Peer-reviewed article
Trends and spatial clustering of hospitalizations due to primary health care sensitive conditions in children under five years in Brazil, 2008-2022.
George Oliveira Silva, Amanda de Calaça Lima, Lucimeire Fermino Lemos, Karina Machado Siqueira, Rafael Alves Guimarães et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined hospitalizations of children under five in Brazil from 2008 to 2022 for conditions that should be preventable or manageable through primary health care. Overall hospitalization rates decreased significantly over the 15-year period, but rates for immunization-preventable diseases and epilepsies increased. Higher coverage of the Family Health Strategy was associated with lower hospitalization rates, suggesting that investment in primary health care reduced preventable hospital admissions.
Key points
- 6,022,752 hospitalizations of children under 5 were recorded between 2008 and 2022
- Overall hospitalization rates decreased significantly over the period (p < 0.05)
- Hospitalizations due to immunization-preventable diseases and epilepsies showed increasing rates
- Higher Family Health Strategy coverage was negatively associated with hospitalization rates (p = 0.002)
- Spatial distribution of hospitalization clusters changed over the 15-year period
Limitations
This is an ecological study based on administrative hospitalization data, so it cannot establish causality or identify individual-level risk factors. The analysis does not explain why immunization-preventable disease hospitalizations increased despite overall improvements.
Abstract
OBJECTIVES: To evaluate the temporal trend and spatial cluster of hospitalizations due to primary health care sensitive conditions in children under 5 years old in Brazil, between 2008 and 2022. STUDY DESIGN: Ecological study of temporal trends and spatial cluster conducted with data on hospitalizations in children under 5 years old in Brazil. METHODS: Data on hospitalizations due to primary health care sensitive conditions were included in the study in all Brazilian regions, disaggregated by states, regions, sex, and health conditions. Using data from the resident population, the standardized hospitalization rates were estimated and evaluated according to temporal trends by Prais-Winsten regression and spatial clusters by Hot Spot analysis. RESULTS: Between 2008 and 2022, 6,022,752 hospitalizations among children were recorded, with a significant decrease in rates throughout this period (p < 0.05). Hospitalizations due to immunization-preventable diseases and epilepsies were the only increasing rates. A negative relation was identified between the hospitalization rates in children under 5 years old and the coverage of the Family Health Strategy (p = 0.002), suggesting that the higher the coverage, the lower the hospitalization rates. The spatial clusters showed changes in the spatial distribution in the rate clusters. CONCLUSION: The patterns of hospitalizations in children under 5 years old changed over the 15 years of the time series, reflecting investments in primary health care. However, the increasing rates reflect the need for surveillance and strengthening of the health care network to care for this population.