Inequalities in the management of back pain care in Brazil - National Health Survey, 2019

Abstract The aim was to assess the presence of socioeconomic inequalities in the management of back pain among Brazilians. Cross-sectional study with data from the National Health Survey (2019). The management of back pain care was assessed using five outcomes: regular exercise; physiotherapy; use of medications or injections; integrative and complementary practice; regular follow-up with a health professional. The magnitude of inequalities of each outcome in relation to exposures (education and income) was estimated using two indices: slope index of inequality (SII) and concentration index (CIX). Of the 90,846 interviewees, 19,206 individuals (21.1%) reported some chronic back problem. The most prevalent outcomes were use of medications and injections (45.3%), physical exercise (26.3%) and regular follow-up with a health professional (24.7%). The existence of inequalities in the management of back pain in the Brazilian population was evident. The adjusted analysis showed that the richest and most educated performed two to three times more physical exercise, physiotherapy, integrative and complementary practices (ICPS) and regular follow-up with a health professional than the poorest and least educated. Absolute (SII) and relative (CIX) inequalities were significant for all outcomes.

摘要 本研究旨在评估巴西人群腰痛管理中的社会经济不平等状况。本研究为横断面研究，采用2019年全国健康调查（National Health Survey, 2019）数据。研究通过5项结局指标评估腰痛护理管理情况：规律运动、物理治疗、药物或注射治疗、整合与补充疗法（integrative and complementary practice, 下文简称ICPs）、定期随访卫生专业人员。采用斜率指数（slope index of inequality, SII）与集中指数（concentration index, CIX）两种指标，估算各项结局与暴露因素（受教育程度与收入）间的不平等程度。在90846名受访对象中，共19206人（占比21.1%）报告存在慢性腰痛相关问题。最常见的结局指标为药物与注射治疗（45.3%）、规律运动（26.3%）以及定期随访卫生专业人员（24.7%）。研究结果显示，巴西人群腰痛管理存在显著的社会经济不平等现象。校正后分析显示，相较于最贫困、受教育程度最低的人群，最富裕、受教育程度最高人群的规律运动、物理治疗、整合与补充疗法以及定期随访卫生专业人员的参与比例为前者的2至3倍。各项结局指标的绝对不平等（SII）与相对不平等（CIX）均具有统计学显著性。