{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T03:10:51Z","timestamp":1778728251712,"version":"3.51.4"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T00:00:00Z","timestamp":1638576000000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between \u2212\u20092.16 and\u2009\u2212\u20092.18 percentage points), kidney failure (between \u2212\u20091.01 and\u2009\u2212\u20091.19 p.p.), and arterial hypertension (between \u2212\u20091.48 and\u2009\u2212\u20091.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between \u2212\u20091.8 and\u2009\u2212\u20092 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-021-07329-9","type":"journal-article","created":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T08:03:27Z","timestamp":1638605007000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Primary care coverage and individual health: evidence from a likelihood\u00a0model using biomarkers in Brazil"],"prefix":"10.1186","volume":"21","author":[{"given":"Fernando Antonio Slaibe","family":"Postali","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Dolores Montoya","family":"Diaz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia Nunes","family":"Ferreira-Batista","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriano Dutra","family":"Teixeira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo","family":"Moreno-Serra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,12,4]]},"reference":[{"key":"7329_CR1","doi-asserted-by":"publisher","first-page":"e0182336","DOI":"10.1371\/journal.pone.0182336","volume":"12","author":"ML Bastos","year":"2017","unstructured":"Bastos ML, Menzies D, Hone T, Dehghani K, Trajman A. The impact of the Brazilian family health strategy on selected primary care sensitive conditions: a systematic review. PLoS One. 2017;12:e0182336.","journal-title":"PLoS One"},{"key":"7329_CR2","doi-asserted-by":"publisher","first-page":"87","DOI":"10.2105\/AJPH.2007.127480","volume":"99","author":"R Aquino","year":"2009","unstructured":"Aquino R, de Oliveira NF, Barreto ML. Impact of the family health program on infant mortality in Brazilian municipalities. Am J Public Health. 2009;99:87\u201393.","journal-title":"Am J Public Health"},{"key":"7329_CR3","doi-asserted-by":"crossref","unstructured":"Bhalotra SR, Rocha R, Soares RR. Does universalization of healthwork? Evidence from health systems restructuring and expansion in Brazil. IZA Discussion Paper No. 12111. 2019. https:\/\/ssrn.com\/abstract=3390099","DOI":"10.2139\/ssrn.3390099"},{"issue":"Suppl 4","key":"7329_CR4","doi-asserted-by":"publisher","first-page":"S593","DOI":"10.2105\/AJPH.2013.301452r","volume":"105","author":"FC Guanais","year":"2015","unstructured":"Guanais FC. The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998\u20132010. Am J Public Health. 2015;105(Suppl 4):S593\u20139 S85\u201392.","journal-title":"Am J Public Health"},{"key":"7329_CR5","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1136\/jech.2005.038323","volume":"60","author":"J Macinko","year":"2006","unstructured":"Macinko J, Guanais FC, de F\u00e1tima M, de Souza M. Evaluation of the impact of the family health program on infant mortality in Brazil, 1990-2002. J Epidemiol Community Health. 2006;60:13\u20139.","journal-title":"J Epidemiol Community Health"},{"key":"7329_CR6","doi-asserted-by":"publisher","first-page":"2070","DOI":"10.1016\/j.socscimed.2007.06.028","volume":"65","author":"J Macinko","year":"2007","unstructured":"Macinko J, Marinho de Souza Mde F, Guanais FC, da Silva Sim\u00f5es CC. Going to scale with community-based primary care: an analysis of the family health program and infant mortality in Brazil, 1999\u20132004. Soc Sci Med. 2007;65:2070\u201380.","journal-title":"Soc Sci Med"},{"issue":"Suppl","key":"7329_CR7","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1002\/hec.1607","volume":"19","author":"R Rocha","year":"2010","unstructured":"Rocha R, Soares RR. Evaluating the impact of community-based health interventions: evidence from Brazil's family health program. Health Econ. 2010;19(Suppl):126\u201358.","journal-title":"Health Econ"},{"key":"7329_CR8","doi-asserted-by":"publisher","first-page":"g4014","DOI":"10.1136\/bmj.g4014","volume":"349","author":"D Rasella","year":"2014","unstructured":"Rasella D, Harhay MO, Pamponet ML, Aquino R, Barreto ML. Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data. BMJ. 2014;349:g4014.","journal-title":"BMJ."},{"key":"7329_CR9","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1377\/hlthaff.2016.0966","volume":"36","author":"T Hone","year":"2017","unstructured":"Hone T, Rasella D, Barreto M, Atun R, Majeed A, Millett C. Large reductions in amenable mortality associated with Brazil's primary care expansion and strong health governance. Health Aff (Millwood). 2017;36:149\u201358.","journal-title":"Health Aff (Millwood)."},{"key":"7329_CR10","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.5588\/ijtld.17.0907","volume":"22","author":"RA de Souza","year":"2018","unstructured":"de Souza RA, Nery JS, Rasella D, Guimar\u00e3es Pereira RA, Barreto ML, Rodrigues L, et al. Family health and conditional cash transfer in Brazil and its effect on tuberculosis mortality. Int J Tuberc Lung Dis. 2018;22:1300\u20136.","journal-title":"Int J Tuberc Lung Dis"},{"key":"7329_CR11","unstructured":"Diaz MDM, Teixeira AD, Postali FAS, Ferreira-Batista NN, Moreno-Serra R. Assessment of the Brazilian primary health care impacts on adult premature mortality. Working paper, University of Sao Paulo; 2019. https:\/\/ideas.repec.org\/p\/spa\/wpaper\/2019wpecon42.html."},{"key":"7329_CR12","doi-asserted-by":"publisher","first-page":"2149","DOI":"10.1377\/hlthaff.2010.0251","volume":"29","author":"J Macinko","year":"2010","unstructured":"Macinko J, Dourado I, Aquino R, Bonolo Pde F, Lima-Costa MF, Medina MG, et al. Major expansion of primary care in Brazil linked to decline in unnecessary hospitalization. Health Aff (Millwood). 2010;29:2149\u201360.","journal-title":"Health Aff (Millwood)"},{"key":"7329_CR13","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.2105\/AJPH.2010.198887","volume":"101","author":"J Macinko","year":"2011","unstructured":"Macinko J, de Oliveira VB, Turci MA, Guanais FC, Bonolo PF, Lima-Costa MF. The influence of primary care and hospital supply on ambulatory care-sensitive hospitalizations among adults in Brazil, 1999-2007. Am J Public Health. 2011;101:1963\u201370.","journal-title":"Am J Public Health"},{"key":"7329_CR14","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1590\/1809-4503201400040014","volume":"17","author":"RF Ceccon","year":"2014","unstructured":"Ceccon RF, Meneghel SN, Viecili PR. Hospitalization due to conditions sensitive to primary care and expansion of the family health program in Brazil: an ecological study. Rev Bras Epidemiol. 2014;17:968\u201377.","journal-title":"Rev Bras Epidemiol."},{"key":"7329_CR15","doi-asserted-by":"publisher","first-page":"e0198428","DOI":"10.1371\/journal.pone.0198428","volume":"13","author":"DFB Cavalcante","year":"2018","unstructured":"Cavalcante DFB, Brizon VSC, Probst LF, Meneghim MC, Pereira AC, Ambrosano GMB. Did the family health strategy have an impact on indicators of hospitalizations for stroke and heart failure? Longitudinal study in Brazil: 1998-2013. PLoS One. 2018;13:e0198428.","journal-title":"PLoS One"},{"key":"7329_CR16","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1590\/1413-81232018236.05072018","volume":"23","author":"LF Pinto","year":"2018","unstructured":"Pinto LF, Freitas MPS, Figueiredo AWS. National information and population survey systems: selected contributions from the ministry of health and the IBGE for analysis of Brazilian state capitals over the past 30 years. Cien Saude Colet. 2018;23:1859\u201370.","journal-title":"Cien Saude Colet"},{"key":"7329_CR17","doi-asserted-by":"publisher","first-page":"207","DOI":"10.5123\/S1679-49742015000200003","volume":"24","author":"PRB de Souza-J\u00fanior","year":"2015","unstructured":"de Souza-J\u00fanior PRB, De Freitas MPS, de Abreu AG, Szwarcwald CL. Desenho da amostra da pesquisa nacional de Sa\u00fade 2013. Epidemiol Serv Sa\u00fade. 2015;24:207\u201316.","journal-title":"Epidemiol Serv Sa\u00fade"},{"issue":"Suppl 02","key":"7329_CR18","first-page":"E190004","volume":"22","author":"CL Szwarcwald","year":"2019","unstructured":"Szwarcwald CL, Malta DC, Souza J\u00fanior PRB, Almeida WDS, Damacena GN, Pereira CA, et al. Laboratory exams of the national health survey: methodology of sampling, data collection and analysis. Rev Bras Epidemiol. 2019;22(Suppl 02):E190004 supl.2.","journal-title":"Rev Bras Epidemiol"},{"issue":"Suppl 02","key":"7329_CR19","first-page":"E190010","volume":"22","author":"DC Malta","year":"2019","unstructured":"Malta DC, Machado \u00cdE, Pereira CA, Figueiredo AW, Aguiar LK, Almeida WDS, et al. Evaluation of renal function in the Brazilian adult population, according to laboratory criteria from the national health survey. Rev Bras Epidemiol. 2019;22(Suppl 02):E190010 supl.2.","journal-title":"Rev Bras Epidemiol."},{"key":"7329_CR20","unstructured":"Fiocruz. Resultados dos exames laboratoriais [data set]. IBGE\/Fiocruz. 2019. https:\/\/www.pns.icict.fiocruz.br\/index.php?pag=resultados_ms. Accessed 26 Feb 2021."},{"key":"7329_CR21","unstructured":"Datasus. Minist\u00e9rio da Sa\u00fade. 2020. https:\/\/datasus.saude.gov.br\/transferencia-de-arquivos\/. Accessed 25 Feb 2021."},{"key":"7329_CR22","unstructured":"PNS. Pesquisa nacional de Sa\u00fade [data set]. Instituto Brasileiro de Geografia e estat\u00edstica. 2013. https:\/\/www.ibge.gov.br\/estatisticas\/sociais\/saude\/9160-pesquisa-nacional-de-saude.html?=&t=downloads. Accessed 25 Feb 2021."},{"key":"7329_CR23","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.socscimed.2013.12.018","volume":"105","author":"CJ Riumallo-Herl","year":"2014","unstructured":"Riumallo-Herl CJ, Kawachi I, Avendano M. Social capital, mental health and biomarkers in Chile: assessing the effects of social capital in a middle-income country. Soc Sci Med. 2014;105:47\u201358.","journal-title":"Soc Sci Med"},{"key":"7329_CR24","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1002\/hec.3372","volume":"26","author":"V Carrieri","year":"2017","unstructured":"Carrieri V, Jones AM. The income-health relationship 'beyond the mean': new evidence from biomarkers. Health Econ. 2017;26:937\u201356.","journal-title":"Health Econ"},{"key":"7329_CR25","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/B978-0-12-815859-3.00022-6","volume-title":"Panel data econometrics","author":"A Davillas","year":"2019","unstructured":"Davillas A, Jones AM, Benzeval M. The income-health gradient: evidence from self-reported health and biomarkers in understanding society. In: Tsionas M, editor. Panel data econometrics. Massachusetts: Academic Press; 2019. p. 709\u201341."},{"key":"7329_CR26","doi-asserted-by":"publisher","first-page":"102251","DOI":"10.1016\/j.jhealeco.2019.102251","volume":"69","author":"A Davillas","year":"2020","unstructured":"Davillas A, Jones AM. Ex ante inequality of opportunity in health, decomposition and distributional analysis of biomarkers. J Health Econ. 2020;69:102251.","journal-title":"J Health Econ"},{"key":"7329_CR27","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1002\/hec.3814","volume":"27","author":"V Carrieri","year":"2018","unstructured":"Carrieri V, Jones AM. Inequality of opportunity in health: a decomposition-based approach. Health Econ. 2018;27:1981\u201395.","journal-title":"Health Econ"},{"key":"7329_CR28","doi-asserted-by":"publisher","first-page":"102356","DOI":"10.1016\/j.jhealeco.2020.102356","volume":"73","author":"A Davillas","year":"2020","unstructured":"Davillas A, Pudney S. Using biomarkers to predict healthcare costs: evidence from a UK household panel. J Health Econ. 2020;73:102356.","journal-title":"J Health Econ"},{"key":"7329_CR29","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/j.socscimed.2018.04.007","volume":"209","author":"PV Nersesian","year":"2018","unstructured":"Nersesian PV, Han HR, Yenokyan G, Blumenthal RS, Nolan MT, Hladek MD, et al. Loneliness in middle age and biomarkers of systemic inflammation: findings from midlife in the United States. Soc Sci Med. 2018;209:174\u201381.","journal-title":"Soc Sci Med"},{"key":"7329_CR30","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s00148-012-0409-9","volume":"26","author":"H J\u00fcrges","year":"2013","unstructured":"J\u00fcrges H, Kruk E, Reinhold S. The effect of compulsory schooling on health\u2014evidence from biomarkers. J Popul Econ. 2013;26:645\u201372.","journal-title":"J Popul Econ"},{"key":"7329_CR31","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1086\/657020","volume":"4","author":"N Powdthavee","year":"2010","unstructured":"Powdthavee N. Does education reduce the risk of hypertension? Estimating the biomarker effect of compulsory schooling in England. J Hum Cap. 2010;4:173\u2013202.","journal-title":"J Hum Cap"},{"key":"7329_CR32","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/j.socscimed.2018.11.033","volume":"220","author":"E Courtin","year":"2019","unstructured":"Courtin E, Nafilyan V, Avendano M, Meneton P, Berkman LF, Goldberg M, et al. Longer schooling but not better off? A quasi-experimental study of the effect of compulsory schooling on biomarkers in France. Soc Sci Med. 2019;220:379\u201386.","journal-title":"Soc Sci Med"},{"key":"7329_CR33","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1590\/S0102-311X2009000600016","volume":"25","author":"ME Alfradique","year":"2009","unstructured":"Alfradique ME, Bonolo Pde F, Dourado I, Lima-Costa MF, Macinko J, Mendon\u00e7a CS, et al. Interna\u00e7\u00f5es por condi\u00e7\u00f5es sens\u00edveis \u00e0 aten\u00e7\u00e3o prim\u00e1ria: a constru\u00e7\u00e3o da lista brasileira como ferramenta para medir o desempenho do sistema de sa\u00fade (Projeto ICSAP - Brasil). Cad Saude Publica. 2009;25:1337\u201349.","journal-title":"Cad Saude Publica"},{"key":"7329_CR34","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1093\/ije\/dyx039","volume":"46","author":"J Benjamin-Chung","year":"2017","unstructured":"Benjamin-Chung J, Abedin J, Berger D, Clark A, Jimenez V, Konagaya E, et al. Spillover effects on health outcomes in low- and middle-income countries: a systematic review. Int J Epidemiol. 2017;46:1251\u201376.","journal-title":"Int J Epidemiol"},{"key":"7329_CR35","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1093\/ije\/dyz010","volume":"48","author":"TJ VanderWeele","year":"2019","unstructured":"VanderWeele TJ, Christakis NA. Network multipliers and public health. Int J Epidemiol. 2019;48:1032\u20137.","journal-title":"Int J Epidemiol"},{"issue":"Suppl 02","key":"7329_CR36","first-page":"e190002","volume":"22","author":"CL Szwarcwald","year":"2019","unstructured":"Szwarcwald CL, Malta DC, Pereira CA, Figueiredo AW, Almeida WDS, Machado \u00cdE, et al. Reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine of the Brazilian adult population. Rev Bras Epidemiol. 2019;22(Suppl 02):e190002 supl.2.","journal-title":"Rev Bras Epidemiol."},{"issue":"Suppl 02","key":"7329_CR37","first-page":"E190006","volume":"22","author":"DC Malta","year":"2019","unstructured":"Malta DC, Duncan BB, Schmidt MI, Machado \u00cdE, Silva AGD, Bernal RTI, et al. Prevalence of diabetes mellitus as determined by glycated hemoglobin in the Brazilian adult population, national health survey. Rev Bras Epidemiol. 2019;22(Suppl 02):E190006 supl.2.","journal-title":"Rev Bras Epidemiol."},{"issue":"Suppl 02","key":"7329_CR38","first-page":"E190008","volume":"22","author":"\u00cdE Machado","year":"2019","unstructured":"Machado \u00cdE, Malta DC, Bacal NS, Rosenfeld LGM. Prevalence of anemia in Brazilian adults and elderly. Rev Bras Epidemiol. 2019;22(Suppl 02):E190008 supl.2.","journal-title":"Rev Bras Epidemiol."},{"key":"7329_CR39","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1182\/asheducation.V2012.1.191.3798260","volume":"2012","author":"R Stasi","year":"2012","unstructured":"Stasi R. How to approach thrombocytopenia. Hematol Am Soc Hematol Educ Program. 2012;2012:191\u20137.","journal-title":"Hematol Am Soc Hematol Educ Program"},{"issue":"2","key":"7329_CR40","doi-asserted-by":"publisher","first-page":"197","DOI":"10.5123\/S1679-49742015000200002","volume":"24","author":"GN Damacena","year":"2015","unstructured":"Damacena GN, Szwarcwald CL, Malta DC, Souza J\u00fanior PRB, Pontes Vieira MLF, Pereira CA, et al. O processo de desenvolvimento da Pesquisa Nacional de Sa\u00fade no Brasil, 2013. Epidemiol Serv Sa\u00fade. 2015;24(2):197\u2013206.","journal-title":"Epidemiol Serv Sa\u00fade"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-021-07329-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-021-07329-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-021-07329-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T20:06:40Z","timestamp":1638648400000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-021-07329-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["7329"],"URL":"https:\/\/doi.org\/10.1186\/s12913-021-07329-9","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"9 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All methods employed in this study were carried out in accordance with relevant guidelines and regulations, mainly the Brazilian National Health Council (CNS) Resolution 466\/2012. The authors of this paper had no participation in the data collection, which was carried out by two governmental institutions in Brazil and were made publicly available on the internet. We do not have any access to personal information about the participants, which are kept confidential by Fiocruz. The Brazilian legislation (Resolution 510, of April 7, 2016, from the National Health Council\/Health Ministry) establishes that studies that use information with public access will not be registered or evaluated by the Research Ethics Committee. This study fits into that category. The Brazilian National Health Survey (PNS 2013) methodology, including the collection of biomarkers, was approved by the National Commission for Ethics in Research (CONEP: ) under #10853812.7.0000.0008 []. All respondents have signed a Free and Informed Consent Term [], whose model can be found in . Accessed 20 October 2021 [, ]..","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1300"}}