Internação de idosos por acidente vascular encefálico no Estado do Rio de Janeiro, Brasil: uma perspectiva ecológica

Abstract

This research aims to investigate the association between contextual variables and admission rates of the aged due to stroke in the Unified Health System in Rio de Janeiro State. It is an ecological study with a cross-sectional from 2006 to 2014. Initially, the individual profile of these hospitalizations was drawn considering the sex, age group and the subtype of stroke. All admissions underwent a population adjustment, forming the aged admission rate due to stroke (TIHIdAVE). At the aggregate level, a demographic analysis was carried out by age group through ANOVA and by sex, within each age group, through the Studen t or Mann Whitney tests. Then, the TIHIdAVE was categorized into tertiles and spatially distributed. The tertiles I and III were chosen for association analyses by the extreme polar method and analysed bivariate with the contextual variables through the Student t or Mann Whitney tests. The variables that presented statistical significance were inserted into a binary logistic regression model. A total of 82.796 hospitalizations of elderly people with stroke were registered for the study period. Females accounted for 50.49% of admissions while the age group of 70 to 79 years presented higher proportion (37.62%). The strokes not specified as hemorrhagic or ischemic accounted for 64.66% of the diagnoses, while the hemorrhagic strokes had higher lethality. There was an age gradient of the dependent variable, with the elderlies group having the highest rates (p <0.001) and a predominance among men up to 79 years. The spatial distribution has formed two large mosaics of high admission rates. The first consists of neighboring towns of Northwest Fluminense Region and the Serrana Region and another in Central - South Fluminense Region. Bivariate association was observed in 5 of 6 contextual variables. The proportion of the elderlies (p <0.001), the aged illiteracy rate (p = 0.01), the coverage of primary care (p <0.001) and the outpatient follow-up rate of hypertension and diabetes (p = 0.001) were positively associated to the group of higher rates of hospitalization, while the ratio of income (p = 0.01) was negatively associated to them. In multivariate analysis, only the proportion of the elderlies (OR = 1.55 95%CI 1:07 to 2:25), coverage of primary care (OR = 1.5 95%CI 1:01 to 1:11) and the income ratio (OR = 0.82 95%CI 0.67 to 0.99) maintained the association. In conclusion, there is a predominance of women and younger elders in the hospitalization of the aged due to stroke in individuated level. However, after the population adjustments, higher rates among men with a significant increase with age was seen. In addition, spatial pattern in the form of mosaic suggests a social influence on the hospitalization of the elderly due stroke. And finally, contextual variables in three dimensions studied were associated in some way to the elderly hospitalization rate in the municipalities of the Rio de Janeiro State.