Socioeconomic Inequalities in the Use of Health Services among Older Brazilian Adults according to Frailty: Evidence from the Fibra Study

Abstract

Physical frailty has been described as a complex geriatric syndrome. Independent of frailty, older people have been showing an increased health care services utilization. The objective is to assess an interaction effect between frailty and education on the association with the use of health services in community-dwelling older Brazilians. This is a cross-sectional study. The study was conducted with community-dwelling older Brazilian individuals. The sample had 5,473 older adults derived from the FIBRA Study. The definition of frailty was made using the physical frailty phenotype. The level of education was assessed by complete years of schooling. The use of health services was assessed by the occurrence of hospitalization, for individuals receiving home visits and having attended four or more medical consults in the past 12 months. The robust Poisson regression model with a robust error variance was used to estimate the prevalence ratio (PR) and its 95% confidence intervals to set the association between frailty and use of health services, considering the interaction between frailty and education in final model. Considering all sample, 16.4% were hospitalized, 14.1% received home visits, and 48.2% attended four or more medical consults. The interaction term between frailty and education was statistically significant only for hospitalization, showing a higher prevalence of health services utilization among pre-frail (PR1.68 95% CI 1.15–2.47) and frail (PR1.77 95% CI 1.08–2.90) older individuals with low education compared to non-frail highly educated peers. Low-educated and frail older people were more likely to be hospitalized and should be carefully looked after by health professionals.