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[Risk factors for hospitalization of children aged 1 to 4 years in Sao Luis, Maranhao, Brazil]
A A Silva1, U A Gomes, S R Tonial
1Departamento de Saúde Pública, Universidade Federal do Maranhão, Rua Barão de Itapary 155, São Luís, MA 65020-070, Brasil. aasilva@elo.com.br.
Insights
Children from low-income families and those with private insurance face higher pediatric hospitalization risks in Brazil. This highlights potential disparities in healthcare access and quality, particularly for outpatient-sensitive conditions.
Area of Science:
- Pediatric Health
- Public Health
- Health Services Research
Background:
- Pediatric hospitalization rates are influenced by socioeconomic factors and healthcare access.
- Understanding risk factors is crucial for developing targeted public health interventions.
- Outpatient-sensitive diseases represent a significant burden on healthcare systems.
Purpose of the Study:
- To identify risk factors associated with pediatric hospitalization in São Luís, Maranhão, Brazil.
- To analyze the role of socioeconomic status and insurance type in hospitalization.
- To investigate the contribution of outpatient-sensitive diseases to hospital admissions.
Main Methods:
- Cross-sectional, multi-stage cluster sample survey of 596 children aged 1-4 years.
- Standardized questionnaires administered to mothers or primary caregivers.
- Cox proportional hazards model adapted for cross-sectional data to adjust for confounders.
Main Results:
- Overall pediatric hospitalization rate was 24.4%, with pneumonia and diarrhea as primary causes.
- Children from families earning less than one minimum monthly wage had higher hospitalization risk.
- Children with private insurance also showed an increased risk of hospitalization.
Conclusions:
- Low socioeconomic status and private insurance are significant risk factors for pediatric hospitalization.
- A high proportion of hospitalizations were for outpatient-sensitive conditions, suggesting potential issues with primary care.
- The findings indicate possible healthcare access disparities and may signal unnecessary or iatrogenic hospitalizations.
Abstract:
Risk factors for pediatric hospitalization were studied using a cross-sectional multi-stage cluster sample survey. A standardized questionnaire was answered by children's mothers or other care providers. In the municipality of São Luís, Maranhão, Brazil, 596 children aged 1 to 4 years were sampled in 50 census tracts. Design effect was calculated for each estimate. Hospitalization rate was 24. 4%. Main causes of hospitalization were pneumonia (7.3%) and diarrhea (7.1%). The Unified National Health System (SUS) and private insurance accounted for 78.1% and 18.2% of hospital admissions, respectively. After adjustment for confounding by Cox proportional hazards model modified for cross-sectional design, children whose families earned less than one minimum monthly wage and those with private insurance were at higher risk of hospitalization. Hospitalization due to outpatient-sensitive diseases accounted for most cases. The U-shaped hospitalization pattern suggests low quality of outpatient services among the poor and may be a proxy indicator for unnecessary and iatrogenic hospitalization among privately insured children.