Requalificação urbana e internações por asma em crianças e adolescentes residentes em Belo Horizonte, projeto BH-viva: buscando associações e descortinando desigualdades das áreas vulneráveis

Abstract

Asthma is a disease that causes the inflammation of the airways of the lungs, and one of the main causes of hospitalization on Brazil's Universal Healthcare System (Sistema Único de Saúde - SUS) among children and adolescents. It is a condition that answers well to primary attention, is potentially avoidable and has a great impact on the economy and healthcare systems.The BH-VIVA Project investigates the impact of investment in housing and rehabilitation of vulnerable areas, carried out by the Viva Viva Program (PVV), on the health and well-being of individuals. We have hypothesized thatthe rates of hospitalization for asthma among the villages is higher than in the formal city (“cidade formal”- CF). The objective was to analyze whether there is a difference in the occurrence of hospitalizations rates for asthma in children and adolescents residents in areas with and without PVV intervention. This is a descriptive and cross-sectional study, with hospitalization data collected from SUS, and it has analyzed the asthma hospitalization rates from 2002 to 2018, by gender, age and Health Vulnerability Index (HVI). It has analyzed: 4 villages with intervention (VCI), 4 villages without intervention (VSI) and the CF.Descriptive analyzes were performed, as well as temporary trends and estimation of hospitalization risks. The risks have been calculated using the Poisson regression model, with the rates being the explanatory variable. The differences between rates are due to the relative risks and the 95% confidence gaps (p<0,05). For each data series, we have estimated the trend line, the regression equation, the determination coefficient (R²) and the chloroplastic maps.The results have shown a significant downward trend in hospitalization rates in the period for all units of analysis; it found prevalence of hospitalizations of males and children from 0-4 years old, with 50% of the complete database and 75% between 0-19 years old. Due to the relevance of asthma on children aging 0-4 years, the results have been deepened in this group. Seasonality was observed in hospitalizations on the period between March and May. The average rates for the period were 2006.5; 1698.5 and 965.8 for 100 thousand inhabitants, respectively in the VCI, VSI and CF. There was a reduction in the VCI rate (53.67%), the VSI rate (65.21%) and CF rate (71.45%). The average rates for VSI in the villages were higher in areas of medium risk and, in CF, in areas of high/very high risk. In BH, the "Criança que Chia" program was an initiative that contributed to reducing hospital admissions and ambulatory asthma control. The PVV program may have contributed to the reduction of unhealthy conditions and the improvement of asthmatic children's life quality in general. However, despite significantly higher rates in the "vilas", the reduction in hospitalizations has occurred on the city in general, and it was not possible to identify the real direct influence of the PVV program. Thus, the need for investments in actions and multisectoral programs is reinforced to reduce the rates of hospitalization for asthma in children and adolescents in vulnerable areas, so that the mitigation of the disease occurs equitably in the areas of the city. Further studies are recommended, which make it possible to explore in more depth the relationships between urban rehabilitation interventions and hospitalizations for asthma in children and adolescents.