Prevalência de fraturas e utilização de serviços de fisioterapia: Um estudo de base populacionalThe burden of fractures in Brazil: a population-based study Introduction: The elderly population is growing fast worldwide, and therefore, investigation of health outcomes peculiar to these individuals is a public health priority nowadays. The decade between 2000-2010 is denominated as the Bone and Joint Decade, and researchers are encouraged to quantity the burden of musculo-skeletal disorders worldwide. This is particularly relevant to developing countries, where the burden of these diseases is not well known. This study aims to evaluate the prevalence of fractures (lifetime and previous year) and its association with socio-demographic variables and medical diagnosis of osteoporosis. Materials and methods: Population-based cross-sectional study including a multiple-stage sample of individuals aged 20 years or more living in Pelotas, a southern Brazilian city. Both the lifetime prevalence of fractures and the proportion of fractures in the year prior to the interview were investigated. Sex, age, skin color, socioeconomic level, schooling level and medical diagnosis of osteoporosis were used as independent variables. After descriptive and crude analyses, a Poisson regression was carried out in order to provide prevalence ratios including adjustment for confounding. Results: The lifetime prevalence of fractures was 28.3%, and 2.3% of the individuals broke a bone in the year prior to the interview. Among men, most fractures were caused by sports practice and happened in leisure-time outside home. Among women, most fractures occurred inside home and were caused by falls. The lifetime prevalence of fractures was positively associated with male sex and white or mixed skin color. The prevalence of fractures in the year prior to the interview was greater among the poorest and individuals with a medical diagnosis of osteoporosis. Among all fractures happened in older adults (=60 years) in the 12 months prior to the interview, 83.3% were caused by falls. Conclusions: Data of this investigation might help policy makers to reduce the burden of fractures, particularly among women and older adults, by stimulating prevention against household falls and osteoporosis. Special attention should be given to the poorest individuals, because they present a higher risk of fractures, as well as several other health negative outcomes. Key words: fracture, osteoporosis, epidemiology, falls, musculo-skeletal disorders. Aims: (a) To determine the lifetime utilization of physiotherapy; (b) to estimatethe prevalence of physiotherapy utilization in the year prior to the interview; (c)to explore the association between physiotherapy utilization and gender, age,skin color, socioeconomic level and schooling. Methods: Population-based cross-sectional study, including 3100 subjectsaged 20 years or more living in the urban area of Pelotas, southern Brazil. Thesample was selected following a multiple-stage protocol; the census tractsdelimited by the Brazilian Institute of Geography and Statistics were the primarysample units. Following descriptive and crude analyses, Poisson regressionmodels taking the clustering of the sample into account were carried out. Results: The lifetime utilization of physiotherapy was 30.2%; and physiotherapyutilization in the 12 months prior to the interview was reported by 4.9%. Women,elderly subjects, and those from higher socioeconomic levels were more likelyto use physiotherapy. Restricting analysis to individuals who attendedphysiotherapy, 66% used public health services, 25% used insurance healthservices and 9% had private sections. Conclusions: Utilization of physiotherapy in this Brazilian sample was lowerthan reported in both developed and developing countries. To the best of ourknowledge, this is the first population-based study on physiotherapy utilizationcarried out in Brazil. Our data might help public health authorities to organizethe health service in terms of this important demand.Key words: physiotherapy, epidemiology, socioeconomic level, inequities,health services utilization. Objetivos: (a) Determinar a prevalência de utilização de serviços defisioterapia na vida; (b) estimar a prevalência de uso de fisioterapia no anoanterior à entrevista; (c) explorar a associação entre a utilização de fisioterapiae sexo, idade, cor da pele, padrão de consumo socioeconômico e escolaridade. Métodos: Estudo transversal de base populacional incluindo 3100 indivÃduoscom 20 anos de idade ou mais residentes na zona urbana de Pelotas, RS,Brasil. A amostra foi selecionada em múltiplos estágios, sendo que as unidadesamostrais primárias foram os setores censitários delimitados pelo InstitutoBrasileiro de Geografia e EstatÃstica. Após análises descritivas e brutas,modelos de regressão de Poisson foram utilizados, levando em consideração aestratégia amostral por conglomerados. Resultados: A prevalência de utilização de fisioterapia na vida foi de 30,2%,sendo que 4,9% dos entrevistados usaram algum serviço de fisioterapia nos 12meses anteriores à entrevista. Mulheres, idosos e pessoas de nÃvelsocioeconômico alto apresentaram maior uso de fisioterapia. Entre os usuáriosde fisioterapia, 66% usaram o Sistema Único de Saúde, 25% usaram planos desaúde ou convênios e 9% tiveram consultas particulares. Conclusões: A utilização de fisioterapia nesta amostra brasileira foi menor doque a relatada em paÃses desenvolvidos e em desenvolvimento. Com base narevisão de literatura, este é o primeiro estudo de base populacional sobreutilização de fisioterapia no Brasil. Nossos dados podem ajudar as autoridadesde saúde na organização do sistema de saúde para atender esta importantedemanda. Palavras chave: fisioterapia, epidemiologia, nÃvel socioeconômico, iniqüidade,utilização de serviços de saúde. | 
