Fatores associados à prevalência de hipertensão arterial sistêmica na população penitenciária feminina do Brasil

Abstract

Introduction:Brazilhasthe third largestprisonpopulationin theworld, withapproximately726,712 people incarcerated in 2016. Previous studieshave shown thattheprevalenceofdiseases in theprison populationis higherthan inthe generalpopulation, especiallyinwomen. In the USA, a prevalence ofhypertension in the prison population is estimatedat30.2In theprison population in Brazil, especiallyin women, the prevalenceofhypertension is stillunknown beyond its associatedriskfactors. Objective:To estimate the prevalence ofSystemic ArterialHypertension and theriskfactorsassociatedwithits higherprevalencein women inprison in Brazil. Methodology:The presentanalysis used data fromthe National Health Surveyon the Female PenitentiaryPopulationandonPrisonServants.Thestudywascarriedoutin 9Brazilian states selected through theimportanceandsize ofthe population imprisoned bythe State. Women were investigated in 15 units with a capacityofmore than 75 preyand who hadtheirown health services.The surveyutilized computer-assisted self-interviewing(ACASI)technology. Information on sociodemographic characteristics, the prison system, and healthbehaviors and conditions,as wellasanestimateoftheprevalence ofSAH, weremeasured.Themagnitude ofthe independentassociation ofsociodemographic riskfactors, prison systemfactors, behaviorand health conditionswith the presence ofSAHwas estimated bymeans ofodds ratio and its respective 95%confidenceintervalusinglogistic regression. Weincluded inthe multivariate modeltheexplanatoryvariables thatremained associated with SAHin thebivariate analysis with a levelofsignificanceup to 5%. The explanatoryvariableswere inserted in the multivariate modelusingforward modelingand the results were considered statisticallysignificantforthe p-values<0.05.Analyzeswere performed usingStata 13.0(StataCorporation, College Station, USA). Results:Ofthe totalof1,295 women participatingin thisstudy, 24.4%had SAH, mostwere over31 years old (54.6%), 51.5%self-reported brown /whiteand 32.6%white ,48.3%attended the 7th grade ofelementaryschooland only28.7%studied insidethe prison environment. Aftera mutualadjustmentforthe riskfactors thatwere associatedin thebivariateanalysis, weobserveda directandgradientrelationship betweenage and SAH, in which age greaterthan 41yearswasindependentlyassociated witha 7timesgreaterchanceofhavingSAHcompared to thosewhohave less than 25 years (OR= 7.04, 95%CI= 4.03-12.28). Thosewho self-referred race /blackcolor(OR=3.29,95%CI= 1.99 -5.43)had high cholesterol(OR= 2.60, 95%CI= 1.37-4.92), and were obese (OR= 3.72, 95%CI= 2.37-5.84)were also independentlyassociated with ahigherprevalenceofSAH. The highestnumberofpeople with preydivided cellwasassociated with a higherprevalence ofSAHwithouta dose responserelationship (ORfor6 to 10 prey= 1.99, 95%CI= 1.18-2.34, ORfor11 to 19prey=1.87,95%CI= 1.21-2.90, ORfor> 20 prey= 1.70,95%CI= 1.01-2.88). Thetime inseclusion,smoking, and alcoholconsumptiondid notremain associatedinthemultivariate analysis and were notincluded in the finalmodel. Conclusion:Women with ahistoryofincarceration have many riskfactors forSAH, such asolderage, beingblack, obeseand beyond the immobilityand stressgenerated byspecific factors ofincarceration, such as exposure to excess personsbycells, which increase theirprevalence. Prevention, diagnosis andtreatmentofhypertension in the incarcerated population are complex and improvingcardiovascularhealth requiresindividualbehavioralmodification as wellascorrective changesin thehealth system. Itisnecessarytoapplypreventive and curative means,ensuringtheinclusion of these women in the actions ofpromotion and health care advocated by SUS.