Internações em idosos e fatores contextuais associados no nordeste brasileiro

Abstract

This study aimed to investigate the hospitalizations of the elderly by cause group and conditions sensitive to primary care (ICSAP), identifying their relationship with contextual factors in the Northeast region of Brazil. A study with an ecological proposal was carried out by using secondary data from the Hospital Information System (SIH-SUS) to describe hospitalization rates by cause group and by ICSAP in the elderly aged 60 and over from the years 2010 to 2015. As a dependent variable, the hospital admission rate in the elderly was used by cause group and by ICSAP. Non-hierarchical cluster analysis (K-means) was performed by grouping the municipalities based on the groups of causes of general admissions and those sensitive to primary care, with 3 Clusters being formed, which were classified as high, intermediate and low hospitalization rates. For the association with the dependent variables, 11 independent socioeconomic contextual variables were selected, summarizing them through the Factor Analysis, with the extraction of the factors being performed by Principal Component Analysis (PCA). Therefore, a component called "Urbanization and its reflexes" was obtained, the second named "Favorable socioeconomic context" and the third entitled "Little education and necessity of the State". Other than these variables, the indexes of GINI, IDH, FIRJAN, the average coverage of primary care in the municipalities from the years 2010 to 2015, and the rate of the number of consultations in the elderly in basic care in the same period were used. The total hospitalization rate in the period was 1,212.60, with the greatest number being due to diseases of the circulatory system, followed by diseases of the respiratory system and infectious and parasitic diseases. The clusters of hospitalization rates differed significantly in relation to the contextual factors, so that the municipalities with the highest hospitalization rates presented the highest values for the favorable socioeconomic context, the highest values being related to the little education and state necessity of municipalities with lower hospitalization rates. In relation to the ICSAP, the total hospitalization rate was 527,524 (43.5% of all hospitalizations), with the highest number due to heart failure, followed by cerebrovascular diseases and infectious gastroenteritis. There was a significant difference between all the clusters and factors, where the cluster with the highest admission rates was the one that presented the highest averages for the favorable socioeconomic context and for little education and state necessity. The cluster with the lowest hospitalization rates had the highest averages for the "urbanization and its reflexes" factor. In the analysis of the coverage of primary care and the rate of consultations of the elderly in basic care, it was observed that the clusters did not differ significantly. Having this context in mind, one may conclude that in the elderly population of the Northeast there is a majority of hospitalizations due to diseases of the circulatory system and ICSAP due to heart failure. Contextual factors interfere significantly in hospitalizations of the elderly population, and it is important to analyze them in the construction of public health policies, taking into account the vulnerabilities of this population and contributing to health equity.