Doenças cardiovasculares, condições sensíveis à Atenção Primária à Saúde: estudo comparativo das taxas de internação e seu impacto econômico em municípios de pequeno, médio, grande porte e metrópoles do Brasil no período de 2008 a 2014

Abstract

Introduction: In recent years, the country's health policies have given priority to primary health care. Cardiovascular diseases (CVD) are the leading cause of mortality and hospitalization in the country and is considered sensitive to primary care. In a demographic transition perspective, with the increase in the elderly population in Brazil, it is important to evaluate the trends of hospitalizations for CVD and its economic impact on local health systems, particularly if thesemunicipalities are small, medium or large and if occurred in public or hired private institutions with the Health System. Objectives: to analyze CVD hospitalization rates in Brazil from 2008 to 2014, by age group, sex, hospital legal status and population size of the patient's home municipality; and estimate the costs expended. Methods: The study design was mixed ecological trends and patterns of hospitalizations for CVD, with the unit of analysis municipalities ranked by population size. Time series were obtained with annual information from allmunicipalities, based on secondary data from various databases and information systems. Results: The study evaluated 3.191.343 hospitalizations for CVD occurred in 5565 municipalities. It was observed downward trend in hospitalization rates from CVD and inverse relationship with the population of the municipality size (p <0.001, R2 rate-size: 0,0372; R2 rate-year: 0,0031). The rates were higheramong males and older age groups. The hospitalization rates for Coronary Artery Disease (CAD) were higher than for cerebrovascular diseases (CVD), it is the main component of CVD. During the period, public spending on hospitalizations for CVD was US$ 2.544.833.005. The trend of total expenditure on hospitalizations for CVD has been growing both in public hospitals (31.8%) and by the hired private hospitals (16.4%). The average hospitalization for CVD tends to increaseas it grows the population size of the patient's home county. The average hospital stay was greater in hired private hospitals, for males, aged 60-69 years and in metropolises. Conclusion: the results of this study have important implications for Brazilian healthcare model. There needs to be greater effectiveness of the actions of primary care in the CVD approach, especially in small and medium-sized cities and accessibility to health services and treatments occur with greater equity in all of Brazil.