ABSTRACT BACKGROUND: Emotional distress increases, also affected by the setting. OBJECTIVE: To estimate changes in prevalence of severe anxiety and depressive symptoms and associated factors. DESIGN AND SETTING: This cross-sectional study included adults living in Manaus selected through a three-stage probability sampling in 2015 and 2019. METHODS: This is an analysis of two surveys conducted. The outcomes were assessed by Generalized Anxiety Disorder 7-item (≥ 15 points) and Patient Health Questionnaire 9-item (≥ 20), and changes were tested by chi-square goodness-of-fit. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated by Poisson regression. RESULTS: Severe anxiety symptoms increased from 3.3% (95%CI = 2.7–3.9) in 2015 (n = 3,479) to 8.7% (95%CI = 7.5–9.8) in 2019 (n = 2,321); severe depressive symptoms changed from 2.5% (95%CI = 2.0–3.0) to 8.5% (95%CI = 7.3–9.6). Variations were more pronounced in social vulnerability (P < 0.05). Outcomes were higher in women (anxiety: PR = 1.27; 95%CI = 1.20–1.34, depression: PR = 1.35; 95%CI = 1.27–1.44), low-income individuals (anxiety: PR = 1.90; 95%CI = 1.20–3.00, depression: PR = 1.98; 95%CI = 1.22–3.19), less educated individuals (anxiety: PR = 2.20; 95%CI = 1.16–4.18, depression: PR = 2.37; 95%CI = 1.23–4.60), and individuals with poor health status (anxiety: PR = 9.06; 95%CI = 6.72–12.21, depression: PR = 8.99; 95%CI = 6.67–12.12). CONCLUSION: Severe anxiety and depression tripled in Manaus, potentially reflecting Brazilian socioeconomic crises. BACKGROUND increases setting OBJECTIVE factors SETTING crosssectional cross sectional threestage three stage 201 METHODS conducted 7item item 7 ≥ ( 1 points 9item 9 20, 20 , 20) chisquare chi square goodnessoffit. goodnessoffit goodness fit. fit goodness-of-fit (PR 95 95CI CI regression RESULTS 33 3 3.3 2.7–3.9 2739 2 n 3,479 3479 479 87 8 8.7 7.5–9.8 7598 5 2,321 2321 321 2,321) 25 2.5 2.0–3.0 2030 0 85 8.5 7.3–9.6. 7396 7.3–9.6 . 6 7.3–9.6) P 0.05. 005 0.05 05 0.05) (anxiety 1.27 127 27 120134 34 1.20–1.34 1.35 135 35 1.27–1.44, 127144 1.27–1.44 44 1.27–1.44) lowincome low income 1.90 190 90 120300 00 1.20–3.00 1.98 198 98 1.22–3.19, 122319 1.22–3.19 22 19 1.22–3.19) 2.20 220 116418 16 4 18 1.16–4.18 2.37 237 37 1.23–4.60, 123460 1.23–4.60 23 60 1.23–4.60) 9.06 906 06 6721221 72 12 21 6.72–12.21 8.99 899 99 6.67–12.12. 6671212 6.67–12.12 67 6.67–12.12) CONCLUSION crises 3. 2.7–3. 273 3,47 347 47 8. 7.5–9. 759 2,32 232 32 2. 2.0–3. 203 739 7.3–9. 0.0 1.2 12013 1.20–1.3 1.3 13 12714 1.27–1.4 1.9 12030 1.20–3.0 12231 1.22–3.1 2.2 11641 1.16–4.1 2.3 12346 1.23–4.6 9.0 672122 6.72–12.2 8.9 89 667121 6.67–12.1 2.7–3 3,4 7.5–9 75 2,3 2.0–3 73 7.3–9 0. 1. 1201 1.20–1. 1271 1.27–1. 1203 1.20–3. 1223 1.22–3. 1164 1.16–4. 1234 1.23–4. 9. 67212 6.72–12. 66712 6.67–12. 2.7– 3, 7.5– 2, 2.0– 7.3– 120 1.20–1 1.27–1 1.20–3 122 1.22–3 116 1.16–4 123 1.23–4 6721 6.72–12 6671 6.67–12 2.7 7.5 2.0 7.3 1.20– 1.27– 1.22– 11 1.16– 1.23– 672 6.72–1 667 6.67–1 7. 1.20 1.22 1.16 1.23 6.72– 66 6.67– 1.1 6.72 6.67 6.7 6.6 6.

Abstract Objective: To assess the prevalence and factors associated with poor self-rated health according to respondents’ sex in Manaus, Brazil. Methods: This was a cross-sectional population-based study with adults in Manaus in 2019. Adjusted prevalence ratios and 95% confidence intervals (95%CI) were calculated using Poisson regression following a hierarchical model. Results: Poor self-rated health occurred in 35.2% (95%CI 33.3;37.2) of the 2,321 participants and was higher in females (PR = 1.27; 95%CI 1.13;1.43). In the general population, among both sexes, poor self-rated health was higher among the oldest, those with moderate and severe food insecurity and with chronic diseases (p-value < 0.05). Among females, poor health was also higher among the evangelical and those with mild food insecurity. Among males, self-rated health was also poorer among the retired and those with education below elementary level (p-value < 0.001). Conclusion: The female sex had the poorest health rating, influenced by morbidity and access to food. Objective selfrated self rated respondents Brazil Methods crosssectional cross sectional populationbased population based 2019 95 95CI CI model Results 352 35 2 35.2 33.337.2 333372 33.3 37.2 33 3 37 33.3;37.2 2321 321 2,32 PR 1.27 127 1 27 1.131.43. 113143 1.13 1.43 . 13 43 1.13;1.43) sexes oldest pvalue p value 0.05. 005 0.05 0 05 0.05) males 0.001. 0001 0.001 001 0.001) Conclusion rating 201 9 35. 337 33.337. 33337 333 33. 372 37. 33.3;37. 232 32 2,3 1.2 12 131 1.131.43 11314 113 1.1 143 1.4 4 1.13;1.43 00 0.0 000 0.00 20 33.337 3333 33.3;37 23 2, 1. 1.131.4 1131 11 14 1.13;1.4 0. 33.33 33.3;3 1.131. 1.13;1. 33.3; 1.131 1.13;1 1.13;

Resumo Objetivo: Analisar a prevalência e fatores associados à autoavaliação de saúde ruim segundo o sexo em Manaus. Métodos: Trata-se de estudo transversal de base populacional com adultos residentes em Manaus em 2019. Razões de prevalências (RP) ajustadas e intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson hierarquizada. Resultados: Saúde autoavaliada como ruim ocorreu em 35,2% (IC95% 33,3;37,2) dos 2.321 participantes e foi maior no sexo feminino (RP = 1,27; IC95% 1,13;1,43). Na população geral, em ambos os sexos, saúde autoavaliada como ruim foi maior entre os mais velhos, com insegurança alimentar moderada e grave e com presença de doenças crônicas (p-valor < 0,05). No sexo feminino, saúde ruim foi maior em evangélicas e com insegurança alimentar leve. No masculino, aposentados e com nível de ensino inferior ao fundamental também apresentaram pior autoavaliação (p-valor < 0,001). Conclusão: Pessoas do sexo feminino apresentaram pior avaliação de saúde, influenciada por morbidade e acesso a alimentação. Objetivo Métodos Tratase Trata se 2019 RP 95 IC95 IC hierarquizada Resultados 352 35 2 35,2 (IC95 33,337,2 333372 33,3 37,2 33 3 37 33,3;37,2 2321 321 2.32 1,27 127 1 27 1,131,43. 113143 1,13 1,43 . 13 43 1,13;1,43) geral sexos velhos pvalor p valor 0,05. 005 0,05 0 05 0,05) leve masculino 0,001. 0001 0,001 001 0,001) Conclusão alimentação 201 9 IC9 35, (IC9 337 33,337, 33337 333 33, 372 37, 33,3;37, 232 32 2.3 1,2 12 131 1,131,43 11314 113 1,1 143 1,4 4 1,13;1,43 00 0,0 000 0,00 20 (IC 33,337 3333 33,3;37 23 2. 1, 1,131,4 1131 11 14 1,13;1,4 0, 33,33 33,3;3 1,131, 1,13;1, 33,3; 1,131 1,13;1 1,13;

Resumen Objetivo: Analizar la prevalencia y los factores asociados a la mala autoevaluación de salud según sexo en Manaus, Brasil. Métodos: Se trata de un estudio poblacional transversal con adultos residentes en Manaus en 2019. Las razones de prevalencia ajustadas (RP) y los intervalos de confianza del 95% (IC95%) se calcularon mediante regresión jerárquica de Poisson. Resultados: Autoevaluación mala de salud ocurrió en 35,2% (IC95% 33,3;37,2) de los 2.321 participantes y fue mayor en el sexo femenino (RP = 1,27; IC95%1,13;1,43). En la población general, femenina y masculina, la mala autoevaluación de salud fue mayor entre ancianos, con inseguridad alimentaria moderada y grave y con enfermedades crónicas (p-valor < 0,05). En el sexo femenino, la mala salud fue mayor en evangélicas y con inseguridad alimentaria leve. En el sexo masculino, jubilados y con educación inferior al nivel básico también tuvieron una peor autoevaluación (p-valor < 0,001). Conclusión: Personas de sexo femenino tuvieron una peor valoración de salud, influenciada por la morbilidad y el acceso a la alimentación. Objetivo Brasil Métodos 2019 RP 95 IC95% IC95 IC Poisson Resultados 352 35 2 35,2 (IC95 33,337,2 333372 33,3 37,2 33 3 37 33,3;37,2 2321 321 2.32 1,27 127 1 27 IC95%1,131,43. IC95113143 IC95%1,13 1,43 . 13 43 IC95%1,13;1,43) general masculina ancianos pvalor p valor 0,05. 005 0,05 0 05 0,05) leve masculino 0,001. 0001 0,001 001 0,001) Conclusión alimentación 201 9 IC9 35, (IC9 337 33,337, 33337 333 33, 372 37, 33,3;37, 232 32 2.3 1,2 12 131 IC95%1,131,43 IC9511314 IC95113 IC95%1,1 143 1,4 4 IC95%1,13;1,43 00 0,0 000 0,00 20 (IC 33,337 3333 33,3;37 23 2. 1, IC95%1,131,4 IC951131 IC9511 IC95%1, 14 IC95%1,13;1,4 0, 33,33 33,3;3 IC95%1,131, IC951 IC95%1 IC95%1,13;1, 33,3; IC95%1,131 IC95%1,13;1 IC95%1,13;

ABSTRACT Objective: To assess the incidence of tuberculosis in Brazil between 2001 and 2022 and estimate the monthly incidence forecast until 2030. Methods: This is a time-series study based on monthly tuberculosis records from the Notifiable Diseases Information System and official projections of the Brazilian population. The monthly incidence of tuberculosis from 2001 to 2022 was evaluated using segmented linear regression to identify trend breaks. Seasonal autoregressive integrated moving average (Sarima) was used to predict the monthly incidence from 2023 to 2030, deadline for achieving the sustainable development goals (SDGs). Results: There was a decrease in incidence between January/2001 and December/2014 (4.60 to 3.19 cases-month/100,000 inhabitants; β=-0.005; p<0.001), followed by an increase between January/2015 and March /2020 (β=0.013; p<0.001). There was a sharp drop in cases in April/2020, with the onset of the pandemic, and acceleration of the increase in cases since then (β=0.025; p<0.001). A projection of 124,245 cases in 2030 was made, with an estimated incidence of 4.64 cases-month/100,000 inhabitants, levels similar to those in the 2000s. The Sarima model proved to be robust, with error of 4.1% when removing the pandemic period. Conclusion: The decreasing trend in tuberculosis cases was reversed from 2015 onwards, a period of economic crisis, and was also impacted by the pandemic when there was a reduction in records. The Sarima model can be a useful forecasting tool for epidemiological surveillance. Greater investments in prevention and control need to be made to reduce the occurrence of tuberculosis, in line with the SDGs. Objective 200 202 Methods timeseries time series population breaks (Sarima SDGs . (SDGs) Results January2001 January January/200 December2014 December 2014 December/201 4.60 460 4 60 (4.6 319 3 19 3.1 casesmonth/100,000 casesmonth100000 casesmonth month/100,000 month 100 000 cases-month/100,00 inhabitants β=0.005 β0005 β β= 0.005 0 005 β=-0.005 p<0.001, p0001 p p<0.001 , 001 p<0.001) January2015 January/201 2020 /202 β=0.013 β0013 013 (β=0.013 p<0.001. April2020 April April/2020 β=0.025 β0025 025 (β=0.025 124245 124 245 124,24 203 464 64 4.6 2000s s robust 41 1 4.1 Conclusion 201 onwards crisis surveillance 20 (SDGs January200 January/20 December201 December/20 46 6 (4. 31 3. casesmonth/100,00 casesmonth10000 month100000 month/100,00 10 00 cases-month/100,0 β=0.00 β000 0005 0.00 β=-0.00 p000 p<0.00 January201 /20 β=0.01 β001 01 (β=0.01 April202 April/202 β=0.02 β002 02 (β=0.02 12424 12 24 124,2 4. 2 January20 January/2 December20 December/2 (4 casesmonth/100,0 casesmonth1000 month10000 month/100,0 cases-month/100, β=0.0 β00 0.0 β=-0.0 p00 p<0.0 /2 (β=0.0 April20 April/20 1242 124, January2 January/ December2 December/ ( casesmonth/100, casesmonth100 month1000 month/100, cases-month/100 β=0. β0 0. β=-0. p0 p<0. / (β=0. April2 April/2 casesmonth/100 casesmonth10 month100 month/100 cases-month/10 β=0 β=-0 p<0 (β=0 April/ casesmonth/10 casesmonth1 month10 month/10 cases-month/1 β=- p< (β= casesmonth/1 month1 month/1 cases-month/ (β casesmonth/ month/ cases-month

RESUMO Objetivo: Avaliar a incidência de tuberculose no Brasil entre 2001 e 2022 e estimar a previsão de incidência mensal até 2030. Métodos: Trata-se de estudo de série temporal que partiu de registros mensais de tuberculose do Sistema de Informação de Agravos de Notificação e projeções oficiais da população brasileira. Avaliou-se a incidência mensal de tuberculose entre 2001 e 2022 por meio de regressão linear segmentada para identificar quebras de tendências. Utilizou-se o modelo autorregressivo integrado de médias móveis sazonais (Sarima) para prever a incidência mensal de 2023 a 2030, prazo para alcançar os objetivos de desenvolvimento sustentável (ODS). Resultados: Observou-se diminuição da incidência entre janeiro/2001 e dezembro/2014 (de 4,60 para 3,19 casos-mês/100 mil habitantes; β=-0,005; p<0,001), seguida de aumento entre janeiro/2015 e março/2020 (β=0,013; p<0,001). Houve queda abrupta de casos em abril/2020, com início da pandemia e aceleração do aumento de casos desde então (β=0,025; p<0,001). Projetaram-se 124.245 casos de tuberculose em 2030, com incidência estimada em 4,64 casos-mês/100 mil habitantes, patamares da década de 2000. O modelo Sarima mostrou-se robusto, com erro de 4,1% ao remover o período pandêmico. Conclusão: A tendência decrescente nos casos de tuberculose foi revertida a partir de 2015, período de crises econômicas, e foi também impactada pela pandemia quando houve redução nos registros. O modelo Sarima pode ser uma ferramenta de previsão útil para a vigilância epidemiológica. Maiores investimentos na prevenção e controle precisam ser aportados para reduzir a ocorrência de tuberculose, em linha com os ODS. Objetivo 200 202 2030 Métodos Tratase Trata se brasileira Avaliouse Avaliou tendências Utilizouse Utilizou (Sarima ODS . (ODS) Resultados Observouse Observou janeiro2001 janeiro janeiro/200 dezembro2014 dezembro 2014 dezembro/201 460 4 60 4,6 319 3 19 3,1 casosmês/100 casosmês100 casosmês mês/100 mês 100 casos-mês/10 habitantes β=0,005 β0005 β β= 0,005 0 005 β=-0,005 p<0,001, p0001 p p<0,001 , 001 p<0,001) janeiro2015 2015 janeiro/201 março2020 março 2020 março/202 β=0,013 β0013 013 (β=0,013 p<0,001. abril2020 abril abril/2020 β=0,025 β0025 025 (β=0,025 Projetaramse Projetaram 124245 124 245 124.24 464 64 2000 mostrouse mostrou robusto 41 1 4,1 pandêmico Conclusão econômicas epidemiológica 20 203 (ODS janeiro200 janeiro/20 dezembro201 201 dezembro/20 46 6 4, 31 3, casosmês/10 casosmês10 mês100 mês/10 10 casos-mês/1 β=0,00 β000 0005 0,00 00 β=-0,00 p000 p<0,00 janeiro201 março202 março/20 β=0,01 β001 01 (β=0,01 abril202 abril/202 β=0,02 β002 02 (β=0,02 12424 12 24 124.2 2 janeiro20 janeiro/2 dezembro20 dezembro/2 casosmês/1 casosmês1 mês10 mês/1 casos-mês/ β=0,0 β00 000 0,0 β=-0,0 p00 p<0,0 março20 março/2 (β=0,0 abril20 abril/20 1242 124. janeiro2 janeiro/ dezembro2 dezembro/ casosmês/ mês1 mês/ casos-mês β=0, β0 0, β=-0, p0 p<0, março2 março/ (β=0, abril2 abril/2 β=0 β=-0 p<0 (β=0 abril/ β=- p< (β= (β

Objectives: To estimate the prevalence of antidepressant use in Brazil. Methods: We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data, and assessed the methodological quality. We pooled the prevalence of antidepressant use using meta-analyses of proportions (Freeman-Tukey transformation) and estimated heterogeneity by the I2 statistic. OR meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. Results: Out of 3,299 records retrieved, 23 studies published in 28 reports were included, with a total of 75,061 participants. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; I2 = 98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; I2 = 0%) than men (4.6%; 95%CI 3.1-6.8%; I2 = 0%) (p < 0.001; OR = 2.82; 95%CI 1.72-4.62). Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; I2 = 37.6% vs. men: 0.5%; 95%CI 0.2-1.0%; I2 = 0%, p < 0.001; OR = 4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with mean participant age (p = 0.035; residual I2 = 0%; regression coefficient = 0.003). Conclusion: Four out of every 100 Brazilians used antidepressants in this 3-decade assessment. Use increased with age and was more prevalent in women compared to men. Registration number: PROSPERO CRD42022345332. Objectives Brazil Methods MEDLINE Embase Scopus LILACS 2023 data quality metaanalyses meta analyses FreemanTukey Freeman Tukey transformation I statistic reference betweenstudy between study metaregressions. metaregressions regressions. regressions meta-regressions Results 3299 299 3,29 retrieved 2 included 75061 75 061 75,06 participants 40 4 0 4.0 95CI CI 95 2.75.6% 2756 2.7 5.6% 7 5 6 2.7-5.6% 98.5%. 985 98.5% . 98 98.5%) 12.0% 120 12 (12.0% 9.515.1% 95151 9.5 15.1% 9 15 1 9.5-15.1% 0% 4.6% 46 (4.6% 3.16.8% 3168 3.1 6.8% 8 3.1-6.8% 0.001 0001 001 2.82 282 82 1.724.62. 172462 1.72 4.62 72 62 1.72-4.62) (women 2.3% 1.63.1 1631 1.6 1.6-3.1 376 37 37.6 vs 0.5% 05 0.21.0% 0210 0.2 1.0% 0.2-1.0% 4.18 418 18 2.108.30. 210830 2.10 8.30 10 30 2.10-8.30) Betweenstudy Between 0.035 0035 035 0.003. 0003 0.003 003 0.003) Conclusion 3decade decade assessment number CRD42022345332 CRD 202 329 29 3,2 7506 06 75,0 4. 2.75.6 275 27 2. 56 5.6 2.7-5.6 98.5 12.0 (12.0 515 9.515.1 9515 9. 151 15.1 9.5-15.1 4.6 (4.6 16 3.16.8 316 31 3. 68 6.8 3.1-6.8 0.00 000 00 2.8 724 1.724.62 17246 172 1.7 462 1.72-4.62 2.3 63 1.63. 163 1. 1.6-3. 37. 0.5 21 0.21.0 021 02 0. 1.0 0.2-1.0 4.1 41 108 2.108.30 21083 210 2.1 830 8.3 2.10-8.30 0.03 03 CRD4202234533 20 32 3, 750 75, 2.75. 5. 2.7-5. 98. 12. (12. 51 9.515. 951 15. 9.5-15. (4. 3.16. 6. 3.1-6. 0.0 1.724.6 1724 17 1.72-4.6 1.63 1.6-3 0.21. 0.2-1. 2.108.3 2108 83 8. 2.10-8.3 CRD420223453 2.75 2.7-5 (12 9.515 9.5-15 (4 3.16 3.1-6 1.724. 1.72-4. 1.6- 0.21 0.2-1 2.108. 2.10-8. CRD42022345 2.7- (1 9.51 9.5-1 ( 3.1- 1.724 1.72-4 0.2- 2.108 2.10-8 CRD4202234 9.5- 1.72- 2.10- CRD420223 CRD42022 CRD4202 CRD420 CRD42 CRD4

Abstract Objective: To assess the prevalence and factors associated with poor self-rated health according to respondents’ sex in Manaus, Brazil. Methods: This was a cross-sectional population-based study with adults in Manaus in 2019. Adjusted prevalence ratios and 95% confidence intervals (95%CI) were calculated using Poisson regression following a hierarchical model. Results: Poor self-rated health occurred in 35.2% (95%CI 33.3;37.2) of the 2,321 participants and was higher in females (PR = 1.27; 95%CI 1.13;1.43). In the general population, among both sexes, poor self-rated health was higher among the oldest, those with moderate and severe food insecurity and with chronic diseases (p-value < 0.05). Among females, poor health was also higher among the evangelical and those with mild food insecurity. Among males, self-rated health was also poorer among the retired and those with education below elementary level (p-value < 0.001). Conclusion: The female sex had the poorest health rating, influenced by morbidity and access to food.

Resumen Objetivo: Analizar la prevalencia y los factores asociados a la mala autoevaluación de salud según sexo en Manaus, Brasil. Métodos: Se trata de un estudio poblacional transversal con adultos residentes en Manaus en 2019. Las razones de prevalencia ajustadas (RP) y los intervalos de confianza del 95% (IC95%) se calcularon mediante regresión jerárquica de Poisson. Resultados: Autoevaluación mala de salud ocurrió en 35,2% (IC95% 33,3;37,2) de los 2.321 participantes y fue mayor en el sexo femenino (RP = 1,27; IC95%1,13;1,43). En la población general, femenina y masculina, la mala autoevaluación de salud fue mayor entre ancianos, con inseguridad alimentaria moderada y grave y con enfermedades crónicas (p-valor < 0,05). En el sexo femenino, la mala salud fue mayor en evangélicas y con inseguridad alimentaria leve. En el sexo masculino, jubilados y con educación inferior al nivel básico también tuvieron una peor autoevaluación (p-valor < 0,001). Conclusión: Personas de sexo femenino tuvieron una peor valoración de salud, influenciada por la morbilidad y el acceso a la alimentación.

Resumo Objetivo: Analisar a prevalência e fatores associados à autoavaliação de saúde ruim segundo o sexo em Manaus. Métodos: Trata-se de estudo transversal de base populacional com adultos residentes em Manaus em 2019. Razões de prevalências (RP) ajustadas e intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson hierarquizada. Resultados: Saúde autoavaliada como ruim ocorreu em 35,2% (IC95% 33,3;37,2) dos 2.321 participantes e foi maior no sexo feminino (RP = 1,27; IC95% 1,13;1,43). Na população geral, em ambos os sexos, saúde autoavaliada como ruim foi maior entre os mais velhos, com insegurança alimentar moderada e grave e com presença de doenças crônicas (p-valor < 0,05). No sexo feminino, saúde ruim foi maior em evangélicas e com insegurança alimentar leve. No masculino, aposentados e com nível de ensino inferior ao fundamental também apresentaram pior autoavaliação (p-valor < 0,001). Conclusão: Pessoas do sexo feminino apresentaram pior avaliação de saúde, influenciada por morbidade e acesso a alimentação.

ABSTRACT Objective: To assess the incidence of tuberculosis in Brazil between 2001 and 2022 and estimate the monthly incidence forecast until 2030. Methods: This is a time-series study based on monthly tuberculosis records from the Notifiable Diseases Information System and official projections of the Brazilian population. The monthly incidence of tuberculosis from 2001 to 2022 was evaluated using segmented linear regression to identify trend breaks. Seasonal autoregressive integrated moving average (Sarima) was used to predict the monthly incidence from 2023 to 2030, deadline for achieving the sustainable development goals (SDGs). Results: There was a decrease in incidence between January/2001 and December/2014 (4.60 to 3.19 cases-month/100,000 inhabitants; β=-0.005; p<0.001), followed by an increase between January/2015 and March /2020 (β=0.013; p<0.001). There was a sharp drop in cases in April/2020, with the onset of the pandemic, and acceleration of the increase in cases since then (β=0.025; p<0.001). A projection of 124,245 cases in 2030 was made, with an estimated incidence of 4.64 cases-month/100,000 inhabitants, levels similar to those in the 2000s. The Sarima model proved to be robust, with error of 4.1% when removing the pandemic period. Conclusion: The decreasing trend in tuberculosis cases was reversed from 2015 onwards, a period of economic crisis, and was also impacted by the pandemic when there was a reduction in records. The Sarima model can be a useful forecasting tool for epidemiological surveillance. Greater investments in prevention and control need to be made to reduce the occurrence of tuberculosis, in line with the SDGs.

RESUMO Objetivo: Avaliar a incidência de tuberculose no Brasil entre 2001 e 2022 e estimar a previsão de incidência mensal até 2030. Métodos: Trata-se de estudo de série temporal que partiu de registros mensais de tuberculose do Sistema de Informação de Agravos de Notificação e projeções oficiais da população brasileira. Avaliou-se a incidência mensal de tuberculose entre 2001 e 2022 por meio de regressão linear segmentada para identificar quebras de tendências. Utilizou-se o modelo autorregressivo integrado de médias móveis sazonais (Sarima) para prever a incidência mensal de 2023 a 2030, prazo para alcançar os objetivos de desenvolvimento sustentável (ODS). Resultados: Observou-se diminuição da incidência entre janeiro/2001 e dezembro/2014 (de 4,60 para 3,19 casos-mês/100 mil habitantes; β=-0,005; p<0,001), seguida de aumento entre janeiro/2015 e março/2020 (β=0,013; p<0,001). Houve queda abrupta de casos em abril/2020, com início da pandemia e aceleração do aumento de casos desde então (β=0,025; p<0,001). Projetaram-se 124.245 casos de tuberculose em 2030, com incidência estimada em 4,64 casos-mês/100 mil habitantes, patamares da década de 2000. O modelo Sarima mostrou-se robusto, com erro de 4,1% ao remover o período pandêmico. Conclusão: A tendência decrescente nos casos de tuberculose foi revertida a partir de 2015, período de crises econômicas, e foi também impactada pela pandemia quando houve redução nos registros. O modelo Sarima pode ser uma ferramenta de previsão útil para a vigilância epidemiológica. Maiores investimentos na prevenção e controle precisam ser aportados para reduzir a ocorrência de tuberculose, em linha com os ODS.

Resumo O objetivo deste artigo é avaliar a prevalência do uso de psicotrópicos e antidepressivos e fatores associados em uma cidade da Amazônia. Dois estudos transversais foram realizados em Manaus, em 2015 e 2019, com adultos selecionados por amostragem probabilística. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson. Foram incluídos 3.479 participantes em 2015 e 2.321 em 2019; 2,0% usaram psicotrópicos em 2015 e 2,7% em 2019. Antidepressivos foram usados por 0,4% (2015) e 1,4% (2019). O uso de psicotrópicos foi menor em jovens (RP = 0,41; IC95%: 0,19-0,90), sem companheiros (RP = 0,64; IC95%: 0,44-0,93) e trabalhadores informais (RP = 0,47; IC95%: 0,25-0,86), mas maior em pessoas com saúde ruim (RP = 2,86; IC95%: 1,71-4,80), multimorbidade (RP = 3,24; IC95%: 1,87-5,60) e que visitaram médico (RP = 3,04; IC95%: 1,45-6,38) ou dentista (RP = 1,50; IC95%: 1,08-2,10). O uso de antidepressivos foi maior em 2019 (RP = 2,90; IC95%: 1,52-5,54), e pessoas com saúde ruim (RP = 2,77; IC95%: 1,16-6,62) e multimorbidade (RP = 8,72; IC95%: 2,71-28,00), mas menor em trabalhadores informais (RP = 0,33; IC95%: 0,12-0,87) e desempregados (RP = 0,26; IC95%: 0,08-0,81). O uso de psicotrópicos permaneceu estável em Manaus de 2015 a 2019, enquanto o de antidepressivos triplicou, sendo marcados por desigualdades sociais.

Abstract This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.

Resumo O objetivo deste artigo é avaliar a prevalência do uso de psicotrópicos e antidepressivos e fatores associados em uma cidade da Amazônia. Dois estudos transversais foram realizados em Manaus, em 2015 e 2019, com adultos selecionados por amostragem probabilística. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson. Foram incluídos 3.479 participantes em 2015 e 2.321 em 2019; 2,0% usaram psicotrópicos em 2015 e 2,7% em 2019. Antidepressivos foram usados por 0,4% (2015) e 1,4% (2019). O uso de psicotrópicos foi menor em jovens (RP = 0,41; IC95%: 0,19-0,90), sem companheiros (RP = 0,64; IC95%: 0,44-0,93) e trabalhadores informais (RP = 0,47; IC95%: 0,25-0,86), mas maior em pessoas com saúde ruim (RP = 2,86; IC95%: 1,71-4,80), multimorbidade (RP = 3,24; IC95%: 1,87-5,60) e que visitaram médico (RP = 3,04; IC95%: 1,45-6,38) ou dentista (RP = 1,50; IC95%: 1,08-2,10). O uso de antidepressivos foi maior em 2019 (RP = 2,90; IC95%: 1,52-5,54), e pessoas com saúde ruim (RP = 2,77; IC95%: 1,16-6,62) e multimorbidade (RP = 8,72; IC95%: 2,71-28,00), mas menor em trabalhadores informais (RP = 0,33; IC95%: 0,12-0,87) e desempregados (RP = 0,26; IC95%: 0,08-0,81). O uso de psicotrópicos permaneceu estável em Manaus de 2015 a 2019, enquanto o de antidepressivos triplicou, sendo marcados por desigualdades sociais.

Abstract This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.

Resumen Objetivo: investigar las características sociodemográficas y clínicas de los usuarios de antipsicóticos atípicos, atendidos por el Componente Especializado de Asistencia Farmacéutica (CEAF) para el tratamiento de la esquizofrenia en Brasil, de 2008 a 2017. Métodos: estudio de cohorte retrospectivo utilizando registros de autorizaciones de trámites de alta complejidad del Sistema de Información Ambulatorio del SUS, de todos los estados brasileños. Resultados: de los 759.654 usuários identificados, el 50,5% era del sexo feminino de la región Sudeste (60,2%), diagnosticadas con esquizofrenia paranoide (77,6%). Hubo una mayor prevalencia de risperidona (63,3%) entre niños y adolescentes; de olanzapina (34,0%) en adultos; y quetiapina (47,4%) en ancianos. Alrededor del 40% de los niños/adolescentes estaba bajo uso no autorizado de antipsicóticos según la edad. La adherencia al CEAF fue alta (82%), y la deserción a los seis meses fue del 24%. Conclusión: los hallazgos amplían el conocimiento sobre el perfil sociodemográfico y clínico de los usuarios y destacan la práctica del uso off-label. Objetivo atípicos (CEAF Brasil 200 2017 Métodos SUS brasileños Resultados 759654 759 654 759.65 identificados 505 50 5 50,5 60,2%, 602 60,2% , 60 2 (60,2%) 77,6%. 776 77,6% . 77 6 (77,6%) 63,3% 633 63 3 (63,3% adolescentes 34,0% 340 34 0 (34,0% adultos 47,4% 474 47 4 (47,4% ancianos 40 niñosadolescentes edad 82%, 82 82% (82%) 24 24% Conclusión offlabel. offlabel off label. label off-label 20 201 75965 75 65 759.6 50, 60,2 (60,2% 77,6 7 (77,6% 63,3 (63,3 34,0 (34,0 47,4 (47,4 8 (82% 7596 759. 60, (60,2 77, (77,6 63, (63, 34, (34, 47, (47, (82 (60, (77, (63 (34 (47 (8 (60 (77 (6 (3 (4 ( (7

Abstract Objective: to investigate sociodemographic and clinical characteristics of users of atypical antipsychotics receiving care via the Specialized Component of Pharmaceutical Assistance (Componente Especializado da Assistência Farmacêutica - CEAF), for the treatment of schizophrenia in Brazil, between 2008 and 2017. Methods: this was a retrospective cohort study using records of the authorizations for high complexity procedures retrieved from the Outpatient Information System of the Brazilian National Health System, from all Brazilian states. Results: of the 759,654 users, 50.5% were female, from the Southeast region (60.2%), diagnosed with paranoid schizophrenia (77.6%); it could be seen a higher prevalence of the use of risperidone (63.3%) among children/adolescents; olanzapine (34.0%) in adults; and quetiapine (47.4%) in older adults; about 40% of children/adolescents were in off-label use of antipsychotics according to age; adherence to CEAF was high (82%), and abandonment within six months was 24%. Conclusion: the findings expand knowledge about the sociodemographic and clinical profile of users and highlight the practice of off-label use. Objective Componente CEAF, , CEAF) Brazil 200 2017 Methods states Results 759654 759 654 759,65 505 50 5 50.5 female 60.2%, 602 60.2% 60 2 (60.2%) 77.6% 776 77 6 (77.6%) 63.3% 633 63 3 (63.3% childrenadolescents children adolescents 34.0% 340 34 0 (34.0% adults 47.4% 474 47 4 (47.4% 40 offlabel off label age 82%, 82 82% (82%) 24 24% Conclusion 20 201 75965 75 65 759,6 50. 60.2 (60.2% 77.6 7 (77.6% 63.3 (63.3 34.0 (34.0 47.4 (47.4 8 (82% 7596 759, 60. (60.2 77. (77.6 63. (63. 34. (34. 47. (47. (82 (60. (77. (63 (34 (47 (8 (60 (77 (6 (3 (4 ( (7

Resumo Objetivo: investigar características sociodemográficas e clínicas de usuários de antipsicóticos atípicos assistidos pelo Componente Especializado da Assistência Farmacêutica (CEAF), para tratamento da esquizofrenia no Brasil, de 2008 a 2017. Métodos: estudo de coorte retrospectivo utilizando registros das autorizações de procedimentos de alta complexidade do Sistema de Informações Ambulatoriais do Sistema Único de Saúde, de todos os estados brasileiros. Resultados: dos 759.654 usuários, 50,5% eram do sexo feminino, da região Sudeste (60,2%), diagnosticados com esquizofrenia paranoide (77,6%); observou-se maior prevalência de uso da risperidona (63,3%) entre crianças/adolescentes; de olanzapina (34,0%), em adultos; e quetiapina (47,4%), nos idosos; cerca de 40% das crianças/adolescentes estavam sob uso off-label de antipsicóticos segundo a idade; a adesão ao CEAF foi alta (82%), e o abandono em seis meses foi de 24%. Conclusão: os achados ampliam o conhecimento sobre perfil sociodemográfico e clínico dos usuários e destacam a prática do uso off-label. Objetivo CEAF, , (CEAF) Brasil 200 2017 Métodos Saúde brasileiros Resultados 759654 759 654 759.65 505 50 5 50,5 feminino 60,2%, 602 60,2% 60 2 (60,2%) 77,6% 776 77 6 (77,6%) observouse observou se 63,3% 633 63 3 (63,3% criançasadolescentes crianças adolescentes 34,0%, 340 34,0% 34 0 (34,0%) adultos 47,4%, 474 47,4% 47 4 (47,4%) idosos 40 offlabel off label idade 82%, 82 82% (82%) 24 24% Conclusão offlabel. label. (CEAF 20 201 75965 75 65 759.6 50, 60,2 (60,2% 77,6 7 (77,6% 63,3 (63,3 34,0 (34,0% 47,4 (47,4% 8 (82% 7596 759. 60, (60,2 77, (77,6 63, (63, 34, (34,0 47, (47,4 (82 (60, (77, (63 (34, (47, (8 (60 (77 (6 (34 (47 ( (7 (3 (4

Abstract Objective: to investigate sociodemographic and clinical characteristics of users of atypical antipsychotics receiving care via the Specialized Component of Pharmaceutical Assistance (Componente Especializado da Assistência Farmacêutica - CEAF), for the treatment of schizophrenia in Brazil, between 2008 and 2017. Methods: this was a retrospective cohort study using records of the authorizations for high complexity procedures retrieved from the Outpatient Information System of the Brazilian National Health System, from all Brazilian states. Results: of the 759,654 users, 50.5% were female, from the Southeast region (60.2%), diagnosed with paranoid schizophrenia (77.6%); it could be seen a higher prevalence of the use of risperidone (63.3%) among children/adolescents; olanzapine (34.0%) in adults; and quetiapine (47.4%) in older adults; about 40% of children/adolescents were in off-label use of antipsychotics according to age; adherence to CEAF was high (82%), and abandonment within six months was 24%. Conclusion: the findings expand knowledge about the sociodemographic and clinical profile of users and highlight the practice of off-label use.

Resumen Objetivo: investigar las características sociodemográficas y clínicas de los usuarios de antipsicóticos atípicos, atendidos por el Componente Especializado de Asistencia Farmacéutica (CEAF) para el tratamiento de la esquizofrenia en Brasil, de 2008 a 2017. Métodos: estudio de cohorte retrospectivo utilizando registros de autorizaciones de trámites de alta complejidad del Sistema de Información Ambulatorio del SUS, de todos los estados brasileños. Resultados: de los 759.654 usuários identificados, el 50,5% era del sexo feminino de la región Sudeste (60,2%), diagnosticadas con esquizofrenia paranoide (77,6%). Hubo una mayor prevalencia de risperidona (63,3%) entre niños y adolescentes; de olanzapina (34,0%) en adultos; y quetiapina (47,4%) en ancianos. Alrededor del 40% de los niños/adolescentes estaba bajo uso no autorizado de antipsicóticos según la edad. La adherencia al CEAF fue alta (82%), y la deserción a los seis meses fue del 24%. Conclusión: los hallazgos amplían el conocimiento sobre el perfil sociodemográfico y clínico de los usuarios y destacan la práctica del uso off-label.

Resumo Objetivo: investigar características sociodemográficas e clínicas de usuários de antipsicóticos atípicos assistidos pelo Componente Especializado da Assistência Farmacêutica (CEAF), para tratamento da esquizofrenia no Brasil, de 2008 a 2017. Métodos: estudo de coorte retrospectivo utilizando registros das autorizações de procedimentos de alta complexidade do Sistema de Informações Ambulatoriais do Sistema Único de Saúde, de todos os estados brasileiros. Resultados: dos 759.654 usuários, 50,5% eram do sexo feminino, da região Sudeste (60,2%), diagnosticados com esquizofrenia paranoide (77,6%); observou-se maior prevalência de uso da risperidona (63,3%) entre crianças/adolescentes; de olanzapina (34,0%), em adultos; e quetiapina (47,4%), nos idosos; cerca de 40% das crianças/adolescentes estavam sob uso off-label de antipsicóticos segundo a idade; a adesão ao CEAF foi alta (82%), e o abandono em seis meses foi de 24%. Conclusão: os achados ampliam o conhecimento sobre perfil sociodemográfico e clínico dos usuários e destacam a prática do uso off-label.

ABSTRACT BACKGROUND: Workplaces can be sources of mental distress. In healthcare services, this can also affect patients. OBJECTIVE: To assess the prevalence of and factors associated with depressive symptoms, burnout, job satisfaction and patient safety culture and the relationships between these constructs, among healthcare workers. DESIGN AND SETTING: Cross-sectional study in a university hospital in Manaus, Brazil. METHODS: Randomly selected workers were interviewed based on Brazilian-validated tools. We calculated the prevalence ratio (PR) and 95% confidence interval (CI) of depressive symptoms and burnout using Poisson regression with robust variance; and the β-coefficient of safety culture and job satisfaction using linear regression. Outcome relationships were assessed using partial least-squares structural equation modeling. RESULTS: 300 professionals were included; 67.3% were women. The prevalence of depressive symptom was 19.0% (95% CI: 14.5; 23.5%) and burnout, 8.7% (95% CI: 5.2; 12.3%). Lack of work stability increased depression (PR = 1.88; 95% CI: 1.17; 3.01) and burnout (PR = 2.17; 95% CI: 1.03; 4.57); and reduced job satisfaction (β = -11.93; 95% CI: -18.79; -5.07). Depressive symptoms and burnout were positively correlated, as also were job satisfaction and safety culture (P < 0.001); job satisfaction was negatively correlated with burnout (P < 0.001) and depression (P = 0.035). CONCLUSION: Impermanent employment contracts increased depression and burnout and reduced job satisfaction. Job satisfaction reduced poor mental health outcomes and increased safety culture. Job satisfaction and safety culture were directly proportional (one construct increased the other and vice versa), as also were depression and burnout. Better working conditions can provide a virtuous cycle of patient safety and occupational health.

Objective: To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions among these individuals in Manaus, estado do Amazonas, Brazil, in 2019. Methods: Cross-sectional population-based study conducted with adults aged ≥18 years. Among people on polypharmacy (≥5 medicines), the presence of drug interactions was investigated in the icromedex database. Prevalence ratios (PR) were calculated by Poisson regression with robust variance, following hierarchical analysis and considering the complex sample design. Results: Out of the 2,321 participants were included, 2.8% (95%CI 2.1;3.6) were on polypharmacy, of which 74.0% presented drug interactions, with four or more interactions per person (40.4%) and high severity (59.5%) being the most frequent. Polypharmacy was higher among the elderly (PR=3.24 – 95%CI 1.25;8.42), poor health (PR=2.54 – 95%CI 1.14;5.67), previous hospitalization (PR=1.90 – 95%CI 1.09;3.32) and multimorbidity (PR=3.20 – 95%CI 1.53;6.67). Conclusion: Polypharmacy was more frequent among the elderly and people with health problems, who potentially had more drug interactions.

Objetivo: Analizar la prevalencia y factores asociados a polifarmacia y la presencia de posibles interacciones farmacológicas en Manaus, estado do Amazonas, Brasil, en 2019. Métodos: Estudio poblacional transversal realizado con adultos con edad ≥18 años. Entre personas en polifarmacia (≥5 medicamentos), se investigó la presencia de interacciones farmacológicas en Micromedex. Razones de prevalencia (RP) se calcularon mediante regresión de Poisson con varianza robusta, siguiendo análisis jerárquico y considerando el diseño de muestra complejo. Resultados: De los 2.321 participantes, 2,8% (IC95% 2,1;3,6) se encontraban en polifarmacia, de los cuales 74,0% presentaban interacciones, siendo más frecuentes cuatro o más interacciones por persona (40,4%) y de alta gravedad (59,5%). Polifarmacia fue mayor entre los ancianos (RP=3,24 – IC95% 1,25;8,42), mala salud (RP=2,54 – IC95% 1,14;5,67), hospitalización previa (RP=1,90 – IC95% 1,09;3,32) y multimorbilidade (RP=3,20 – IC95% 1,53;6,67). Conclusión: Polifarmacia fue más frecuente entre los ancianos y personas con problemas de salud, que potencialmente tenían más interacciones farmacológicas.

Objetivo: Analisar a prevalência e fatores associados à polifarmácia e a presença de potenciais interações medicamentosas em Manaus, estado do Amazonas, Brasil, em 2019. Métodos: Estudo transversal de base populacional, com adultos na idade ≥18 anos. Entre pessoas em polifarmácia (≥5 medicamentos), pesquisou-se a presença de interações medicamentosas na base Micromedex. Razões de prevalências (RP) foram calculadas por regressão de Poisson com variância robusta, seguindo análise hierárquica e considerando o delineamento amostral complexo. Resultados: Dos 2.321 participantes, 2,8% (IC95% 2,1;3,6) estavam em polifarmácia e destes, 74,0% apresentaram interações, sendo mais frequentes quatro ou mais interações por pessoa (40,4%) e gravidade alta (59,5%). Polifarmácia foi maior entre idosos (RP=3,24 – IC95% 1,25;8,42), saúde ruim (RP=2,54 –IC95% 1,14;5,67), hospitalização prévia (RP=1,90 – IC95% 1,09;3,32) e multimorbidade (RP=3,20 – IC95% 1,53;6,67). Conclusão: A polifarmácia foi mais frequente entre idosos e pessoas com problemas de saúde, que tiveram mais interações medicamentosas.

ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.

ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.