Impact of the COVID-19 pandemic on prenatal, diabetes and medical appointments in the Brazilian National Health System

Chisini, Luiz Alexandre; Castilhos, Eduardo Dickie de; Costa, Francine dos Santos; D'Avila, Otávio Pereira

doi:10.1590/1980-549720210013

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Revista Brasileira de Epidemiologia

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Sumário

Special Article • Rev. bras. Epidemiol. 24 • 2021 • https://doi.org/10.1590/1980-549720210013 copy

Impact of the COVID-19 pandemic on prenatal, diabetes and medical appointments in the Brazilian National Health System

Impacto da pandemia COVID-19 no Pré-natal, Diabetes e consulta médica no Sistema Único de Saúde Brasileiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objectives:

The purpose of this study was to describe the impact of the COVID-19 pandemic on Primary Health Care in Brazil.

Methodology:

This retrospective ecological study was carried out using Brazilian municipality data obtained from the information systems of the National Public Health System. The outcomes were medical appointments, prenatal procedures and diabetes care. The exposure variable was the occurrence of the COVID-19 pandemic, based on the first case reported in Brazil. Multilevel mixed-effects negative binomial regression was used to analyze the association between the number of procedures per 10,000 inhabitants and COVID-19.

Results:

Data from 5,564 Brazilian municipalities were included in the present study. Regarding medical appointments, the largest reduction occasioned by the pandemic occurred in May (IRR = 0.27, 95%CI 0.24 – 0.30). Prenatal procedures were reduced by 65% (IRR = 0.35, 95%CI 0.32 – 0.38), also in May. In addition, diabetes care saw the biggest reductions in April 2020 (IRR = 0.24, 95%CI 0.11 – 0.53) and May 2020 (IRR = 0.19, 95%CI 0.09 – 0.43). From February to December 2020, the pandemic had a significant effect on the total number of procedures evaluated.

Conclusion:

The findings showed a reduction in prenatal procedures, diabetes and medical consultations performed in Brazil's Primary Health Care, following the onset of the COVID-19 pandemic.

Keywords
Coronavirus infections; Prenatal care; Diabetes mellitus; Medical care; Primary health care

Variables	Mean	SD	Minimum	Median	Maximum
Rate of medical appointment procedures per 10 thousand inhabitants/month, Feb to Dec 2018/2019 (SIA-SUS)	424.1	5,626.2	0	0	805,915.3
Rate of medical appointments per 10 thousand inhabitants/month, Feb to Dec 2020 (SIA-SUS)	232.7	1,471.3	0	0	156,979.9
Rate of prenatal procedures per 10 thousand inhabitants/month, Feb to Dec 2018/219 (SIA-SUS)	23.6	759.8	0	0	158,461.7
Rate of prenatal procedures per 10 thousand inhabitants/month, Feb to Dec 2020 (SIA-SUS)	13.2	650.6	0	0	155,895.1
Rate of diabetes care per 10 thousand inhabitants/month, Feb to Dec 2018/2019 (SIA-SUS)	2.8	212.1	0	0	67,138.4
Rate of diabetes care per 10 thousand inhabitants/month, Feb to Dec 2020 (SIA-SUS)	0.13	5.1	0	0	1,094.6
Family health strategy coverage as % of inhabitants, 2020 (SIAB)	89.7	20.9	0	100	100
IDH of Brazilian municipalities 2010 (UNDP)	0.66	0.07	0.42	0.66	0.86
Gini index of Brazilian municipalities 2010 (UNDP)	0.50	0.07	0.28	0.50	0.81
Rate of basic health units per 10 thousand inhabitants, 2020 (CNES)	0.000035	0.0001951	0	0.0003325	0.0018981
Rate of physicians per 10 thousand inhabitants, 2020 (CNES)	0.011	0.0049	0	0.010	0.066
Rate of nurses per 10 thousand inhabitants, 2020 (CNES)	0.0009	0.0005	0	0.0008	0.006

Impact of COVID-19 compared to the period prior to the pandemic
Group of procedures (reference: prior to pandemic)	Crude			Adjusted
Group of procedures (reference: prior to pandemic)	IRR	95%CI	P-value	IRR	95%CI	P-value
	February 2020
Total procedures	0.60	0.56 – 0.65	< 0.001	0.60	0.55 – 0.60	< 0.001
Medical appointments	0.72	0.64 – 0.82	< 0.001	0.64	0.57 – 0.72	< 0.001
Prenatal procedures	0.64	0.59 – 0.68	< 0.001	0.64	0.59 – 0.68	< 0.001
Diabetes care	1.51	0.88 – 2.61	0.135	1.43	0.82 – 2.48	0.199
	March 2020
Total procedures	0.48	0.45 – 0.52	< 0.001	0.48	0.45 – 0.52	< 0.001
Medical appointments	0.64	0.57 – 0.72	< 0.001	0.54	0.47 – 0.61	< 0.001
Prenatal procedures	0.48	0.44 – 0.52	< 0.001	0.48	0.45 – 0.51	< 0.001
Diabetes care	0.62	0.34 – 1.09	0.100	0.58	0.33 – 1.01	0.056
	April 2020
Total procedures	0.27	0.25 – 0.29	< 0.001	0.27	0.25 – 0.29	< 0.001
Medical appointments	0.38	0.33 – 0.42	< 0.001	0.33	0.29 – 0.37	< 0.001
Prenatal procedures	0.48	0.44 – 0.51	< 0.001	0.38	0.35 - 0.42	< 0.001
Diabetes care	0.23	0.10 - 0.54	0.001	0.24	0.11 - 0.53	< 0.001
	May 2020
Total procedures	0.23	0.21 - 0.24	< 0.001	0.23	0.21 - 0.25	< 0.001
Medical appointments	0.34	0.30 - 0.39	< 0.001	0.27	0.24 - 0.30	< 0.001
Prenatal procedures	0.51	0.46 - 0.57	< 0.001	0.35	0.32 - 0.38	< 0.001
Diabetes care	0.21	0.08 - 0.52	0.001	0.19	0.09 - 0.43	< 0.001
	June 2020
Total procedures	0.48	0.45 - 0.51	< 0.001	0.48	0.45 - 0.51	< 0.001
Medical appointments	0.56	0.49 - 0.63	< 0.001	0.41	0.38 - 0.44	< 0.001
Prenatal procedures	0.63	0.59 - 0.66	< 0.001	0.63	0.59 - 0.66	< 0.001
Diabetes care	0.62	0.34 - 1.14	0.129	0.61	0.35 - 1.07	0.086
	July 2020
Total procedures	0.49	0.47 - 0.53	< 0.001	0.49	0.46 - 0.52	< 0.001
Medical appointments	0.66	0.58 - 0.74	< 0.001	0.44	0.41 - 0.48	< 0.001
Prenatal procedures	0.59	0.56 - 0.63	< 0.001	0.59	0.56 - 0.63	< 0.001
Diabetes care	0.73	0.41 - 1.31	0.299	0.71	0.43 - 1.20	0.212
	August 2020
Total procedures	0.48	0.46 - 0.51	< 0.001	0.48	0.46 - 0.51	< 0.001
Medical appointments	0.54	0.48 - 0.61	< 0.001	0.45	0.41 - 0.48	< 0.001
Prenatal procedures	0.56	0.53 - 0.59	< 0.001	0.56	0.53 - 0.59	< 0.001
Diabetes care	0.62	0.37 - 0.99	0.049	0.61	0.38 - 0.99	0.047
	September 2020
Total procedures	0.54	0.51 - 0.57	< 0.001	0.54	0.51 - 0.57	< 0.001
Medical appointments	0.65	0.58 - 0.74	< 0.001	0.50	0.46 - 0.54	< 0.001
Prenatal procedures	0.61	0.58 - 0.64	< 0.001	0.61	0.58 - 0.65	< 0.001
Diabetes care	0.81	0.47 - 1.39	0.458	0.79	0.47 - 1.32	0.378
	October 2020
Total procedures	0.50	0.47 - 0.53	< 0.001	0.50	0.47 - 0.53	< 0.001
Medical appointments	0.59	0.52 - 0.67	< 0.001	0.45	0.41 - 0.48	< 0.001
Prenatal procedures	0.59	0.56 - 0.63	< 0.001	0.59	0.56 - 0.62	< 0.001
Diabetes care	0.91	0.54 - 1.54	0.741	0.92	0.52 - 1.57	0.758
	November 2020
Total procedures	0.53	0.50 - 0.57	< 0.001	0.54	0.50 - 0.57	< 0.001
Medical appointments	0.68	0.60 - 0.77	< 0.001	0.65	0.57 - 0.74	< 0.001
Prenatal procedures	0.62	0.59 - 0.66	< 0.001	0.62	0.58 - 0.65	< 0.001
Diabetes care	0.74	0.43 - 1.29	0.301	0.73	0.45 - 1.20	0.227
	December 2020
Total procedures	0.37	0.35 - 0.39	< 0.001	0.37	0.34 - 0.39	< 0.001
Medical appointments	0.59	0.52 - 0.68	< 0.001	0.60	0.53 - 0.69	< 0.001
Prenatal procedures	0.46	0.43 - 0.49	< 0.001	0.45	0.43 - 0.49	< 0.001
Diabetes care	0.28	0.14 - 0.55	< 0.001	0.29	0.16 - 0.54	< 0.001

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[1] Corresponding author: Luiz Alexandre Chisini. Graduate Program in Dentistry, Universidade do Vale do Taquari, Rua Avelino Talini, 171, CEP: 95914-014, Bairro Universitário, Lajeado, RS, Brazil. E-mail: alexandrechisini@gmail.com