Mortalidade e internações hospitalares entre crianças no Brasil e na Macrorregião Nordeste: estudo ecológico de série temporal (2000-2019)

Abstract

Child morbidity and mortality in Brazil has shown a significant decrease in recent decades; however, mortality rates remain high when compared to countries with a Human Development Index considered to be very high. In addition, social problems and inequities are still very evident and require the promotion of effective public policies. However, since the beginning of the millennium, it is possible to observe a government effort in favor of child health, actions that have contributed to the improvement of mortality and hospitalization rates in the country, a fact that motivated the development of this dissertation. This is an ecological, time-series study with a quantitative approach, based on secondary data on hospital mortality and morbidity in children (<1 year), in childhood (<5 years) and in children between 5 and 14 years old, in Brazil and in the Northeast Macroregion, between 2000 and 2019. Data collection took place from January to August 2024 through the Mortality, Live Births, Hospital Admissions and Resident Population Information System via the Brazilian Institute of Geography and Statistics - IBGE. Trend analysis was carried out using the Joinpoint statistical software. In Brazil and the Northeast, a trend of significant reduction was observed until 2014 in infant and childhood mortality rates; after that year, the curve followed a stationary behavior. Among children aged 5 to 14 years, there was a continuous downward trend, with regional and temporal variations, with a greater decrease after 2013 in the country and in 2012 in the Northeast. In hospital admission rates, there are more fluctuations in values, among children under 1 year of age there is a significant decrease in the coefficient, however, after the inflection year, in 2014, in Brazil and, in 2011, in the Northeast, there is a vertiginous increase in hospitalizations, with a similar scenario occurring among children under 5 years of age, with the change occurring in the years 2015 and 2008, respectively. Among children aged 5 to 14 years, an opposite scenario is evident in the country, where the greatest reduction occurs after the inflection point in the period of 2010. In the Northeast, however, it continues to decrease until the year 2017, presenting a behavior of growth in the rate. Black children indicated a higher percentage of deaths, being more prevalent in the male sex, compared to the female sex, with diseases originating in the perinatal period as the main cause of death among children between 1 year and 5 years of age and external causes of morbidity and mortality among those aged 5 to 14 years. During the two decades, it was possible to observe significant advances in the reduction of morbidity and mortality in both scenarios. However, advances in social indicators and health care actions have been severely affected by austerity measures, constituting a challenge for the country to strengthen the maintenance and evolution of public policies.