Chronic disease risk and protective behaviors in Brazilian state capitals and the Federal District, according to the National Health Survey and the Chronic Disease Risk and Protective Factors Telephone Survey Surveillance System, 2019

Thaís Cristina Marquezine Caldeira Marcela Mello Soares Luiza Eunice Sá da Silva Izabella Paula Araújo Veiga Rafael Moreira Claro About the authors

Abstract

Objective:

To describe and compare the results of the main risk and protective factors for chronic non-communicable diseases, in the 26 Brazilian capitals and the Federal District, obtained through the National Health Survey (PNS) and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) in 2019.

Methods:

Cross-sectional study, in which the difference in prevalence between health behavior indicators investigated by PNS and VIGITEL was calculated.

Results:

The largest discrepancy between the surveys, PNS (n = 32,111) and VIGITEL (n = 52,443), were observed in relation to leisure-time physical activity (6.8 in percentage points - p.p.), recommended physical activity in the transport domain (7.4 p.p.), and high screen time (21.8 p.p.). Both surveys presented similar prevalence regarding nutritional status, food consumption, smoking, alcohol abuse and negative self-rated health.

Conclusion:

Prevalence in both surveys presented small differences, but point to results in the same direction.

Keywords:
Health Surveys; Chronic Disease; Lifestyle; Risk Factors; Epidemiological Monitoring; Cross-sectional Studies

Study contributions

Main results

Both surveys show similar prevalence for most of the indicators. Significant differences were observed for the indicators of physical activity and sedentary behavior.

Implications for services

The comparison between surveys carried out through different methodologies enables the identification of the limits of their application in public policies proposals and monitoring.

Perspectives

The results contribute to the improvement of surveys and indicators used to monitor risk and protective factors for chronic diseases in the country.

Introduction

Chronic non-communicable diseases (NCDs) are the major public health problem at present because they result in loss of quality of life and a high number of deaths.11. World Health Organization. Noncommunicable Diseases (NCD) Country Profiles 2018. Geneva: WHO; 2018.,22. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet-Global Health Metrics [Internet]. 2020 out 17 [acesso em 06 jan 2021]; 396(10258): 1204-22. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30925-9/fulltext doi: 10.1016/S0140-6736(20)30925-9
https://www.thelancet.com/journals/lance...
The risk factors involved in the etiology of these diseases stand out for being behavioral and modifiable, such as: inadequate diet, physical inactivity, abusive consumption of alcoholic beverages and smoking.11. World Health Organization. Noncommunicable Diseases (NCD) Country Profiles 2018. Geneva: WHO; 2018.

In this scenario, it is worth highlighting the importance of surveillance and monitoring of these diseases and their risk factors for the planning and promotion of health in the population.33. World Health Organization. Global Health Observatory (GHO) [Internet]. WHO, 2015 [acesso em 24 dez 2020]. Disponível em: http://www.who.int/gho/en/
http://www.who.int/gho/en...
The information obtained through population health surveys is essential to understand the health profile of the population and the distribution of risk factors.44. Malta DC, Leal MC, Costa MFL, Morais NOL. Inquéritos Nacionais de Saúde: experiência acumulada e proposta para o inquérito de saúde brasileiro. Rev Bras Epidemiol. [Internet]. 2008 maio [acesso em 06 jan 2021]; 11(Supl 1): 159-67. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2008000500017&lng=en doi: 10.1590/S1415-790X2008000500017
http://www.scielo.br/scielo.php?script=s...
Such researches have been carried out in Brazil since the 1970s, mainly through household surveys.55. Stopa SR, Szwarcwald CL, Oliveira MM, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude [Internet]. 2020 out [acesso em 03 jan 2021]; 29(5): e2020315. Disponível em: http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S1679-49742020000500035&lng=pt doi: 10.1590/S1679-49742020000500004 doi: 10.1590/S1679-49742020000500004
http://scielo.iec.gov.br/scielo.php?scri...
,66. Barros MBA. Inquéritos domiciliares de saúde: potencialidades e desafios. Rev Bras Epidemiol. [Internet]. 2008 [acesso em 30 dez 2021]; 11(Supl 1): 6-19. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2008000500002&lng=en doi: 10.1590/S1415-790X2008000500002
http://www.scielo.br/scielo.php?script=s...
Given the high cost and logistics involved in household researches, the use of telephone interviews (faster and at a lower cost) made it possible to carry out health surveys capable of continuously detecting changes in determining and conditioning factors of the population’s health.77. Monteiro CA, Moura EC, Jaime PC, Lucca A, et al. Monitoramento de fatores de risco para doenças crônicas por entrevistas telefônicas. Rev Saude Publica [Internet]. 2005 jan [acesso em 06 jan 2021]; 39(1): 47-57. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102005000100007&lng=en doi: 10.1590/S0034-89102005000100007
http://www.scielo.br/scielo.php?script=s...

Since 2006, an annual health survey has been carried out in Brazil, using landline telephones, aiming at the continuous monitoring of the prevalence and distribution of the most relevant determinants associated with NCDs. The Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL), implemented by the Ministry of Health, together with other surveys carried out in the country, enable the expansion of knowledge on the Brazilian population's health status.77. Monteiro CA, Moura EC, Jaime PC, Lucca A, et al. Monitoramento de fatores de risco para doenças crônicas por entrevistas telefônicas. Rev Saude Publica [Internet]. 2005 jan [acesso em 06 jan 2021]; 39(1): 47-57. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102005000100007&lng=en doi: 10.1590/S0034-89102005000100007
http://www.scielo.br/scielo.php?script=s...
,88. Brasil. Ministério da Saúde. Secretaria de Vigilância. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019. Brasília: Ministério da Saúde; 2020.

Even so, household interviews are a widely used method in the investigation of health outcomes in Brazil. Carried out for the first time in 2013, by means of face-to-face interviews and with a broad scope, the National Health Survey (PNS) took place again in 2019, with the objective of collecting and updating information regarding the living conditions and health status of the population.55. Stopa SR, Szwarcwald CL, Oliveira MM, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude [Internet]. 2020 out [acesso em 03 jan 2021]; 29(5): e2020315. Disponível em: http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S1679-49742020000500035&lng=pt doi: 10.1590/S1679-49742020000500004 doi: 10.1590/S1679-49742020000500004
http://scielo.iec.gov.br/scielo.php?scri...

Given the advantages of using telephone interviews for the continuous provision of health data concerning the population and the robustness of a household survey, the comparison between data obtained from two health surveys carried out in the same year enables the ensures the reliability the information collected in the country. Thus, the objective of this study was to describe and compare the results of the main risk and protective factors for NCDs, in the 26 Brazilian capitals and the Federal District, obtained through the PNS and VIGITEL, in 2019.

Methods

This was a cross-sectional study, carried out using data from two large Brazilian population surveys, the PNS and VIGITEL, in 2019.

The PNS is a population-based household survey, with national representation, carried out by the Ministry of Health and the Brazilian Institute of Geography and Statistics (IBGE), with the objective of producing data on the population's health and living conditions. The PNS 2019 sampling process was based on the master sample for the IBGE's integrated household survey system.99. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde: 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. IBGE, Coordenação de Trabalho e Rendimento; Ministério da Saúde, 2020. From that sample, a cluster sampling process was established, starting with the census sectors (called primary sampling units), followed by a simple random sample of permanent households (secondary units) and, finally, a resident aged ≥ 15 years was randomly selected for the interview (tertiary unit).99. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde: 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. IBGE, Coordenação de Trabalho e Rendimento; Ministério da Saúde, 2020. The interviews were collected between August 2019 and March 2020.99. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde: 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. IBGE, Coordenação de Trabalho e Rendimento; Ministério da Saúde, 2020. For the present study, a subsample referring to individuals aged ≥ 18 years residing in the 26 state capitals and the Federal District was used, in order to enable comparison with data from VIGITEL.

VIGITEL is a telephone survey carried out annually by the Ministry of Health, starting in 2006, with the objective of monitoring the main risk and protective factors for NCDs. In each edition of VIGITEL, a simple random sample of adults ≥ 18 years of age residing in households that have at least one landline, in the 26 Brazilian capitals and the Federal District, is investigated. The sampling used establishes around 2,000 interviews per year in each city, allowing for the estimation of all the factors surveyed with a maximum error of 2 percentage points (p.p) and a 95% confidence interval (95%CI). Smaller samples, of about 1,500 interviews, are accepted in cities where the landline telephone service covers less than 40% of the households, in which case maximum errors of 3 p.p are accepted.88. Brasil. Ministério da Saúde. Secretaria de Vigilância. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019. Brasília: Ministério da Saúde; 2020. For the present study, data collected from January to December 2019 were used.

Weighting factors are assigned to data from both surveys in order to adjust for “non-response” and to ensure that the data represent the universe of the target population [equating their sex and age distribution to that of the total population, in the case of the PNS; and sex, six age groups in years (18-24, 25-4, 35-44, 45-54, 55-64 and ≥ 65)and three levels of schooling in years of study (0-8, 9-11 and ≥ 12), in the case of VIGITEL]. More information on the PNS and VIGITEL methodology can be found in specific publications.88. Brasil. Ministério da Saúde. Secretaria de Vigilância. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019. Brasília: Ministério da Saúde; 2020.,99. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde: 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. IBGE, Coordenação de Trabalho e Rendimento; Ministério da Saúde, 2020.

Initially, the survey questionnaires were collated so that comparable indicators could be identified. To this end, the module on lifestyles (module P) of the PNS was compared to a full version of the 2019 VIGITEL questionnaire, since both questionnaires were developed to enable the creation of indicators involving the same theme. As a result, the comparison between the instruments turned to the analysis of the statements and response options, in order to promote the comparison only for indicators whose expected comparability were, at least, satisfactory. At the end of this process, indicators were selected referring to nutritional status (risk factors: self-reported obesity and overweight), dietary intake (protective factor: consumption of unprocessed or minimally processed foods; and risk factor: consumption of ultra-processed foods), physical activity and sedentary behavior (protective factors: recommended physical activity during leisure time and transport; and risk factor: high screen time), smoking (risk factor: current smoker), alcohol consumption (risk factor: alcohol abuse) and perceived health status (risk factor: negative self-assessment of health status). A detailed description of the questions involved in each indicator, in each of the surveys, is presented in Box 1.

Box 1
Questions and indicators of the National Health Survey and the Surveillance System for Risk and Protective Factors for Non-Communicable Diseases (NCDs) by Telephone Survey (NCDs), 2019

To enable comparison between surveys, sociodemographic data were also analyzed, such as sex (male and female) and age (distributed into ranges: 18-34 years, 35-54 years and ≥ 55 years) of the individuals interviewed in each survey.

The prevalence of each of the indicators (and their 95%CI) was then independently estimated for each of the surveys. This procedure was carried out for the entire population, by sex and age group. Differences in estimated prevalence were identified through absolute difference (in p.p.) and relative difference (in percentage) between the indicators of both surveys. Stata software, version 14.2, was used to organize, process and analyze the data. All analyses were performed using the survey module, taking the sample design of each of the surveys into consideration.

VIGITEL databases are available on the official website of the Ministry of Health (http://svs.aids.gov.br/download/VIGITEL/; accessed in: December 2020). The conduction of VIGITEL was approved by the National Committee of Ethics in Research on Human Beings (Conep), under opinion No. 65610017.1.0000.0008. PNS data are available on IBGE’s official website (https://www.ibge.gov.br/estatisticas/sociais/saude.html; accessed in: December 2020). The conduction of the PNS was approved by Conep under opinion No. 3.529.376. For both surveys, the Free and Informed Consent Term was obtained at the time of the interview.

Results

Data from 32,111 adults living in the capitals and the Federal District who were interviewed by the PNS and 52,443 adults interviewed by VIGITEL, both in 2019, were included in the study. The largest part of the population living in the capitals and the Federal District interviewed by the PNS was female (54.9%), with the highest proportion in the total of adults between 35 and 54 years of age (37.2%). Among the adults interviewed by VIGITEL, the female population was also the majority (54.0%), and the highest proportion in the total of adults aged 18 to 34 years (38.8%) (Table 1).

Table 1
Prevalence and 95% confidence interval of the adult population in the capitals of the 26 states and the Federal District, by sex and age, according to the National Health Survey and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey, Brazil, 2019

Regarding the indicators studied, the greatest percentage differences were observed in the prevalence of recommended physical activity during leisure time, with the prevalence estimated from VIGITEL exceeding 6.8 p.p. to that of the PNS (PNS = 32.2% vs. VIGITEL = 39.0%). Values higher than those identified in VIGITEL were observed in the PNS for recommended transport physical activity, a difference of 7.4 p.p. (PNS = 21.5% vs. VIGITEL = 14.1%), and for high screen time, a difference of 21.8 p.p. (PNS = 84.5% vs. VIGITEL = 62.7%). In addition, the prevalence values of overweight, obesity, consumption of unprocessed or minimally processed foods, consumption of ultra-processed foods, smokers, abusive alcohol consumption and negative self-assessment of health status were similar in both surveys (Table 2).

Table 2
Prevalence, 95% confidence interval and differences between the selected risk and protective factors for chronic non communicable diseases (NCDs), in the adult population of the capitals of the 26 states and the Federal District according to the National Health Survey and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey, Brazil, 2019

In the analysis stratified by sex, there was a difference of 2.4 p.p. (PNS = 29.9% vs. VIGITEL = 32.3%) for females, between the prevalence of consumption of unprocessed or minimally processed foods. All differences referring to physical activity and physical inactivity were similar to the results of the total population for males, while only results referring to transport and high screen time remained similar for females (Table 3).

Table 3
Prevalence, 95% confidence interval and differences between the selected risk and protective factors for chronic non communicable diseases (NCDs), in the adult population of the capitals of the 26 states and the Federal District according to sex, for the National Health Survey and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey, Brazil, 2019

In the age group from 18 to 34 years old, the greatest differences were observed in relation to the prevalence of consumption of non- or minimally processed foods, at 3.5 p.p. (PNS = 21.9% vs. VIGITEL = 25.4%), leisure time physical activity, at 4.9 p.p. (PNS = 43.9% vs. VIGITEL = 48.8%), of physical activity during transport, at 8.0 p.p. (PNS = 23.2% vs. VIGITEL = 15.2%), high screen time, with a difference of 13.2 p.p. (PNS = 88.6% vs. VIGITEL = 75.4%), of smokers, at 3.2 p.p. (PNS = 12.0% vs. VIGITEL = 8.8%) and negative self-assessment of health status, at 2.2 p.p. (PNS = 1.9% vs. VIGITEL = 4.1%) (Table 4).

Table 4
Percentage, 95% confidence interval and differences between the selected risk and protective factors for chronic non communicable diseases (NCDs), in the adult population of the capitals of the 26 states and the Federal District according to age, for the National Health Survey and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey, Brazil, 2019

For the 35 to 54 age group, differences in prevalence estimates were observed for overweight, at 2.8 p.p. (PNS = 65.1% vs. VIGITEL = 62.3%), physical activity during transport, at 4.8 p.p. (PNS = 21.7% vs. VIGITEL = 16.9%), high screen time, at 21.6 p.p. (PNS = 79.9% vs. VIGITEL = 58.3%) and alcohol abuse, at 2.4 p.p. (PNS = 20.8% vs. VIGITEL = 18.4%) (Table 4)

In the age group of ≥ 55 years, differences were identified for: consumption of unprocessed or minimally processed foods (3.0 p.p.; PNS = 36.8% vs. VIGITEL = 33.8%), physical activity during transport (11.2 p.p.; PNS = 19.6% vs. VIGITEL = 8.4%), high screen time (36.8 p.p.; PNS = 85.9% vs. VIGITEL = 49.1%), alcohol abuse (2.5 p.p.; PNS = 10.4% vs. VIGITEL = 7.9%) and negative health self-assessment (1.5 p.p.; PNS = 8.2% vs. VIGITEL = 6.7%). With increasing age, there was an increase in the percentage of consumption of unprocessed or minimally processed foods and negative self-assessment of health status, in parallel with a decrease in physical activity during leisure time, during transport, and of abusive consumption of alcohol for both surveys (Table 4).

Discussion

The present study presented and compared the frequencies of the main risk and protective factors for NCDs related to lifestyle in the adult population of state capitals and the Federal District, according to PNS 2019 and VIGITEL 2019. For most indicators, the results were similar, especially when the questions and response options were similar. However, the greatest differences in prevalence estimates were identified among indicators related to physical activity and sedentary behavior (high screen time), for the entire population and most of the stratifications. Among the stratifications, attention is drawn to the higher number of indicators with differences in prevalence for younger individuals (18 to 34 years old) and for those aged ≥ 55.

The results of the present study deepen and update the comparative analysis carried out based on data from the 2013 PNS and the 2013 VIGITEL.1010. Malta DC, Iser BPM, Santos MAS, Andrade SSA, Stopa SR, Bernal RTI, et al. Estilos de vida nas capitais brasileiras segundo a Pesquisa Nacional de Saúde e o Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas não Transmissíveis por Inquérito Telefônico (Vigitel), 2013. Rev Bras Epidemiol. [Internet]. 2015 dez [acesso em 06 jan 2021]; 18(Supl 2): 68-82. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2015000600068&lng=pt doi: 10.1590/1980-5497201500060007
http://www.scielo.br/scielo.php?script=s...
In that investigation, 11 risk and protective factors were compared for the entire population and by sex. Of those, only three were included in the present study (smokers, abusive consumption of alcohol and recommended physical activity during leisure time), given that the monitoring of most of the other factors was discontinued in the period after the replacement of indicators. It should also be noted that the previous investigation also included indicators for which the calculation methodology already indicated a difference between the surveys and, therefore, for which there was not any expectation of agreement.

The increase in agreement between the studies prevalence obtained may reflect the effort to harmonize the main health surveys investigating risk and protective factors for NCDs. It should be noted that the dissimilarities identified can be explained, resulting from methodological differences,1111. Ponto J. Understanding and Evaluating Survey Research. J Adv Pract Oncol. [Internet]. 2015 mar-abr [acesso 05 jan 2021]; 6(2): 168-71. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601897/
https://www.ncbi.nlm.nih.gov/pmc/article...
involving the sampling, questionnaire and approach used for data collection.1111. Ponto J. Understanding and Evaluating Survey Research. J Adv Pract Oncol. [Internet]. 2015 mar-abr [acesso 05 jan 2021]; 6(2): 168-71. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601897/
https://www.ncbi.nlm.nih.gov/pmc/article...

12. Fahimi M, Link M, Mokdad A, Schwartz DA, Levy P. Tracking chronic disease and risk behavior prevalence as survey participation declines: statistics from the behavioral risk factor surveillance system and other national surveys. Prev Chronic Dis. [Internet]. 2008 jun 15 [acesso 05 jan 2021]; 5(3): A80. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483564/
https://www.ncbi.nlm.nih.gov/pmc/article...
-1313. Pemberton MR, Bose J, Kilmer G, Kroutil LA, Forman-Hoffman VL, Gfroerer JC. Comparison of NSDUH Health and Health Care Utilization Estimates to Other National Data Sources [Internet]. 2013 Sep. In: CBHSQ Data Review. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2012- [acesso em 06 jan 2021]. Disponível em: https://pubmed.ncbi.nlm.nih.gov/27748103/
https://pubmed.ncbi.nlm.nih.gov/2774810...
In the comparison carried out in the present study, two important characteristics should be highlighted: the study population and the data collection method. While the PNS starts from a registry of households in the country to conduct face-to-face household interviews, VIGITEL relies on samples of household landline telephone records provided by the main telephone operators in the country to carry out telephone interviews. Therefore, VIGITEL already starts with a smaller study population than that of the PNS, given that the coverage of landline service in the capitals is close to 60%. Besides, in some of these, it is not possible to carry out an interview even after several attempts (the non-response rate in household surveys ranges from 15% to 20%, while for telephone surveys it ranges from 36% to 60%, depending on the methodology used to estimate and identify the effectively eligible lines).55. Stopa SR, Szwarcwald CL, Oliveira MM, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude [Internet]. 2020 out [acesso em 03 jan 2021]; 29(5): e2020315. Disponível em: http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S1679-49742020000500035&lng=pt doi: 10.1590/S1679-49742020000500004 doi: 10.1590/S1679-49742020000500004
http://scielo.iec.gov.br/scielo.php?scri...
,1414. Keeter S, Miller C, Kohut A, Groves RM, Presser S. Consequences of Reducing Nonresponse in a National Telephone Survey. Public Opin Q. [Internet]. 2000 [acesso em 05 jan 2021]; 64(Supl 2): 125-48. Disponível em: https://academic.oup.com/poq/article-abstract/64/2/125/1825131 doi: 10.1086/317759
https://academic.oup.com/poq/article-abs...

15. Schneider KL, Clark MA, Rakowski W, Lapane KL. Evaluating the impact of non-response bias in the Behavioral Risk Factor Surveillance System (BRFSS). J Epidemiol Community Health. [Internet]. 2012 abr [acesso em 06 jan 2021]; 66(4): 290-5. Disponível em: https://pubmed.ncbi.nlm.nih.gov/20961872/ doi: 10.1136/jech.2009.103861
https://pubmed.ncbi.nlm.nih.gov/20961872...
-1616. Boing AC, Peres KG, Boing AF, Hallal PC, Silva NN, Peres MA. Inquérito de saúde EpiFloripa: aspectos metodológicos e operacionais dos bastidores. Rev Bras Epidemiol. [Internet]. 2014 mar [acesso em 06 jan 2021]; 17(1): 147-62. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2014000100147&lng=en doi: 10.1590/1415-790X201400010012ENG
http://www.scielo.br/scielo.php?script=s...
Even though statistical adjustments are applied in the form of weighting factors, these are not always sufficient to correct such problems.

Previous studies, which compared data from household and telephone surveys, show similarities for most of the indicators analyzed, as is the case of the study conducted in Belo Horizonte/Minas Gerais, with data from VIGITEL, and the household study, Saúde em Beagá (Health in the area of Belo Horizonte),1717. Ferreira AD, César CC, Malta DC, Souza AAC, Ramos CGC, Proietti FA et al. Validade de estimativas obtidas por inquérito telefônico: comparação entre VIGITEL 2008 e inquérito Saúde em Beagá. Rev Bras Epidemiol. [Internet]. 2011 set [acesso em 06 jan 2021]; 14(Supl 1): 16-30. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2011000500003&lng=en doi: 10.1590/S1415-790X2011000500003
http://www.scielo.br/scielo.php?script=s...
and in the study carried out in Campinas/São Paulo, with the ISACamp (household survey) and VIGITEL1818. Francisco PMSB, Azevedo BMB, Segri NJ, Alves MCGP, Cesar CLG, Malta DC. Comparação de estimativas para o auto-relato de condições crônicas entre inquérito domiciliar e telefônico - Campinas (SP), Brasil. Rev Bras Epidemiol. [Internet]. 2011 set [acesso em 06 jan 2021]; 14(Supl 1): 5-15. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2011000500002&lng=en doi: 10.1590/S1415-790X2011000500002
http://www.scielo.br/scielo.php?script=s...
(telephone survey) databases, carried out in 2008. These were used to compare chronic health conditions and, in both studies, similar results were obtained for most of the self-reported conditions investigated.1717. Ferreira AD, César CC, Malta DC, Souza AAC, Ramos CGC, Proietti FA et al. Validade de estimativas obtidas por inquérito telefônico: comparação entre VIGITEL 2008 e inquérito Saúde em Beagá. Rev Bras Epidemiol. [Internet]. 2011 set [acesso em 06 jan 2021]; 14(Supl 1): 16-30. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2011000500003&lng=en doi: 10.1590/S1415-790X2011000500003
http://www.scielo.br/scielo.php?script=s...
,1818. Francisco PMSB, Azevedo BMB, Segri NJ, Alves MCGP, Cesar CLG, Malta DC. Comparação de estimativas para o auto-relato de condições crônicas entre inquérito domiciliar e telefônico - Campinas (SP), Brasil. Rev Bras Epidemiol. [Internet]. 2011 set [acesso em 06 jan 2021]; 14(Supl 1): 5-15. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2011000500002&lng=en doi: 10.1590/S1415-790X2011000500002
http://www.scielo.br/scielo.php?script=s...
Such conditions, on the other hand, were not investigated in this study. The investigation of the quality of the surveys was also analyzed in locations with low telephone service coverage, as is the case of the capitals Rio Branco/Acre, in 2007 (40% coverage),1919. Bernal RTI, Malta DC, Araújo TS, Silva NN. Inquérito por telefone: pesos de pós-estratificação para corrigir vícios de baixa cobertura em Rio Branco, AC. Rev Saude Publica [Internet]. 2013 abr [acesso em 07 jan 2021]; 47(2): 316-25. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102013000200316&lng=pt doi: 10.1590/S0034-8910.2013047003798
http://www.scielo.br/scielo.php?script=s...
and Aracaju/Sergipe, in 2008 (49% coverage).2020. Bernal RTI, Malta DC, Neto OLM, Claro RM, Mendonça BCA, Oliveira ACC, et al. Vigitel-Aracaju, Sergipe, 2008: the effects of post-stratification adjustments in correcting biases due to the small amount of households with a landline telephone. Rev Bras Epidemiol. [Internet]. 2014 mar [acesso em 07 jan 2021]; 17(1): 163-74. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2014000100163&lng=pt doi: 10.1590/1415-790X201400010013ENG
http://www.scielo.br/scielo.php?script=s...
It was observed that the post-stratification process was able to correct most of the biases in the prevalence of the indicators studied1919. Bernal RTI, Malta DC, Araújo TS, Silva NN. Inquérito por telefone: pesos de pós-estratificação para corrigir vícios de baixa cobertura em Rio Branco, AC. Rev Saude Publica [Internet]. 2013 abr [acesso em 07 jan 2021]; 47(2): 316-25. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102013000200316&lng=pt doi: 10.1590/S0034-8910.2013047003798
http://www.scielo.br/scielo.php?script=s...
,2020. Bernal RTI, Malta DC, Neto OLM, Claro RM, Mendonça BCA, Oliveira ACC, et al. Vigitel-Aracaju, Sergipe, 2008: the effects of post-stratification adjustments in correcting biases due to the small amount of households with a landline telephone. Rev Bras Epidemiol. [Internet]. 2014 mar [acesso em 07 jan 2021]; 17(1): 163-74. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2014000100163&lng=pt doi: 10.1590/1415-790X201400010013ENG
http://www.scielo.br/scielo.php?script=s...
but it did not reduce the sample bias for the indicator concerning physical activity during leisure time, for example.1919. Bernal RTI, Malta DC, Araújo TS, Silva NN. Inquérito por telefone: pesos de pós-estratificação para corrigir vícios de baixa cobertura em Rio Branco, AC. Rev Saude Publica [Internet]. 2013 abr [acesso em 07 jan 2021]; 47(2): 316-25. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102013000200316&lng=pt doi: 10.1590/S0034-8910.2013047003798
http://www.scielo.br/scielo.php?script=s...
Differences in the results of the indicators of physical activity, also observed in the present study, may result from the different response options for the construction of the indicator (Box 1) - in the PNS, the respondent can openly report the number of hours they engaged in physical activity, and in VIGITEL, the response options are closed -, which may lead to an overestimation of the indicators of physical activity. It is also worth noting that for the indicator of sufficient physical activity during transport in the PNS, the addition of an option in the answer to the questions (addition of the answer option “club”), may have reflected in higher prevalence, when compared to VIGITEL (Box 1). Besides that, in spite of the fact that both surveys were based on self-reported information, it is commonly accepted that face-to-face interviews, especially those conducted in households, provide the opportunity to obtain better quality answers, since communication between the respondent and the interviewer takes place directly, with a greater volume of resources on the part of the interviewer.2121. Doyle JK. Face-to-Face Surveys. Wiley StatsRef: Statistics Reference Online. [Internet]. 2014 set 29 [acesso em 05 jan 2021]. Disponível em: https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118445112.stat06686 doi: 10.1002/9781118445112.stat06686
https://onlinelibrary.wiley.com/doi/abs/...

In any case, although none of the surveys used here constitute the gold standard for investigating risk and protective factors for NCDs, it is believed that their limitations do not discredit the results obtained. Household or telephone surveys are the main options for collecting data from large population samples in most countries, and self-reported information is recommended and constantly used in large health surveys to monitor NCDs and their factors.44. Malta DC, Leal MC, Costa MFL, Morais NOL. Inquéritos Nacionais de Saúde: experiência acumulada e proposta para o inquérito de saúde brasileiro. Rev Bras Epidemiol. [Internet]. 2008 maio [acesso em 06 jan 2021]; 11(Supl 1): 159-67. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2008000500017&lng=en doi: 10.1590/S1415-790X2008000500017
http://www.scielo.br/scielo.php?script=s...

Household surveys tend to have very broad themes, especially in low- and middle- income countries, where their high cost and complex logistics make it impossible to carry out multiple surveys. As a result, they tend to form the baseline for monitoring a population. In Brazil, the PNS is the most complete health survey ever carried out, with several modules and themes, resulting in an application time ranging from 50 minutes to about 4 hours.55. Stopa SR, Szwarcwald CL, Oliveira MM, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude [Internet]. 2020 out [acesso em 03 jan 2021]; 29(5): e2020315. Disponível em: http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S1679-49742020000500035&lng=pt doi: 10.1590/S1679-49742020000500004 doi: 10.1590/S1679-49742020000500004
http://scielo.iec.gov.br/scielo.php?scri...
Therefore, it is from the PNS data that the most complete health portrait of the Brazilian population is rendered. However, the high cost and logistics involved in carrying out a survey of this nature make it impossible to conduct it with great frequency for monitoring indicator trends. It is currently in its second edition, having been conducted with an interval of six years (2013 to 2019).

Thus, carrying out continuous monitoring along the years is only possible through the adoption of simpler and less expensive methods for obtaining information, as in VIGITEL. The low cost and the agility when compared to household surveys are the advantages of the surveillance system based on telephone interviews.2222. Moura EC, Morais NOL, Malta DC, Moura L, Silva NN, Bernal R, et al. Vigilância de Fatores de Risco para Doenças Crônicas por Inquérito Telefônico nas capitais dos 26 estados brasileiros e no Distrito Federal (2006). Rev Bras Epidemiol. [Internet]. 2008 maio [acesso em 06 jan 2021]; 11(Supl 1): 20-37. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2008000500003&lng=en doi: 10.1590/S1415-790X2008000500003
http://www.scielo.br/scielo.php?script=s...
For example, in 2006, each one of the approximately 54,000 interviews carried out by VIGITEL cost BRL 31.15,2222. Moura EC, Morais NOL, Malta DC, Moura L, Silva NN, Bernal R, et al. Vigilância de Fatores de Risco para Doenças Crônicas por Inquérito Telefônico nas capitais dos 26 estados brasileiros e no Distrito Federal (2006). Rev Bras Epidemiol. [Internet]. 2008 maio [acesso em 06 jan 2021]; 11(Supl 1): 20-37. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2008000500003&lng=en doi: 10.1590/S1415-790X2008000500003
http://www.scielo.br/scielo.php?script=s...
while the cost per interview of the household survey carried out by the Health Surveillance Department and the National Cancer Institute (with a questionnaire similar to the one used by VIGITEL) was around BRL 147.00.2222. Moura EC, Morais NOL, Malta DC, Moura L, Silva NN, Bernal R, et al. Vigilância de Fatores de Risco para Doenças Crônicas por Inquérito Telefônico nas capitais dos 26 estados brasileiros e no Distrito Federal (2006). Rev Bras Epidemiol. [Internet]. 2008 maio [acesso em 06 jan 2021]; 11(Supl 1): 20-37. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2008000500003&lng=en doi: 10.1590/S1415-790X2008000500003
http://www.scielo.br/scielo.php?script=s...
Combined with lower cost, the agility in disseminating the main results of VIGITEL stands out (available just over two months after the end of data collection),88. Brasil. Ministério da Saúde. Secretaria de Vigilância. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019. Brasília: Ministério da Saúde; 2020. especially due to the immediate cleaning of the data soon after collection and its storage directly in electronic media.88. Brasil. Ministério da Saúde. Secretaria de Vigilância. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019. Brasília: Ministério da Saúde; 2020.

Among the limitations of the study, it should be pointed out that, despite the methodological differences, the development of the PNS questionnaire for the lifestyle module was based on the instrument already used by VIGITEL. However, issues inherent to the planning of surveys of this magnitude ended up inducing a series of differences in the questionnaires. Several possibilities must still be considered in order to find differences, such as, for example, the questions are not the same, different response options, or even an alteration in the order of the questions.2323. Galán I, Rodríguez-Artalejo F, Zorrilla B. Comparación entre encuestas telefónicas y encuestas "cara a cara" domiciliarias en la estimación de hábitos de salud y prácticas preventivas. Gac Sanit. [Internet]. 2004 maio [acesso em 06 jan 2021]; 18(Supl 2): 440-50. Disponível em: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112004000800005&lng=es doi: 10.1016/S0213-9111(04)72031-2
http://scielo.isciii.es/scielo.php?scrip...
The design of the present study is only sufficient to identify differences, but not their causes. Investigations in this sense would require studies with a specific design.

A second issue concerns the period of data collection for the surveys. PNS data collection started in the 8th month of VIGITEL’s data collection (August 2019) and was concluded only in March 2020, about 100 days after the conclusion of the 2019 VIGITEL. Such mismatch may impact some of the prevalences that are sensitive to seasonality (mainly the indicators of physical activity).2424. Turrisi TB, Bittel KM, West AB, Hojjatinia S, Hojjatinia S, Mama SK, et al. Seasons, weather, and device-measured movement behaviors: a scoping review from 2006 to 2020. Int J Behav Nutr Phys Act. [Internet] 2021 Fev 4 [acesso em 14 jun 2021]; 18(1): 24. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33541375/ doi: 10.1186/s12966-021-01091-1
https://pubmed.ncbi.nlm.nih.gov/33541375...
Additionally, behavioral changes induced by the onset of the COVID-19 pandemic (in early 2020) may have also been decisive for the discrepancies observed, especially in the indicators of physical activity and sedentary lifestyle. Finally, the small number of indicators validated in both surveys makes it impossible to certify which of the values would be closer to the real one, in the case of the observed discrepancies.

The interconnection between the surveys actually makes it possible to know the population's health status in detail and to identify the evolution of the main indicators. In general, both surveys showed prevalence with small differences, particularly in the case of the indicators of physical activity and sedentary behavior. However, estimates point to results in the same direction, especially in the stratification by sex and age. These results show the importance of different methodologies for monitoring the risk and protective factors of NCDs in the population, which contribute to improving the design of public policies for health promotion.

References

  • Financing

    Caldeira TCM received funding from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CNPq) (Financing code 001) and Claro RM received funding from the Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis from the Ministry of Health (Decentralized Implementation Term No. 89/2019).

Publication Dates

  • Publication in this collection
    08 Aug 2022
  • Date of issue
    2022

History

  • Received
    19 Apr 2021
  • Accepted
    08 Nov 2021
Secretaria de Vigilância em Saúde - Ministério da Saúde do Brasil Brasília - Distrito Federal - Brazil
E-mail: leilapgarcia@gmail.com