Tendencia temporal y costos de las hospitalizaciones con el diagnóstico principal de diabetes <i>mellitus</i> en el Sistema Único de Salud de Brasil, de 2011 a 2019

Analizar la tendencia temporal y los costos de las internaciones por diabetes mellitus (DM) en Brasil, por región, Unidades Federativas (UF) y características poblacionales, de 2011 a 2019.

Métodos

Estudio ecológico con datos del Sistema de Información Hospitalaria, analizando la tendencia anual de las tasas de hospitalización (TH) por DM según sexo, edad, raza/color y región/UF mediante regresión de Prais-Winsten.

Resultados

Se registraron 1.239.574 hospitalizaciones por DM en el país y la TH fue de 6,77/10 mil habitantes en el período. La tendencia de TH por DM fue decreciente en ambos sexos y en la mayoría de las regiones y creciente en la población más joven y en la duración de la estancia. El gasto total fue de 420.692.238 dólares y fue creciente.

Conclusión

La tendencia temporal de TH por DM fue decreciente, con diferencias según región/UF y grupo de edad. La duración media de la estancia y los gastos mostraron una tendencia creciente.

Palabras llave
Diabetes Mellitus; Hospitalización; gastos Hospitalarios; Sistema Único de Salud; Estudios Poblacionales en Salud Pública; Estudios de Series Temporales

Region and Federative Unit	HR 2011	HR 2019	Average HR 2011-2019 (95%CI)	APC (95%CI)	P-value	Trend
Brazil	7.55	6.48	6.77 (6.44;7. 10)	-0.26 (-0.40;-0.09)	0.010	Falling
Northern Region	7.40	7.58	7.34 (7.12;7.57)	0.05 (-0. 24;0.41)	0.800	Stationary
Rondônia	13.24	10.06	11.80 (10.8;12.78)	-0.57 (-0.74;-0.28)	0.010	Falling
Acre	6.53	5.14	5.58 (5.13;6.03)	-0.31 (-0.51;-0.02)	0.040	Falling
Amazonas	4.85	6.99	5.86 (5.11;6.60)	0.91 (0.26;1.82)	0.010	Rising
Roraima	9.07	12.38	10.43 (9.19;11.68)	1.29 (-0.02;4.50)	0.060	Stationary
Pará	6.84	7.81	7.21 (6.91;7.51)	0.02 (-0.01;0.55)	0.060	Stationary
Amapá	6.33	3.29	4.58 (3.52;5.64)	-0.59 (-0.77;-0.28)	0.010	Falling
Tocantins	10.72	6.89	8.23 (6.84;9.63)	-0.70 (-0.87;-0.34)	0.100	Stationary
Northeast Region	8.89	7.64	7.97 (7 .57;8.36)	-0.29 (-0.42;-0.13)	0.010	Falling
Maranhão	9.25	14.83	11.88 (10.31;13.47)	3.79 (2.39;5.76)	< 0.001	Rising
Piauí	12.20	10.27	11.89 (11.05;13.73)	-0.44 (-0.76;0.32)	0.170	Stationary
Ceará	6.56	5.58	5.34 (4.91;5.78)	6.76 (-0.96;-0.63)	< 0.001	Rising
Rio Grande do Norte	8.88	6.68	7.63 (7.00;8.27)	-0.38 (-0.77;0.66)	0.290	Stationary
Paraíba	9.05	6.74	7.58 (7.07;8.09)	-0.34 (-0.61;0.12)	0.110	Stationary
Pernambuco	8.51	5.76	6.43 (5.63;7.24)	-0.92 (-0.96;-0.82)	< 0.001	Falling
Alagoas	9.42	5.33	6.66 (5.55;7.76)	-0.68 (-0.84;-0.38)	0.060	Stationary
Sergipe	4.05	4.27	4.28 (3.72;4.83)	0.17 (-0.37;1.19)	0.540	Stationary
Bahia	10.19	7.61	8.93 (7.92;9.94)	-0.58 (-0.70;-0.40)	< 0.001	Falling
Southeast Region	6.08	5.51	5.61 (5.40;5.82)	-0.48 (-0.67;-0.19)	0.010	Falling
Minas Gerais	7.88	7.82	7.71 (7.48;7.94)	-0.07 (-0.22;-0.11)	0.390	Stationary
Espírito Santo	6.69	6.01	6.34 (6.08;6.61)	-0.21 (-0.29;-0.09)	< 0.001	Falling
Rio de Janeiro	5.59	4.52	4.69 (4.33;5.05)	-0.70 (-0.84;0.46)	< 0.001	Falling
São Paulo	5.37	4.78	4.91 (4.72;5.10)	-0.46 (-0.64;-0.19)	0.010	Falling
Southern Region	8.73	6.81	7.60 (7.06;8.14)	-0.61 (-0.79;- 0.31)	0.010	Falling
Paraná	8.71	6.92	7.50 (6.82;8.18)	-0.41 (-0.68;0.10)	0.080	Stationary
Santa Catarina	7.01	6.22	6.52 (6.27;6.77)	0.17 (-0.28;0.02)	0.070	Stationary
Rio Grande do Sul	9.78	7.08	8.40 (7.65;9.15)	-0.55 (-0.59;-0.50)	< 0.001	Falling
Midwest Region	8.73	5.78	6.77 (5.91;6.63)	-0.87 (-0.92;-0.81)	< 0.001	Falling
Mato Grosso do Sul	7.36	7.40	7.02 (6.66;7.38)	0.00 (-0.52;1.09)	0.100	Stationary
Mato Grosso	8.90	5.77	7.16 (6.26;8.05)	-0.61 (-0.68;-0.53)	< 0.001	Falling
Goiás	9.76	5.22	6.84 (5.54;8.15)	-0.74 (-0.86;-0.53)	< 0.001	Falling
Distrito Federal	7.46	5.59	5 .88 (5.17;6.59)	8.33 (-0.96;-0.69)	< 0.001	Rising

Brazil	Time 2011	Time 2019	Average 2011-2019 (95%CI)	APC (95%CI)	p-value	Trend
Length of stay	6.00	6.50	6.17 (6.00;6.3)	3.90 (1.30;0.27)	0.002	Rising
HR according to Characteristics	HR 2011	HR 2019	Average 2011-2019 (95%CI)	APC (95%CI)	p-value	Trend
HR per sex
Female HR	8.36	6.31	7.12 (6.52;7.72)	-0.46 (-0.56;-0.34)	< 0.001	Falling
Male HR	6.69	6.65	6.43 (6.29;6.58)	-0.48 (-0.69;-0.13)	0.020	Falling
HR per race/skin color
White	4.90	3.83	4.09 (3.79;4.38)	-0.57 (-0.76;-0.35)	< 0.001	Falling
Black	4.03	4.03	3.67 (3.49;3.85)	-0.57 (-0.75;-0.28)	0.010	Falling
Mixed race	205.05	230.16	211.21 (202.79;219.62)	536.03 (0.15; 25,7038.58)	0.040	Rising
Asian	0.08	0.57	0.26 (0.10;0.43)	0.02 (-0.21; 0.32)	0.830	Stationary
Indigenous	1.80	3.96	2.54 (2.05;3.02)	0.82 (-0.11;2.72)	0.090	Stationary
HR by age range
Children and Adolescents	1.23	1 .55	1.35 (1.27;1.43)	0.10 (0.05;0.15)	< 0.001	Rising
0-4 years	0.72	0.76	0.73 (0.71;0.75)	0.00 (0.00;0.02	0.090	Stationary
5-9 years	1.07	1.15	1.09 (1.06;1.12)	0.02 (0.00;0.05)	0.010	Rising
10-14 years	1.73	2.4	1.96 (1.82;1.17)	0.20 (0.15;0.26)	< 0.001	Rising
15-19 years	1.43	1.9	1.57 (1.45;1.7)	0.15 (-0.02;0.35)	0.090	Stationary
Young adult	2.18	2.01	1.98 (1.89;2 .07)	-0.29 (-0.38;-0.19)	< 0.001	Falling
20-24 years	1.43	1.63	1.46 (1.40;1.53)	0.05 (0.00;0.12)	0.070	Stationary
25-29 years	1.68	1.68	1.58 (1.51;1.64)	-0.24 (-0.34;-0.13)	< 0.001	Falling
30-34 years	2.25	1.97	2.02 (1.89;2.15)	-0.29 (-0.46;-0.07)	0.020	Falling
35-39 years	3.33	2.76	2.86 (2.67;3.05)	-0.46 (-0.65;-0.19)	0.010	Falling
Adult	11.01	8.34	9.21 (8.43;9.99)	-0 .86 (-0.93;-0.72)	< 0.001	Falling
40-44 years	4.91	3.9	4.26 (3.92;4.59)	-0.26 (-0.38;-0.13)	< 0.001	Falling
45-49 years	7.90	6.18	6.46 (5.70;7.23)	-0.13 (-0.54;0.66)	0.640	Stationary
50-54 years	12.55	9.7	10.47 (9.67;11.27)	-0.91 (-0.97;-0.66)	< 0.001	Falling
55-59 years	18.70	13.58	15.32 (13.84;16.81)	-0.78 (-0.90;-0.52)	< 0.001	Falling
Young-old	37.68	25.2	30.31 (26.00;33.61)	-0.97 (-0.99;-0.92)	< 0.001	Falling
60-64 years	26.08	18.16	21.24 (19.15;23.33)	-0.99 (-1.00;-0.91)	< 0.001	Falling
65-69 years	33.81	23.62	27.54 (24.08;30.28)	-1.00 (-1.00;-0.97)	< 0.001	Falling
70-74 years	41.55	27.18	33.75 (29.72;37.78)	-0.99 (-0.99;-0.97)	< 0.001	Falling
75-79 years	49.26	31.83	38.68 (34.26;43.11)	-0.99 (-1.00;-0.96)	< 0.001	Falling
Oldest-old (80+)	52.23	30.97	40.53 (34. 90;46.17)	-1.00 (-1.00;-1.00)	< 0.001	Falling

Hospitalization rate per Region and Federative Unit/10,000 inhab.	2011	2012	2013	2014	2015	2016	2017	2018	2019
Brazil	7. 55	7.17	7.04	6.92	6.78	6. 24	6.39	6.44	6.48
Northern Region	7.40	7.40	7.65	7.62	7.18	6.76	7.02	7.52	7.58
Rondônia	13.24	12.31	13.45	13.11	11.20	10.24	11.03	11.74	10.06
Acre	6.53	5.86	6.19	5.67	5.18	5.05	4.81	5.82	5.14
Amazonas	4.85	5.75	5.33	4.42	5.84	5.68	6.34	7.47	6.99
Roraima	9.07	7.43	10.00	12.63	11.45	10.25	10.33	10.41	12.38
Pará	6.84	6.83	7.32	7.79	7.17	6.77	7.08	7.26	7.81
Amapá	6.33	6.40	6.19	4.91	3.76	3.37	3.27	3.57	3.29
Tocantins	10.72	10.44	9.61	9.47	7.59	7.10	5.98	6.28	6.89
Northeast Region	8.89	8.15	8.11	8.24	8.38	7.31	7.53	7.55	7.64
Maranhão	9.25	8.91	11.10	12.02	12.56	10.94	12.91	13.73	14.83
Piauí	12.20	12.67	12.62	12.66	13.28	11.94	10.71	10.57	10.27
Ceará	6.56	5.73	5.17	5.18	5.03	4.79	4.78	5.21	5.58
Rio Grande do Norte	8.88	7.35	6.68	6.82	7.63	8.45	7.86	8.30	6.68
Paraíba	9.05	7.58	7.13	7.40	8.10	7.23	7.57	7.49	6.74
Pernambuco	8.51	7.67	6.93	6.29	5.78	5.51	5.69	5.73	5.76
Alagoas	9.42	8.12	7.58	6.28	6.03	6.29	5.96	4.95	5.33
Sergipe	4.05	3.43	3.30	3.74	4.75	4.73	5.38	5.04	4.27
Bahia	10.19	9.58	9.67	10.25	10.34	7.64	7.72	7.37	7.61
Southeast Region	6.08	5.88	5.76	5.58	5.51	5.21	5.41	5.45	5.51
Minas Gerais	7.88	7.77	8.20	7.79	7.53	7.14	7.59	7.69	7.82
Espírito Santo	6.69	6.61	6.38	6.43	6.79	6.37	5.99	5.84	6.01
Rio de Janeiro	5.59	5.30	4.67	4.62	4.69	4.27	4.24	4.33	4.52
São Paulo	5.37	5.15	4.98	4.83	4.77	4.57	4.79	4.82	4.78
Southern Region	8.73	8. 53	8.10	7.84	7.45	7.13	7. 04	6.98	6.81
Paraná	8.71	8.71	8.46	7.54	6.86	6.48	6.91	6.92	6.92
Santa Catarina	7.01	6.72	6.36	6.03	6.67	6.92	6.42	6.43	6.22
Rio Grande do Sul	9.78	9.43	8.79	9.22	8.50	7.92	7.55	7.38	7.08
Midwest Region	8.73	7.98	7.58	7. 08	6.32	5.85	5.84	5.67	5. 78
Mato Grosso do Sul	7.36	7.25	7.12	6.63	6.45	6.33	6.99	7.70	7.40
Mato Grosso	8.90	8.43	7.70	7.78	7.42	6.60	6.09	5.69	5.77
Goiás	9.76	8.43	8.19	7.54	6.36	5.50	5.57	4.97	5.22
Distrito Federal	7.46	7.09	6.44	5.63	4.84	5.37	5.10	5.37	5.59
Length of stay (days)	6. 00	5.90	6.00	6.00	6.10	6. 30	6.30	6.40	6.50
Total cost per Brazilian National Health System DM hospitalization (BRL)	598 .83	607.91	629.40	645.02	668.54	715 .43	728.04	765.64	793.01
Hospitalization rate per sex (10,000 inhab.)	2011	2012	2013	2014	2015	2016	2017	2018	2019
Female	8.36	7.90	7.68	7.44	7.16	6.36	6.45	6.42	6.31
Male	6.69	6.41	6.37	6.38	6.38	6.12	6.34	6.46	6.65
Hospitalization rate per race/skin color/10,000 inhab.
White	4.90	4.47	4.17	4.08	3.96	3.76	3.80	3.81	3.83
Black	4.03	3.67	3.55	3.48	3.51	3.36	3.66	3.75	4.03
Mixed race	205.05	199.66	205.64	216.95	216.19	196.48	208.76	221.98	230.16
Asian	0.08	0.06	0.07	0.06	0.19	0.36	0.44	0.53	0.57
Indigenous	1.80	2.14	2.46	2.58	2.58	1.98	2.45	2.87	3.96
Hospitalization rate per age range/10,000 inhab.
Children and Adolescents	1 .23	1.24	1.28	1.31	1.34	1 .31	1.41	1.46	1.55
Up to 4 years	0.72	0.72	0.70	0.79	0.72	0.71	0.74	0.74	0.76
5-9 years	1.07	1.05	1.09	1.03	1.07	1.09	1.13	1.14	1.15
10-14 years	1.73	1.71	1.79	1.93	2.03	2.02	2.17	2.18	2.40
15-19 years	1.43	1.48	1.54	1.49	1.53	1.42	1.60	1.78	1.90
Young adult	2.18	2.09	2.04	1.99	1.93	1.79	1.86	1.94	2.01
20-24 years	1.43	1.38	1.42	1.46	1.45	1.38	1.49	1.54	1.63
25-29 years	1.68	1.61	1.60	1.58	1.54	1.42	1.51	1.56	1.68
30-34 years	2.25	2.23	2.18	2.00	1.98	1.80	1.86	1.91	1.97
35-39 years	3.33	3.13	2.95	2.91	2.74	2.57	2.59	2.76	2.76
Adult	11.01	10.24	9.82	9.52	9.15	8.27	8.31	8.24	8.34
40-44 years	4.91	4.87	4.49	4.42	4.11	3.80	3.92	3.88	3.90
45-49 years	7.90	7.42	7.26	7.16	6.79	6.20	6.01	6.25	6.18
50-54 years	12.55	11.47	10.91	10.59	10.29	9.43	9.78	9.49	9.70
55-59 years	18.70	17.19	16.61	15.91	15.40	13.64	13.54	13.35	13.58
Young-old	37.68	34.59	33.15	31.67	30.36	27.07	26.74	26.30	25.20
60-64 years	26.08	24.30	22.80	21.70	20.88	19.16	19.23	18.85	18.16
65-69 years	33.81	31.29	29.97	28.23	27.22	24.85	24.73	24.18	23.62
70-74 years	41.55	39.07	37.99	36.43	33.87	30.10	29.07	28.49	27.18
75-79 years	49.26	43.70	41.84	40.32	39.47	34.16	33.92	33.66	31.83
Oldest-old (80+)	52.23	47.60	45.80	43.69	41.13	35.30	35.18	32.91	30.97

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Betine Pinto Moehlecke Iser | betinee@gmail.com