Determinants of Treatment Seeking Behavior Following Injury in Maringá, Brazil

Background: Injury currently accounts for 6% of all disability adjusted life years (DALYS) lost. As the global incidence of injuries increases, so does the need for care. Current research on access to care and injury does not always account for injury severity or focus on the overall effects of injury. Our project focused on a medium-sized city in Brazil to determine what barriers to care after injury arise in Brazil’s universal health care system.

Methods: Households were randomly selected for survey in the 561 populated districts of the city of Maringa between May 2015 and September 2015. Demographic information was collected for the entire household; one individual from the household was then randomly selected to provide injury history. A chi-square analysis was used to determine the association between care seeking and demographics. A preliminary significance level of α = 0.20 was selected for inclusion of variables into the multivariate logistic regression. A full multivariate logistic regression model using injury as the primary exposure and seeking care as the outcome was run. Thirty reduced models were run; mean squared estimate (MSE) and Akaike Information Criterion (AIC) were calculated to find the best predictive model.

Results: 2678 households and individuals participated, 30.3% individuals reported an injury in their lifetime. The bivariate analysis found that gender (p = 0.034), cause of injury (p = 0.000), race (p = 0.051), severity (p = 0.103) and insurance status (p = 0.026) were potential predictors of seeking care. Education (p = 0.62), income (p = 0.343) and age (p = 0.838) were included in the multivariate model due to past significance in the literature. The reduced multivariate model that eliminated education level and race (MSE = 0.0274, AIC = 0.7689) was chosen as the best representative model and showed gender, age, socioeconomic status, and cause of injury as all strong predictors of care seeking.

Conclusions: Cause of injury is a major predictor for seeking care, as are factors related to socioeconomic status such as insurance and income. Injury cause potentially masked the effects of gender on care seeking. More research needs to be done on specific causes of injuries, the role of gender, and why socioeconomic status is still a barrier to care in a universal access system.