Socioeconomic and regional inequalities of pap smear coverage

Manica, Silvia Troyahn; Drachler, Maria de Lourdes; Teixeira, Luciana Barcellos; Ferla, Alcindo Antônio; Gouveia, Helga Geremias; Anschau, Fernando; Oliveira, Dora Lúcia Leidens Correa de

doi:10.1590/1983-1447.2016.01.52287

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Original Article • Rev. Gaúcha Enferm. (Online) 37 (1) • 2016 • https://doi.org/10.1590/1983-1447.2016.01.52287 linkcopy

Socioeconomic and regional inequalities of pap smear coverage

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives To identify socioeconomic and regional inequalities of pap smear coverage in the state of Rio Grande do Sul.

Methods An ecological study based on data of the 2011-2012 national health information system to estimate the annual coverage of pap smears for the overall female population of the state and for women without private health insurance. We estimated annual pap smear coverage according to the Municipal Social Vulnerability Index and health macro-regions and regions of the state.

Results The percentage of women without private health insurance ranged from 38.1% to 94.2% in the health regions. Pap smear coverage was 17.3% for the overall female population and 23.8% for women without private health insurance. Pap smear coverage was higher in more socially vulnerable municipalities and regions with a higher percentage of women with private health insurance.

Conclusions The prevalence of private health insurance should be considered in studies that address the coverage of the Brazilian Unified Health System (SUS).

Health inequalities; Cervix neoplasms prevention; State healthcare coverage

	Resident women between 25 and 64		PS coverage of the SUS
Municipal variables	Total residents	Without private health insurance	Coverage of total resident women	Coverage of women without private health insurance
Municipal variables	N	%	%	%
IVS-5*
< -0.50	4620799	66.7	15.3	23.0
-0.50 to 0.00	587756	90.8	22.1	24.3
0.01 to 1.00	517415	93.6	25.8	27.6
> 1.00	193984	97.1	25.9	26.6

Macro-region

Serra	612186	48.3	15.2	31.5
Metropolitan	2611137	64.2	14.8	23.0
Vales	487314	82.5	21.2	25.7
South	558790	85.1	14.4	16.9
North	632332	85.9	23.5	27.4
Missioneira	483921	87.0	23.0	26.5
Centre-West	534274	88.5	18.3	20.7
Total State	5919954	72.4	17.3	23.8

	Resident women between 25 and 64		PS coverage of the SUS
Health regions	Total residents	Without private health insurance	Coverage of total resident women	Coverage of women without private health insurance
	N	%	%	%
Campos de Cima da Serra	49342	85.3	11.0	12.9
Pampa	97023	92.1	15.0	16.3
South Region	461767	83.6	14.2	17.0
Vale do Caí and Metropolitan	398612	62.1	11.3	18.1
Vale do Paranhana and Costa Serra	113845	85.6	15.8	18.4
Verdes Campos	229170	82.7	15.9	19.3
Western Border	240786	92.5	19.4	21.0
Carbonífera/Costa Doce	203154	83.1	18.6	22.4
Vale da Luz	64865	81.2	18.5	22.7
Portal das Missões	82728	90.6	20.9	23.1
Botucaraí Region	59744	93.4	22.0	23.5
Capital and Vale do Gravataí	1287522	55.7	13.2	23.7
Entre-Rios	66036	94.2	22.9	24.3
Jacuí Centre	106401	92.7	22.6	24.3
Vinte e Oito Region	181302	81.2	19.8	24.4
Bons Ventos	110475	92.2	22.5	24.4
Vale dos Sinos	424604	65.3	16.8	25.7
Sete Povos das Missões	152430	90.5	23.3	25.8
Rota da Produção	89257	89.6	23.4	26.1
Caminho das Águas	140733	92.4	24.7	26.8
Araucárias Region	69078	92.2	24.7	26.8
Diversidade Region	121800	81.2	22.4	27.6
Planalto Region	165607	75.0	21.0	28,0
Northeastern Border	125245	85.8	24.6	28.7
Belas Praias	75107	92.3	27.1	29.3
Vinhedos and Basalto	160867	58.2	17.1	29.3
Alto Uruguai Gaúcho	125036	84.4	25.0	29.6
Valleys and Mountains	115441	73.9	24.2	32.8
Uva and Vale	95568	45.2	16.3	36.1
Caxias and Hortênsias	306409	38.1	14.6	38.3
Total State	5919954	72.4	17.3	23.8

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[TFN1001] Source: DATASUS, IBGE, ANS, SES/RS.

[TFN2001] *IVS-5 - municipal social vulnerability index measured in standard deviation of the state average, where <-0.50 indicates lower social vulnerability and >1.00 indicates higher social vulnerability.