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Self-Reported Prevalence of Disability in Brazil, According to the National

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Self-Reported Prevalence of Disability in Brazil, According to the National DOI: 10.1590/1413-812320152110.17512016 3253 Self-reported prevalence of disability in Brazil, ARTICLE according to the National Health Survey, 2013 Deborah Carvalho Malta 1 Sheila Rizzato Stopa 2 Rogerio Canuto 3 Nayara Lopes Gomes 4 Vera Lúcia Ferreira Mendes 5 Bárbara Niegia Garcia de Goulart 6 Lenildo de Moura 7 Abstract Objective: To describe the self-reported prevalence of intellectual disability, physical, he- aring and visual, according to sociodemographic variables, degree of limitation and frequency of rehabilitation service use. Methods: Data from 1 Escola de Enfermagem, the National Health Survey, a population survey. Universidade Federal de the self-reported prevalence of physical, mental, Minas Gerais. Av. Alfredo visual and hearing were calculated and their 95% Balena 190, Santa Efigênia. 30130-100 Belo Horizonte confidence intervals, stratified by sex, age, race MG Brasil. / color, for Brazil, place of residence and Major [email protected] Regions. Results: The prevalence of self-reported 2 Departamento de Epidemiologia. Faculdade disability in the country was 6.2% (12.4 million de Saúde Pública, people). The prevalence of disability was 1.3% Universidade de São Paulo. higher in men, in people aged 60 or more in the São Paulo SP Brasil. 3 Hospital Sara Kubischeck. Northeast. Visual impairment was more preva- Brasília DF Brasil. lent (3.6%), increased with age, as well as hearing 4 Instituto Brasileiro de loss. Acquired deficiency was higher in relation to Geografia e Estatística. Rio de Janeiro RJ Brasil. the birth (except intellectual). Lesser degree of li- 5 Coordenação Geral de mitation was observed among those who reported Saúde da Pessoa com visual impairment and the use of health services Deficiência, Departamento de Ações Programáticas was less frequent. Conclusion: It is necessary to e Estratégicas em Saúde, expand access to health promotion, early diag- Secretaria de Atenção à nosis and treatment, as well as strengthen public Saúde, Ministério da Saúde. Brasília DF Brasil. policies aimed at this population. 6 Programa de Pós- Key words Disabled persons, Self report, Health Graduação em surveys, Health inequalities Epidemiologia, Universidade Federal do Rio Grande do Sul. Porto Alegre RS Brasil. 7 Organização Pan- Americana de Saúde. Brasília DF Brasil. 3254 et al. Malta DC Malta Introduction in social life. The concept of incapability, on the other hand, is defined as the result of interacting One billion people is estimated to have some dysfunctions presented by the individual, limita- kind of impairment or disability, which accounts tion of their activities and restricted social par- for approximately 15% of the worldwide popu- ticipation, in addition to environmental factors5. lation1. According to WHO, at least 10% of the Disability is seen as a consequence resulting children worldwide are born with or acquire from individual’s health conditions and diseas- some type of physical, mental or sensory disabili- es; context of physical and social environments; ty that leads to negative influences on their devel- different cultural perceptions and attitudes re- opment. Additionally, the access to rehabilitation garding disabilities; and availability of services is very unequal; in developing countries, only 3% and specific laws. Thus, ICF is not characterized of the people in need of assistance are provided only as a tool to measure the functional status some kind of rehabilitation service2. of impaired people; it also allows assessing life Brazilian laws define disability as the loss or conditions and helping to access social inclusion abnormality of a psychological, physiological or policies6. anatomical structure or function that renders the Studies have demonstrated that some pop- execution of an activity impossible within what ulation groups seem to be more susceptible to would be considered normal for human beings3. disabilities. Aspects such as age group, sex, edu- The Continued Payment Benefit Law establish- cation and income seem to be more associated to es that a person with disability is someone who a given type and level of disability6,7. presents long-term (at least two years) disabili- Prevalence studies, surveys and national in- ties of physical, mental, intellectual or sensory quiries about disability are complex due to sever- nature4. al measurement challenges on which comparable The concept of disability is evolving, as well data are based8,9. We reiterate the complexity of as the understanding of the role performed by the phenomenon – both regarding theoretical healthcare professionals and services, aiming and conceptual discussion around the term, such to creating a wider foundation for social inclu- as the use of different expressions, typologies, sion5. However, Ancient Greece handed down terminologies10. to Western civilization its views on disabilities: The Brazilian National Health Survey (NHS) back then, disabilities were considered an event includes self-referred disabilities (intellectual, that would make survival/living difficult, because physical, hearing and visual) as the subject, aim- the person would not have the necessary energy ing at supporting the public policies planning10. and strength to deal with agriculture or to fight The objective of this document is to describe a war5. the self-referred prevalence of intellectual, phys- Such interpretation remained through other ical, hearing and visual disabilities in Brazil, ac- historical contexts – always linked to social exclu- cording to social/demographical variables, level sion. After the end of World War II, the scenario of limitation and frequency of use rehabilitation began to change, as Europe was in need of men services. for its labor market. The veterans of war, even when mutilated in the battles, had distinguished social and cultural qualities, marking the begin- Methods ning of labor rights laws in that continent5. From that point on, after several efforts were made by The National Health Survey (NHS) is a na- social movements, legal advancements have been tion-wide survey carried out by Ministry of obtained in several countries in terms of rights Health along with Brazilian Institute of Geog- and protection3-5. raphy and Statistics (IBGE) and whose data was The most currently and internationally ac- collected from each household between August cepted concept, drawn from International Clas- 2013 and February 2014. NHS is part of IBGE’s sification of Functioning (ICF), is based on Integrated Household Survey (IHS) and uses a environmental factors and each individual’s master sample from that system, which allows potentials, without being restricted exclusively better geographical dissemination and improved to incapabilities and limitations of people with precision in estimates. disabilities6. Such classification establishes that The NHS sample was comprised of clusters functioning is based on components of functions in three selection stages. In the first stage, prima- and body structures, activities and participation ry sampling units (PSUs), comprised of census 3255 Ciência & Saúde Coletiva, 21(10):3253-3264, 2016 21(10):3253-3264, Coletiva, & Saúde Ciência regions, were selected. During the second stage, a disability or was the disability acquired? (1 Born fixed number (10-14) of private households was with disability 2. Acquired. How old were the selected in each PSU. For the third stage, an indi- person when that happened?). vidual who is 18 years old or older was selected c) G17. Overall, to what extent does the hear- from each sampled household. For all stages of ing disability limit the daily life activities? (1. It the NHS sample, a simple random sample was does not limit; 2. A little; 3. Moderately; 4. Se- used as selection method11. verely; 5. Very severely). Regarding the sample, out of the 81,254 High limitation was considered those with homes selected, 69,994 were habited. 64,348 in- severe/very severe level of limitation. terviews were carried out, with loss rate of 20.8% d) G18. Any rehabilitation service is used due and response rate of 91.9%. The sample was estab- to hearing disability? (1. Yes 2. No). lished by considering the level of precision wanted Mental disability is considered intellectual for the estimations of some indicators of interest, functioning significantly lower to the average, allowing for estimation of some parameters in dif- expressed before 18 years of age and limitations ferent geographic levels of disaggregation11. associated to two or more adaptive abilities, such The data was collected using handheld com- as: communication; personal care; social abilities; puters (Personal Digital Assistant, PDA), pro- use of community resources; health and safety; grammed to assess the input values. The NHS academic abilities; leisure; and work. questionnaire is divided into three parts: in- The method to calculate intellectual disabili- formation about the household; information ty was similar to what was previously described, about all the individuals living in it, provided by as well as with physical disability. a proxy; information about a select individual Visual disability or blindness were based on (adult who is 18 years old or older)11. the legal definition in which visual acuity is the Thus, valid information was collected from same or below 0.05 (best eye) with the best op- 205,000 dwellers. During data analysis, expan- tical correction; poor vision, which means visual sion factors or sample weights were used for acuity between 0.3 and 0.05 (best eye) with the PSUs, households, all the residents in a given best optical correction; the cases in which the home and select resident11. sum of the visual field measurement in both eyes The classification of disability was per the is equal to or below 60o; or the simultaneous oc- Brazilian laws; according to those laws, hearing currence of any of the previous conditions. In this disability is defined as bilateral, partial or total case, visual disability was considered for anyone hearing loss, of forty one decibels (dB) or higher, who answered Yes to the following question: G21 established by audiogram in the frequencies of ... Is any hearing disability present? (1. Yes; 2. No); 500Hz, 1,000Hz, 2,000Hz and 3,000Hz.
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