ABSTRACT
Objective:
To analyze the influence of individual and contextual factors of the hospital and the municipality of care on the survival of patients with Severe Acute Respiratory Syndrome due to COVID-19.
Methods:
Hospital cohort study with data from 159,948 adults and elderly with Severe Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to December 31, 2022 and reported in the Influenza Epidemiological Surveillance Information System. The contextual variables were related to the structure, professionals and equipment of the hospital establishments and socioeconomic and health indicators of the municipalities. The outcome was hospital survival up to 90 days. Survival tree and Kaplan-Meier curves were used for survival analysis.
Results:
Hospital lethality was 30.4%. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax collection rates had lower survival rates compared to other groups identified in the survival tree (p<0.001).
Conclusion:
The study indicated the interaction of contextual factors with the individual ones, and it shows that hospital and municipal characteristics increase the risk of death, highlighting the attention to the organization, operation, and performance of the hospital network.
Keywords:
COVID-19; Survival; Hospital care; Social environment
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Notes: The tree contains 17 nodes, 6 decision-making nodes represented by circles and 9 terminal nodes represented by squares, which contain the survival curve estimated by the Kaplan-Meier Method. Above each terminal node, the number of cases in that node (n) is specified, while at decision-making nodes the node number is identified.
Notes: Each curve represents the cases contained in the terminal nodes classified as follows: Node 3 – Mild Risk, No Link to SUS; Node 4 – Mild Risk, Link with SUS; Node 8 – Medium Risk, GINI Coefficient ≥0.575, Defibrillator/Bed Ratio ≥0.123; Node 9 – Medium Risk, GINI Coefficient ≥0.575, Defibrillator/Bed Ratio <0.123; Node 11 – Medium Risk, GINI Coefficient <0.575, IDS COVID = 1; Node 12 – Medium Risk, GINI Coefficient <0.575, IDS COVID = 2 to 5; Node 14 – High Risk, Revenues Raised ≥19.5%; Node 15 – High Risk, Revenues Raised <19.5%.