ArticleInternational journal of environmental research and public health2024
Lifestyle and Cardiometabolic Risk Factors Associated with Impoverishment Due to Out-of-Pocket Health Expenditure in São Paulo City, Brazil.
Article in International journal of environmental research and public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Financial Toxicity in Diabetes: The State of What We Know.Current diabetes reports · 2025Pooled it
- Association of hospitalization costs with demographic, socioeconomic, and lifestyle characteristics: Population-based study in Sao Paulo city, Brazil, 2003-2015.Health policy OPEN · 2026Article
- Socioeconomic and cardiometabolic factors associated with outpatient healthcare utilization and direct costs in São Paulo, Brazil.BMC public health · 2026Observational
- Factors Associated with the Odds, Duration, and Costs of Health-Related Absenteeism: A Population-Based Study in São Paulo City, Brazil.Healthcare (Basel, Switzerland) · 2026Article
- Effects of Primary Healthcare Quality and Effectiveness on Hospitalization Indicators in Brazil.Journal of market access & health policy · 2025Article
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Authors and funding
6 authors.
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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.
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