Healthcare utilisation among low-income individuals affected by violence in Rio de Janeiro, Brazil: a retrospective cohort study.

BACKGROUND

Violence is associated with adverse health outcomes and affects healthcare utilisation, but there is limited robust evidence on this relationship in the context of violence in urban environments. This study examines subsequent patterns of healthcare utilisation by individuals who accessed healthcare as a result of experiencing violence in Rio de Janeiro, Brazil.

METHODS

A retrospective cohort analysis was conducted on 529,219 low-income individuals from January 2010 to December 2016. Electronic medical records were screened for ICD-10 and primary care codes, and clinical free text identifying individuals who used healthcare due to violence. Control individuals (who did not use healthcare due to violence) were identified via coarsened exact matching. Logistic panel regression assessed the association between healthcare use due to violence and subsequent healthcare utilisation.

RESULTS

2,038 individuals used healthcare due to violence. This group were 11% more likely (OR:1.11;95%CI:1.00-1.24;p < 0.05) to use PHC in the subsequent 1-3 months after initial healthcare use compared to those not using healthcare due to violence. They were 79% less likely (OR:0.21;95%CI:0.05-0.93;p < 0.05) to be Hospitalised at 7-12 months. Female users were 4.25 times (OR:4.25;95%CI:2.14-8.44;p < 0.001) and 2.57 times (OR:2.57;95%CI:1.20-5.53;p < 0.05) more likely to use PHC for poor pregnancy outcomes in the first 1-3 months and 7-12 months, respectively. PHC use for mental health increased by 50% (OR:1.50;95%CI:1.27-1.77;p < 0.005) in the subsequent 1-3 months after initial healthcare use.

CONCLUSIONS

Violence was associated with short-term increases in healthcare utilisation among low-income individuals in Rio de Janeiro, Brazil.