Individual and contextual characteristics associated to the functional limitation in Belo Horizonte, MG, 2002-2003: A multilevel analysis

Background: This study aimed to evaluate the relationship between neighborhood, household and individual characteristics with functional limitation for habitual activities (FLHA). Methods: 2253 Individuals (³15yo) living in Belo Horizonte, Brazil, from a multicenter household survey carried out by Brazilian National Cancer Institute (2003) reported functional status for habitual activities. The presence of FLHA related to the participants and its association with demographic characteristics: gender and age; individual perception: self perception of  health  (individual level variables); socioeconomics characteristics (total income, family’s head age and schooling (household level variables); and neighborhood characteristics (Health Vulnerability Index used for the City Health Department to classify the census tracts in 4 risk category - low, moderate, high and very high (contextual level variables) – it was analyzed. Multivariate multilevel analysis was performed by STATA software.
 Results: Among 2,492 interviewed, 278 (12,3%) reported FLHA. 54.4% were women, and were 37.9±16.7yo. In the final multilevel model were strongly associated with FLHA: female gender (OR=0,5; p=0,00), age (OR=1,1; p=0,000), bad self perception of health (OR=5,2; p=0,000) at the individual level and living in high (OR=2,7; p=0,000) and very high risk census tracts (OR=2,6; p=0,008) at the contextual level. The second level variables were not associated with FLHA. Conclusions: Functional limitation among urban Brazilians has been changing not only throughout the life, as they have been influenced by factors related to the bad conditions of life. Adult women, living in area of high risk and very high risk of the health vulnerability proportionally have been the ones that were more related to limitations/difficulties to do its habitual activities. The results point out the necessity of specific interventions directing the most vulnerable population.