Tese
Programa de Transferência Condicionada de Renda e indicadores de doenças crônicas não transmissíveis: uma análise das mulheres adultas beneficiárias do Programa Bolsa Família
Fecha
2021-08-10Registro en:
orcid.org/0000-0003-3808-6041
Autor
Quéren Hapuque de Carvalho
Institución
Resumen
Introduction: studies show that populations with worse socioeconomic conditions are more
susceptible to the development of chronic non-communicable diseases (CNCDs). Another set
of evidence points out that social protection policies aimed at improving socioeconomic
conditions have positive impacts on health. In the Brazilian context, the Bolsa Família Program
(PBF) is the largest Conditional Cash Transfer Program in terms of population coverage in the
world, with the granting of this benefit preferably given to women, conforming to the concept
of positive discrimination. However, there is an important gap with regard to possible health
inequities, that is, whether women beneficiaries of the BFP are more susceptible to CNCDs and
their risk factors. Objective: estimate the magnitude of chronic non-communicable diseases
(NCDs), their risk factors and their evolution in the population of Brazilian women, according
to the receipt of the Bolsa Família Program (BFP) benefit. Methods: this thesis consists of three
articles. (Article 1): this is an integrative literature review on the occurrence of CNCD and its
risk factors in the beneficiary population of the Bolsa Família Program (BFP), which was
searched in national and international databases, with a time cut from 2004 to 2020. (Article
2): cross-sectional study and time series using data from the Surveillance System for Risk and
Protection Factors for Chronic Diseases by Telephone Survey, from 26 Brazilian states and the
Federal District in the period from 2016 to 2019. The crude and adjusted prevalences and
prevalence ratios of the indicators for CNCDs were estimated with the respective confidence
intervals using the Poisson regression model. In the analysis of the temporal trend of the period
in question, the simple linear regression model was used, with the outcome variable being the
CNCD indicators and the explanatory variable the year of the survey. (Article 3): descriptive
cross-sectional study carried out with data from the National Health Survey to assess the
prevalence of NCD indicators, including laboratory tests, in the population of Brazilian women
of reproductive age according to receiving the BF. Indicators were compared among women of
reproductive age (18 to 49 years) who said they had or not Bolsa Família, and the prevalence
and confidence interval were calculated using Pearson's χ2. Results: (Article 1): 23 articles are
part of the analysis corpus of this review. There was a predominance of cross-sectional studies
(86.95%), with the majority carried out in the state of Minas Gerais (21.74%) and Brazil
(21.74%), 78.26% of the publications were in national journals and 2020 was the year with the
most publications (17.39%). The analyzes performed allowed the construction of three
categories by thematic similarity: 1. Prevalence of risk factors for CNCDs in women
beneficiaries of the BFP; 2. Nutritional status and food insecurity in children, adolescents and
families benefiting from the PBF; 3. Food consumption of PBF beneficiaries. (Article 2): this
article showed that PBF beneficiaries had higher prevalences of tobacco use, overweight and
obesity, lower consumption of fruits and vegetables, less physical activity during leisure time,
lower coverage of preventive exams for cancer (Pap and mammography), in addition to
evaluating their health status worse. Among the beneficiaries, the trend analysis showed an
increase in the prevalence of overweight from 55.9% to 62.6% and screen time without TV
(tablet, cell phone and/or computer use) from 13.5% to 27 .8%. (Article 3): it was observed in
this article that women of reproductive age who are beneficiaries of the BF have worse health
indicators when compared to non-beneficiaries, such as a higher occurrence of overweight
(33.5%) and obesity (26.9%) (p<0.001), hypertension 13.4% versus 4.4% (p<0.001), tobacco
use (11.2%) versus 8.2% (p = 0.029), in addition to 6.2% realizing their health worse, compared
to 2.4% of non-beneficiary women (p<0.001). Conclusion: data analysis showed that CNCD
risk factors were higher among Bolsa Família beneficiaries, however, this is not a causal
relationship, with BF being a marker of socioeconomic inequality. Furthermore, the results
shown here confirm that the resources allocated to the PBF have been directed to the population
with the greatest need for health, thus seeking to reduce inequities, and reinforce the importance
of the continuity and permanence of affirmative policies for this vulnerable population.