Hospitalizations for diabetes mellitus and the Family Health Strategy, Paraná, Brazil, 2000-2012

Arruda, Guilherme Oliveira de; Schmidt, Débora Berger; Marcon, Sonia Silva

doi:10.1590/1413-81232018232.23092015

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Free Themes • Ciênc. saúde colet. 23 (2) • Feb 2018 • https://doi.org/10.1590/1413-81232018232.23092015 copy

Hospitalizations for diabetes mellitus and the Family Health Strategy, Paraná, Brazil, 2000-2012

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to identify trends in hospitalization for diabetes mellitus and their correlation with the Family Health Strategy (FHS) coverage in the state of Paraná, by Health District (HD), between 2000 and 2012. It is an ecological study based on secondary data from the Hospital Information System of the Brazilian Unified Health System and the Primary Care Department. There was downward trend for general admission rates (from 10.2 to 9.0/10,000 inhabitants), but upward trend for some HDs. No correlation was observed between admission rates and the FHS coverage for the state. However, there was strong inverse correlation for Paranaguá, Metropolitan, Foz do Iguaçu and Umuarama HDs, and strong and direct correlation for Pato Branco, Campo Mourão, Cianorte, Telêmaco Borba and Ivaiporã HDs. Overall, hospitalizations for diabetes mellitus proved to be decreasing and without correlation with FHS coverage; however, there were differences according to HDs.

Key words
Diabetes Mellitus; Hospitalization; Family Health Strategy; Public health care services coverage; Primary Health Care

Health Region	2000		2001		2002		2003		2004		2005		2006
Health Region	%	Rt	%	Rt	%	Rt	%	Rt	%	Rt	%	Rt	%	Rt
Paraná	22.4	10.2	31.5	10.7	35.9	10.1	38.4	9.3	41.4	9.1	45.9	9.8	48.0	9.5
1^st Paranaguá HD	7.8	12.2	4.3	12.8	13.1	12.5	12.2	11.2	7.2	8.8	19.5	9.6	23.3	11.6
2^nd Metropolitan HD	15.3	9.7	19.1	10.2	20.3	8.3	19.8	7.0	24.0	5.9	27.9	4.6	31.4	5.1
3^rd Ponta Grossa HD	10.1	12.8	11.8	12.2	20.0	11.8	21.7	11.6	28.5	9.5	36.4	9.1	36.5	8.5
4^th Irati HD	16.7	9.6	21.6	11.0	28.0	9.5	32.4	8.3	46.1	6.5	52.2	7.2	66.3	11.5
5^th Guarapuava HD	12.3	10.1	23.1	11.8	29.2	10.8	43.1	9.4	52.1	9.3	52.4	11.0	53.0	10.8
6^th União da Vitória HD	13.3	6.7	17.4	10.5	19.4	6.8	23.5	7.8	27.6	10.3	36.4	10.2	40.5	8.2
7^th Pato Branco HD	17.6	7.6	20.4	9.1	27.5	9.2	31.7	8.1	14.3	9.1	27.0	10.6	30.9	11.6
8^th F. Beltrão HD	20.4	9.7	34.1	10.1	44.0	7.6	52.4	9.8	57.8	8.9	65.2	11.9	66.3	10.7
9^th F. do Iguaçu HD	8.0	5.6	15.4	5.3	16.0	7.4	17.4	6.2	21.6	6.2	39.2	6.9	42.4	5.4
10^th Cascavel HD	30.7	5.3	39.0	6.0	34.3	4.2	34.6	3.8	34.0	3.9	38.9	6.4	36.1	6.0
11^th Campo Mourão HD	18.8	9.4	34.4	10.0	41.8	12.6	45.1	12.3	43.8	14.2	67.7	16.8	71.5	19.3
12^th Umuarama HD	39.1	26.1	40.6	27.7	43.8	29.2	47.6	32.8	54.9	31.3	61.0	43.3	65.1	36.1
13^th Cianorte HD	39.6	7.5	59.9	8.3	59.6	11.5	64.6	11.6	69.6	15.9	67.1	17.4	67.5	21.1
14^th Paranavaí HD	35.1	11.5	62.9	9.7	67.4	12.6	72.0	13.8	73.8	11.7	82.7	14.4	88.2	11.8
15^th Maringá HD	41.1	11.0	43.5	11.4	44.2	10.6	49.3	11.9	55.3	12.0	39.2	14.0	52.3	13.4
16^th Apucarana HD	62.8	16.2	85.2	15.8	91.7	17.1	92.0	13.8	90.8	15.4	89.2	17.2	91.1	13.0
17^th Londrina HD	23.7	10.2	65.1	9.9	74.8	9.2	76.2	9.0	76.6	10.0	77.4	9.2	66.9	7.5
18^th C. Procópio HD	35.5	21.4	32.6	20.8	61.9	26.0	67.2	24.3	67.7	20.2	72.9	23.5	77.2	20.6
19^th Jacarezinho HD	17.7	14.8	38.2	13.8	48.6	15.2	58.7	11.9	58.6	13.9	69.5	16.6	68.8	17.2
20^th Toledo HD	11.7	9.2	16.3	12.6	16.8	9.8	22.1	8.5	26.4	10.1	29.9	12.8	28.4	14.6
21^st Telêmaco Borba HD	19.5	12.0	19.4	11.1	25.3	7.4	29.5	2.5	38.1	9.0	59.6	12.3	66.3	9.3
22^rd Ivaiporã HD	45.6	3.9	54.2	7.8	63.3	9.7	64.0	9.2	64.6	10.6	78.0	14.3	78.0	18.2
Health Region	2007			2008			2009	2010			2011		2012
Health Region	%		Tx	%	Tx		%	Tx	%	Tx	%	Tx	%	Tx
Paraná	47.5		8.4	50.5	9.5		51.9	9.8	55.7	10.0	55.7	9.0	57.3	9.0
1^st Paranaguá HD	30.6		10.1	39.9	11.1		39.3	11.8	49.8	9.0	50.6	8.9	52.8	7.0
2^nd Metropolitan HD	31.2		4.6	33.4	4.5		34.5	4.9	38.8	5.4	38.9	4.6	42.3	5.3
3^rd Ponta Grossa HD	34.8		9.2	45.6	10.5		45.0	11.3	41.5	12.2	44.1	10.7	45.0	9.1
4^th Irati HD	57.6		7.5	57.1	9.7		64.4	11.8	64.2	14.4	63.9	12.7	60.8	7.5
5^th Guarapuava HD	52.7		9.7	57.8	13.6		58.3	16.1	69.6	13.4	68.6	12.0	68.9	12.4
6^th União da Vitória HD	40.4		5.7	40.1	8.5		40.0	8.5	41.7	10.2	42.7	12.2	46.6	11.5
7^th Pato Branco HD	36.8		11.0	48.4	10.0		55.6	13.0	64.1	12.0	64.9	11.5	64.5	10.8
8^th F. Beltrão HD	68.3		10.2	69.1	10.3		70.9	9.8	78.5	10.7	79.7	10.8	80.3	11.5
9^th F. do Iguaçu HD	39.3		5.4	43.2	6.0		41.6	4.7	54.3	4.0	52.4	3.9	52.6	3.8
10^th Cascavel HD	32.7		6.0	34.6	6.4		36.5	6.5	38.6	6.1	38.2	6.6	42.5	5.1
11^th Campo Mourão HD	75.0		15.5	71.9	19.4		80.1	18.7	82.3	15.3	81.1	14.9	82.1	17.0
12^th Umuarama HD	70.0		27.5	61.9	10.1		72.8	12.9	75.0	12.0	74.7	11.7	79.7	8.0
13^th Cianorte HD	72.8		18.7	70.4	17.1		72.4	16.0	69.5	16.8	68.9	15.2	69.8	13.7
14^th Paranavaí HD	87.9		12.2	79.6	14.1		816	18.5	86.8	17.8	84.2	17.2	85.5	14.3
15^th Maringá HD	48.6		11.3	50.8	13.3		53.7	12.7	55.0	12.1	57.8	9.8	55.1	10.5
16^th Apucarana HD	95.1		11.2	96.1	11.8		96.5	13.5	97.0	16.8	96.7	15.3	94.7	12.5
17^th Londrina HD	70.2		5.6	72.0	6.3		68.8	5.0	68.0	6.1	63.6	6.9	65.5	6.0
18^th C. Procópio HD	78.6		17.6	78.1	24.4		78.2	20.5	79.0	24.3	79.7	19.1	81.3	22.4
19^th Jacarezinho HD	60.0		15.1	69.7	20.1		75.8	20.5	79.0	22.3	82.1	16.3	85.6	16.0
20^th Toledo HD	25.6		13.5	33.6	12.6		30.4	12.7	32.2	12.9	37.7	10.2	35.2	10.3
21^st Telêmaco Borba HD	53.7		8.7	60.7	12.0		65.2	12.4	71.7	15.1	73.8	13.7	75.5	25.7
22^rd Ivaiporã HD	72.6		10.5	66.5	14.6		74.3	15.2	78.8	19.1	75.6	12.4	73.3	17.8

State/Region	Model	p	r²	Trend
State of Paraná	Y = 9.288 – 0.059 + 0.025	0.012	0.669	Downward until 2007
1^st Paranaguá HD	Y = 10.524 + 0.252 +0.007 – 0.028	< 0.001	0.911	Upward from 2004
2^nd Metropolitan HD	Y = 4.920 – 0.407 + 0.101	< 0.001	0.981	Downward until 2007
3^rd Ponta Grossa HD	Y = 9.576 – 0.075 + 0.100	0.008	0.698	Downward until 2006
4^th Irati HD	Y = 8.795 + 0.353 + 101	0.005	0.740	Upward from 2004
5^th Guarapuava HD	Y = 11.170 + 0.383 + 0.042	0.011	0.677	Upward from 2003
6^th União da Vitória HD	Y = 8.300 – 0.298 + 0.056 + 0.027	0.010	0.786	Downward until 2007
7^th Pato Branco HD	Y = 10.409 + 0.371	< 0.001	0.888	Upward
8^th F. Beltrão HD	Y = 10.082 + 0.168	0.006	0.583	Upward
9^th F. do Iguaçu HD	Y = 5.591 – 0.246	< 0.001	0.813	Downward
10^th Cascavel HD	Y = 5.555 + 0.192	0.004	0.616	Upward
11^th Campo Mourão HD	Y = 17.126 + 0.605 – 0.172	< 0.001	0.953	Upward until 2007
12^th Umuarama HD	Y = 29.947 – 2.407 – 0.514	0.001	0.819	Downward from 2005
13^th Cianorte HD	Y = 17.975 + 0.625 – 0.262	< 0.001	0.935	Upward until 2006
14^th Paranavaí HD	Y = 13.936 + 0.585	< 0.001	0.794	Upward
15^th Maringá HD	Y = 12.880 + 0.024 – 0.083	< 0.001	0.871	Upward until 2006
16^th Apucarana HD	Y = 13.679 – 0.210 + 0.088	0.032	0.578	Downward until 2007
17^th Londrina HD	Y = 7.682 – 0.472	< 0.001	0.847	Downward
18^th C. Procópio HD	Y = 22.055 – 0.174	0.109	0.260	Stable
19^th Jacarezinho HD	Y = 16.655 + 0.681	< 0.001	0.790	Upward
20^th Toledo HD	Y = 12.626 + 0.226 – 0.089	0.023	0.610	Upward until 2006
21^st Telêmaco Borba HD	Y = 10.709 + 0.850	0.001	0.698	Upward
22^rd Ivaiporã HD	Y = 12.909 + 0.880	< 0.001	0.858	Upward

Health Region	Correlation Coefficient	p-value	Correlation
State of Paraná	-0.532^* * Pearson coefficient;	0.061	No correlation
1^st Paranaguá HD	-0.603^* * Pearson coefficient;	0.029	Strong
2^nd Metropolitan HD	-0.657^ Spearman coefficient.	0.015	Strong
3^rd Ponta Grossa HD	-0.529^* * Pearson coefficient;	0.063	No correlation
4^th Irati HD	0.459^ Spearman coefficient.	0.114	No correlation
5^th Guarapuava HD	0.427^* * Pearson coefficient;	0.146	No correlation
6^th União da Vitória HD	0.413^ Spearman coefficient.	0.160	No correlation
7^th Pato Branco HD	0.709^* * Pearson coefficient;	0.007	Strong
8^th F. Beltrão HD	0.523^* * Pearson coefficient;	0.067	No correlation
9^th F. do Iguaçu HD	-0.643^* * Pearson coefficient;	0.018	Strong
10^th Cascavel HD	0.307^ Spearman coefficient.	0.214	No correlation
11^th Campo Mourão HD	0.637^ Spearman coefficient.	0.019	Strong
12^th Umuarama HD	-0.555^* * Pearson coefficient;	0.049	Strong
13^th Cianorte HD	0.626^ Spearman coefficient.	0.022	Strong
14^th Paranavaí HD	0.440^ Spearman coefficient.	0.133	No correlation
15^th Maringá HD	-0.197^* * Pearson coefficient;	0.519	No correlation
16^th Apucarana HD	-0.379^ Spearman coefficient.	0.201	No correlation
17^th Londrina HD	0.058^ Spearman coefficient.	0.851	No correlation
18^th C. Procópio HD	-0.256^ Spearman coefficient.	0.399	No correlation
19^th Jacarezinho HD	0.527^* * Pearson coefficient;	0.064	No correlation
20^th Toledo HD	0.313^* * Pearson coefficient;	0.297	No correlation
21^st Telêmaco Borba HD	0.579^* * Pearson coefficient;	0.038	Strong
22^rd Ivaiporã HD	0.868^* * Pearson coefficient;	<0.001	Strong

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[1] Collaborations

GO Arruda, DB Schmidt and SS Marcon were responsible for the conception and development of the study, data analysis and interpretation, writing of the manuscript and critical review of the content.