Armed violence and shootouts in Rio de Janeiro: relevance to impoverished communities and primary care health...

This article aims to analyze the effect of armed violence, operationalized as recorded shooting events, on communities and primary healthcare services in Rio de Janeiro. The models incorporate data from 1,500 interviewees and their respective territories and health services. The mediation analysis uses a proxy for the effects of violence on the operation of these services: the presence/absence of doctors in primary care health teams. Despite the use of a single proxy for a complex situation that substantially affects primary care services in underserved territories, the observed effect was pronounced, corresponding to a 20-30% modulation of the associations between armed violence and self-reported systemic arterial hypertension, diabetes, and depression. The simple association was not significant for self-reported anxiety, after controlling for intervening variables, but mediation was. The findings support the integrated analysis of data from residents in these communities, information about territories, and the operation of services, using appropriate analytic strategies. Such studies have a diagnostic function and support policies that understand urban health in an integrated manner and promote structural interventions.