Perceived discrimination in health services and associated factors in Manaus Metropolitan Region, Brazil: a cross-sectional population-based study.

Objectives: Discrimination is the differentiated treatment of individuals due to prejudgments. Discriminatory practices in health care result in negative effects on patients' health. In Brazil, skin color represents the main form of racial discrimination, which may have an impact on the accessibility and quality of health care. The Brazilian Amazon lacks investigations on this topic at the population level. This study aims to estimate the prevalence of perceived discrimination in health services and associated factors in the Manaus Metropolitan Region, state of Amazonas, Brazil.Design: A population-based cross-sectional study was conducted with a probabilistic sample of adults interviewed in 2015. The associated factors were investigated by calculating the prevalence ratio (PR) using Poisson regression with robust variance.Results: A total of 4,001 participants were included. The overall prevalence of perceived discrimination was 12.9% (95% confidence interval [CI]: 11.8-13.9%). When compared to the reference categories, women (PR = 1.43; 95%CI: 1.20-1.70), individuals with brown skin color (Brazilian mixed race; PR = 1.33; 95%CI: 1.04-1.71), people who suffer from hypertension (PR = 1.27;95%CI: 1.03-1.57), and people who frequently used health services (p≤0.03) experienced more discrimination from health professionals.Conclusions: The prevalence of perceived discrimination in health services in Manaus Metropolitan Region is frequent and is associated with ethnic, social and health-related factors. Investments in inclusive public health policies and a better quality of health assistance are required to tackle this problem.

Prevalence of Self-Reported Chronic Diseases and Health Services Utilization by Ethnic Minorities in Manaus Metropolitan Region.

Objectives: To assess the prevalence of, and associated factors to, self-reported chronic diseases and health care utilization by ethnicity in the Manaus Metropolitan Region. Methods: We conducted a cross-sectional, population-based survey from May through August 2015. Using probabilistic sampling in three stages, we recruited adults aged ≥18 years. Ethnicity was self-identified as White, Black, Yellow, Brown (Brazilian mixed-race), and Indigenous. We calculated adjusted prevalence ratios (PR) and 95% CI of chronic diseases and health service utilization for each ethnic minority and compared the data using Poisson regression with data from White respondents. Results: In this study, we interviewed 4,001 people. Of these, 15.9% were White, 7.5% Black, 3.4% Yellow, 72.1% Brown, and 1.0% Indigenous. Indigenous respondents had the highest prevalence of self-reported hypertension (29.4%), diabetes (12.3%) and hypercholesterolemia (17.0%) among the ethnic respondent groups. Compared with the White population, Browns had less health insurance coverage (PR=.76; 95% CI: .62-.93) and reported hypertension (PR=.84; 95% CI: .72-0.98) and diabetes (PR=.69; 95% CI: .51-.94) less frequently. Yellows visited the doctor more frequently than Whites (PR=1.13; 95% CI: 1.04-1.22), with no significant difference in prevalence of diseases. Conclusions: Indigenous respondents had higher prevalence rates of the investigated diseases. Compared with Whites, Brown respondents had lower rates of self-reported arterial hypertension and diabetes, as well as lower rates of private health insurance coverage.