important risk factor for morbid events on health and its impact on health of the Brazilian population is still poorly understood. In the first paper, the main purpose is to investigate the association between SRH and social and demographic factors, health behaviors and morbidity. In the second paper, the main purpose is to estimate the association between racial discrimination and different health outcomes, such as: SRH, physical morbidity and depression, controlling for social and demographic variables, health behaviors and Body Mass Index, in the population of blacks and mullatoes. This study has a cross-sectional design and is based on data obtained from the national survey Research for Social Dimension of Inequalities. The interviewees answered to a structured questionnaire and had their anthropometric measures collected. In the first paper, 12,324 household chiefs and their spouses, aged 20 years or older, were evaluated. In the second paper, the study population was composed of 3,863 family chiefs who answered to the question about racial discrimination and who classified themselves as blacks or mullatoes. The measurement of SRH was based on the question obtained from the SF-36 quality-of-life questionnaire. For the first paper, SRH was treated as a dichotomous variable: Good (categories: Excellent, Very Good and Good) and Poor (Regular and Bad). For the second paper, the five original categories were considered. Analysis will be developed using univariate and multivariate logistic regression models for binary (paper 1) and ordinal data (paper 2). Results were presented in the form of Odds Ratios and respective 95% confidence intervals. Older age, illiteracy, smoking habits, obesity and chronic diseases were associated to higher chances of having poor SRH. As income increased, it was observed a reduction of 20% in the chance of having poor SRH. Physical activity was associated to a lower chance of having poor SRH. In the second paper, racial discrimination was associated to a higher chance of having: poor SRH, physical morbidity and depression. The present study identified the influence of several social and demographic factors, health behaviors, and physical morbidity in SRH. Individuals with poor SRH will compose the health services demand. It also showed that racial discrimination was negatively associated to the three evaluated health outcomes (SRH, physical morbidity and depression). These results may trace profiles of vulnerable population subgroups, that is, people with higher risks of becoming ill or of searching for health services because of an existent disease. This find may help in the definitions of target populations for the adequate establishment of health planning and programs