Necessidade de reabilitação no Brasil de 1990 A 2019, a partir de estimativas do Global Burden Disease Study, e a operacionalização da rede de cuidados à pessoa com deficiência no Amazonas

Abstract

Aim: This study aimed to assess the implementation of the Care Network for Persons with Disabilities (RCPCD) in Amazonas and to determine the rehabilitation needs in Brazil, taking into account five main categories of impairment for national health service planning. These needs were stratified by age groups as well as by Brazilian regions with uneven development. Methods: Step 1: A qualitative assessment of the RCPCD implementation in Amazonas was conducted, including a document analysis related to the network. Step 2: A secondary analysis of the Global Burden of Disease study (1990–2019) was performed, using Years Lived with Disability (YLD) rates for all ages and age-standardized metrics. The set of health conditions eligible for rehabilitation was selected and organized based on the five types of impairment as defined by the RCPCD within Brazil's public health system. Results: Step 1: None of the RCPCD implementation stages were satisfactorily carried out in Amazonas. Step 2: A national increase of 24% (1990–2019) in overall per capita rehabilitation needs was observed (i.e., YLD rates per 100,000 inhabitants), along with a 6% decrease in age-standardized YLD rates. “Physical” impairments accounted for 77% of rehabilitation needs in Brazil in 2019; 69% of these impairments originated from musculoskeletal conditions. The increase in rehabilitation needs was also observed across all five Brazilian regions, ranging from 16% to 25%. Conclusions: Rehabilitation needs are increasing throughout Brazil and its regions due to population aging and the epidemiological transition. Brazilian regions with lower income and population density (e.g., more rural or remote areas) also showed growth in rehabilitation needs, although these areas are often underserved by health professionals. The RCPCD in Amazonas is in an early stage of implementation, which hampers the organization and progress of services aimed at persons with disabilities.