Fatores associados ao óbito em internação hospitalar por acidente vascular cerebral no Sistema Único de Saúde do Brasil de 2018 a 2022

Abstract

This study aimed to investigate factors potentially associated with the likelihood of death in hospitalizations for Stroke (Cerebrovascular Accident, CVA) within the Brazilian Unified Health System (SUS) from 2018 to 2022 nationwide. The study utilized data from the Hospital Information System of the Unified Health System (SIH-SUS), which was also cross-referenced with certain data from the National Registry of Health Establishments (CNES), both of which are Ministry of Health systems. Hospitalizations were selected from the SIH-SUS database based on diagnoses falling within the groups of the International Classification of Diseases (ICD-10) corresponding to the codes I60, I61, I63, or I64, and/or in which the stroke treatment procedures 03.03.04.014-9 or 03.03.04.030-0 were recorded. To explain the occurrence of death (response variable), variables such as geographic region of hospitalization, patient's sex and age group, length of hospital stay in days, utilization of Intensive Care Unit (ICU), estimated distance between the municipality of residence and hospitalization, hospital billing amount (as a means of quantifying the dimension and complexity of hospital and professional services employed), hospital size, and presence of ministerial accreditation for stroke care in the hospital were selected. Initially, the association between the response variable and each explanatory variable was tested using Pearson's Chi-squared test, except for the quantitative variable length of hospital stay, for which the Mann-Whitney test was used to compare medians. Binary logistic regression models were then employed separately for males and females (to allow for comparison of the influence of other variables between men and women), using length of hospital stay in days as an adjusting variable along with each of the other explanatory variables to explain the probability of death during hospitalization for stroke (as the longer a patient stays in the hospital, the more exposed they are to death during hospitalization). Based on the findings, the following factors were considered as increasing the likelihood of in-hospital death for patients hospitalized for stroke: older age, longer distance traveled for hospitalization, hospitalization in the Northeast or North regions, use of ICU, larger hospital size, and the hospital lacking ministerial accreditation for urgent stroke patient care.