Lifestyle and Cardiometabolic Risk Factors Associated with Impoverishment Due to Out-of-Pocket Health Expenditure in São Paulo City, Brazil

Lucas Akio Iza Trindade, Jaqueline Lopes Pereira, Jean Michel Rocha Sampaio Leite, Marcelo Macedo Rogero, Regina Mara Fisberg and Flavia Mori Sarti ()
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Lucas Akio Iza Trindade: School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
Jaqueline Lopes Pereira: School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
Jean Michel Rocha Sampaio Leite: School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
Marcelo Macedo Rogero: School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
Regina Mara Fisberg: School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
Flavia Mori Sarti: School of Arts, Sciences and Humanities, University of São Paulo, São Paulo 03828-000, Brazil

IJERPH, 2024, vol. 21, issue 9, 1-18

Abstract: The rise in obesity and related chronic noncommunicable diseases (NCDs) during recent decades in Brazil has been associated with increases in the financial burden and risk of impoverishment due to out-of-pocket (OOP) health expenditure. Thus, this study investigated trends and predictors associated with impoverishment due to health expenditure, in the population of São Paulo city, Brazil, between 2003 and 2015. Household data from the São Paulo Health Survey (n = 5475) were used to estimate impoverishment linked to OOP health expenses, using the three thresholds of International Poverty Lines (IPLs) defined by the World Bank at 1.90, 3.20, and 5.50 dollars per capita per day purchasing power parity (PPP) in 2011. The results indicated a high incidence of impoverishment due to OOP disbursements for health care throughout the period, predominantly concentrated among low-income individuals. Lifestyle choices referring to leisure-time physical activity (OR = 0.766 at $3.20 IPL, and OR = 0.789 at $5.50 IPL) were linked to reduction in the risk for impoverishment due to OOP health expenditures whilst there were increases in the probability of impoverishment due to cardiometabolic risk factors referring to obesity (OR = 1.588 at $3.20 IPL, and OR = 1.633 at $5.50 IPL), and diagnosis of cardiovascular diseases (OR = 2.268 at $1.90 IPL, OR = 1.967 at $3.20 IPL, and OR = 1.936 at $5.50 IPL). Diagnosis of type 2 diabetes mellitus was associated with an increase in the probability of impoverishment at only the $1.90 IPL (OR = 2.506), whilst coefficients for high blood pressure presented lack of significance in the models. Health policies should focus on interventions for prevention of obesity to ensure the financial protection of the population in São Paulo city, Brazil, especially targeting modifiable lifestyle choices like promotion of physical activity and reduction of tobacco use.

Keywords: impoverishment; out-of-pocket expenditure; financial protection; obesity; cardiometabolic risk; physical activity (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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