Marciane Kessler

Universidade Regional Integrada do Alto Uruguai e das Missoes, Brazil

Title: Family Health Strategy, Modifiable Risk Factors, and Health Equity Among Older Adults in Southern Brazil

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Biography

Marciane Kessler is a nurse and researcher in Public Health and Epidemiology. She holds a Bachelor's degree in Nursing from UDESC, a Master's from UFSM, and a PhD in Nursing from UFPel, Brazil, with postdoctoral training in Epidemiology at UFPel and research experience at University College London. She is currently a faculty member at URI, Erechim, Brazil. Her research focuses on ageing, social determinants of health, health inequalities, primary health care, health promotion, and health services.

Abstract

Objective: To examine the contribution of modifiable risk factors to mortality among older adults in Bagé, Southern Brazil, and discuss the role of Primary Health Care (PHC) and the Family Health Strategy (FHS) in reducing health inequalities.

Methods: We analyzed data from the population-based SIGa-Bagé cohort, including adults aged 60 years and older followed for nine years. Five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity, and physical inactivity. Mortality was identified through linkage with mortality registers. Associations between risk factors and all-cause mortality were estimated using Cox proportional hazards models, adjusting for age, sex, other risk factors, and socioeconomic position. The study also evaluated the association between FHS coverage, wealth, and mortality.

Results: During the nine-year follow-up, 638 participants in the SIGa-Bagé cohort died in the analysis of modifiable risk factors, while 579 deaths were identified among participants included in the FHS analysis. Physical inactivity had the strongest population-level contribution to mortality (population attributable fraction: 16.7%), followed by current smoking (4.9%). Mortality increased progressively with the number of risk factors. Socioeconomic inequalities in mortality persisted after adjustment for major risk factors. However, FHS coverage modified the association between wealth and mortality, providing protection among the poorest older adults against all-cause mortality (HR=0.59; 95% CI: 0.36–0.96) and avoidable mortality (HR=0.46; 95% CI: 0.25–0.85).

Conclusion: Mortality among older adults in Bagé is strongly influenced by modifiable behaviors and socioeconomic inequalities. The findings highlight the importance of strengthening PHC and the FHS to address both individual risk factors and the social determinants of health. Nurses play a central role in this process through health promotion, prevention, risk assessment, education, continuity of care, and community-based interventions. By identifying vulnerable older adults and facilitating equitable access to comprehensive care, nursing professionals can contribute to reducing avoidable mortality and promoting health equity in ageing communities.