Internações de pessoas idosas no Brasil: iniquidades de gênero, de etnia e na distribuição regional

Abstract

The health and illness process are determined by the way society organizes health units in a territory and at a specific time. This organization is subject to inequities (process of concentration of power) of class, gender and ethnicity, resulting in unequal distribution and access to health-promoting events in the territory. The aging of the population, the need for long-term care increases, mainly for Primary Health Care, but at some time hospital admissions may be necessary. Thus, the objective of this study was to investigate the causes of hospitalization of the older people in the Unified Health System, analyzing in the light of the theoretical framework of social determination in health. For the development of this research, an ecological, exploratory, transversal design were used, using the Hospitalization Authorizations (HAs) generated by the Unified Health System (Sistema Único de Saúde - SUS) between the years 2008 to 2018, due to the causes chapters of the International Classification of Diseases in its tenth revision (ICD-10). The ICD-10 categories and the profile of hospitalizations of the older people due to Conditions Sensitive to Primary Care were also verified. Finally, a data matrix was elaborated, pointing out the critical points, evidenced in data interpretation. During the years 2008 to 2018, 127,039,814 hospitalizations were registered. Of these, 23.28% occurred in people aged 60 years or older. The main causes of hospitalization for people aged 60 and over were due to: diseases of the circulatory system (24.40%); diseases of the respiratory system (15.06%); diseases of the digestive system (10.10%); neoplasms (9.69%); some infectious and parasitic diseases (7.54%); diseases of the genitourinary system (7.26%); injuries from poisoning and some other consequences of external causes (6.90%); and endocrine and metabolic diseases (4.53%).The populations with the worst critical hospital morbidity profile were black (black and brown) and indigenous people in different regions of the country. The profile found in the North Region expresses lower investment (time and average cost per hospitalization) and illness profile related to precarious sanitary conditions and low access to health care (due to infectious and parasitic diseases). Despite presenting different specificities in the causes of hospitalization, the profile of hospital morbidity of black and indigenous people requires actions that address territorial realities and professional qualification to deal with the diversity in care relationships.