Primary care attributes among public health service users and perceived discrimination based on sexual orientation in Brazilian municipalities: evidences from ELSI-Brazil

The impact of primary care on reducing discrimination is still unknown in Brazil. This study aimed to assess the association between problems in primary care attributes and discrimination based on sexual orientation in Brazilian municipalities perceived by adults aged 50 years and over who exclusively use the public health services. Cross-sectional nationally representative study derived from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2019-21, summing 6,663 participants who exclusively use the public health system. The outcome was the self-reported perceived discrimination based on sexual orientation in Brazilian municipalities. The number of problems in primary care attributes, up to 12, included situations related to primary care attributes (access; continuity of care; communication; and care coordination and resolution). Logistic Regression models were used in the statistical analysis, adjusted for sociodemographic characteristics, prior discrimination experience, municipality size, Family Health Strategy coverage, and participation in outside activities. Perceived discrimination based on sexual orientation in Brazilian municipalities was associated with experiencing ≥ 5 problems in primary care attributes (OR = 1.52; 95%CI 1.02; 2.28), after accounting for all covariates. We identified statistically significant negative interactions for both prior discrimination experience and Family Health Strategy coverage, where the observed joint effect (OR = 2.41, 95%CI 1.41; 4.10 and OR = 1.56, 95%CI 0.82; 2.97, respectively) were lower than the expected joint effect. The findings highlight the critical role of high-quality, accessible, and responsive primary care in mitigating perceived inequities, particularly among users of the public health system. Although the Family Health Strategy and prior discrimination experience attenuate this association, municipality size and number of medical appointments are not key factors and further research is needed to elucidate the specific mechanisms.