Pessoas em situação de rua em Salvador/Ba: perfil ocupacional e prevalência de acidentes de trabalho.

Abstract

Introduction: Homeless individuals (HIs) form a vulnerable group that has historically faced poor conditions such as poverty, lack of adequate housing, and deprivation of social rights. In Brazil, HIs are often male, black, with low educational levels, and of working age. With little or no social assistance or formal income, HIs usually engage in various informal economic activities commonly referred to as "corre" to survive. The term "corre" can be considered as any type of labor activity that generates income and ensures subsistence needs, usually food and hygiene. However, these activities are often conducted under unhealthy conditions, with exhaustive work hours predisposing HIs to multiple physical, chemical, ergonomic agents among others, thereby posing health risks and the occurrence of Occupational Accidents (OAs). Information on occupational profile, work process, frequency of OAs, and health consequences among HIs is limited in Brazil. These knowledge gaps often hinder the formulation of adequate public policies, especially professional training programs that could mitigate the daily challenges faced by nearly 236,000people currently facing homelessness in Brazil. Objective: To describe the socio-occupational profile, prevalence of OAs, and the associated factors among HIs in Salvador/BA, from 2021 to 2022. Methodology: Observational epidemiological cross-sectional study with a convenience sample of HIs aged ≥18 years located in public spaces or municipal shelter units in the municipality of Salvador/BA, with data collected from September 2021 to February 2022. A total of 529 individuals participated, from four municipal geographic areas (Health Districts) chosen based on a history of high concentration of His and aligned with the structure of municipal street clinic teams. Structured questionnaires were administered individually by a team of interviewers using mobile devices with REDCap software. The study was approved by the Research Ethics Committee of the Gonçalo Moniz Institute of the Oswaldo Cruz Foundation (IGM/Fiocruz), with protocol No. 42517021.0.0000.0040 in compliance with the resolutions 466/12 and 510/16, all participants consented and signed the Informed Consent Form (ICF). Initially, descriptive analyses of the demographic and occupational profile, as well as OAs prevalence were performed. In the crude analysis, Prevalence Ratios (PR) were calculated to identify possible associations. Variables included in the full multivariable model were selected mainly based on theoretical criteria. We chose to build a parsimonious model, in which the variables that presented PRaj ≥1.10 remained in the final model. Data set construction, organization, and cleaning, as well as statistical analyses, were performed using R software, version 4.2.3 (x64). Results: The predominant socio-demographic and occupational profile corresponded to cisgender males (70.9%), black individuals (91.6%), with no education or only elementary education (73%), engaged in scavenging activities (30.9%), sales (28.3%), and general services (20%). Among the interviewees, the frequency of engaging in "corre" activities was 81.9%, though when asked if they were working, this frequency was much lower, at 26.7%. Regarding the outcome OAs, the overall prevalence was 31.4%, with associations found for age group ≥50 years (PR: 1.13), brown ethnicity (PR: 1.18), alcohol consumption (PR: 1.18), working ≥13h/day (PR: 1.16), experiencing violence during "corre" (PR: 1.23), and having no monthly income (PR: 1.15). Conclusions: Low frequencies of HIs were identified who recognize their activities as "work", referring to them as “corre”. Groups with higher probabilities of experiencing OAs are represented by individuals aged ≥50 years, brown race/color, alcoholics, working ≥13 hours/day, reporting violence during work or "corre", and who had no monthly income. The lack of recognition of interpersonal violence as OAs contributes to occupational vulnerability. Besides recognizing HIs activities as work, training, formal opportunities, and policies for social/professional reintegration are necessary to reduce time spent on the streets.