Family health strategy, private health care, and inequalities in access to mammography in Brazil

Abstract

Objective. To evaluate the association between access to mammography and coverage by the Family Health Strategy (FHS) and supplementary (private) health insurance. Method. An ecological study was performed with data obtained from the Unified Health System Data Processing Department (DATASUS). Time trends were analyzed using the Prais-Winsten method, using the Brazilian federal units (states) as units of analysis. Multiple linear regression was used to investigate the relationship between the dependent variable - women aged 50 to 69 years who had never had a mammogram - and the independent variables (coverage by the FHS or supplementary health insurance and socioeconomic aspects). Results. Acre was the only Brazilian state for which a growth trend in supplementary health coverage was not observed. Roraima, Tocantins, Maranhão, Piauí, Rio Grande do Norte, and Paraíba showed a stable trend for FHS coverage; all other federal states showed an increase in coverage. A significant association was observed between never having had a mammogram at 50 to 69 years of age and two variables: mean per capita income and FHS and supplementary health coverage (R2=0.77; P < 0.001). Conclusion. Unequal access to mammography is a reality in Brazil. Both supplementary private health care and the FHS have helped to improve health care accessibility for Brazilian women.