Departamento de Saúde Pública, Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil.
M.A.T.H. CONSORTIUM - Methods, Analytics, and Technology for Health, Belo Horizonte, Minas Gerais, Brazil.
PLoS One. 2022 Jun 9;17(6):e0269548. doi: 10.1371/journal.pone.0269548. eCollection 2022.
To analyze the spatiotemporal distribution of hospital admission rates for primary care-sensitive conditions (PCSC) in women and children in the first 1000 days of life in Brazil.
Ecological study, with spatiotemporal analyses, using secondary data from Brazilian municipalities. PCSC in women, related to prenatal care and childbirth, and in children under two years old, from 2008 to 2019 were used to characterize trends and formations of spatiotemporal clusters/outliers. Crude PCSC rates were calculated and adjusted by the local empirical Bayesian method, presented in choropleth maps. We also used Anselin Local Moran I type analyses to identify spatial clusters, and space-time cube with clustering by emerging hotspot, followed by time series clustering, for analysis of spatiotemporal trends (alpha = 5%).
A total of 1,850,776 PCSC were registered in pregnant women, puerperae, and children under two years of age in Brazil, representing 1.7% of the total number of hospital admissions in the period. PCSC rates showed different behaviors when the groups of women and children were evaluated, with a predominant growing trend of 109% in admissions in the first group and a reduction of 34.4% in the second. The North, Northeast, and Midwest regions had larger high-risk clusters and more significant increasing trends in PCSC in the two subpopulations studied.
Health actions and services in primary care may be reducing hospital admissions for children, but they are not being effective in reducing hospital admissions for women for causes related to prenatal care and childbirth, especially in the North, Northeast, and Midwest of Brazil. Investments in the qualification of care over the thousand days are urgent in the country.
分析巴西女性和儿童生命最初 1000 天内初级保健敏感条件（PCSC）住院率的时空分布。
这是一项生态研究，使用巴西各市镇的二级数据进行时空分析。使用与产前护理和分娩相关的女性 PCSC 以及 2 岁以下儿童 PCSC 来描述趋势和时空聚类/离群值的形成。计算了未调整和本地经验贝叶斯调整的 PCSC 粗率，并以专题地图形式呈现。我们还使用 Anselin 局部 Moran I 型分析来识别空间聚类，以及具有时空聚类的时空立方体，其中包括新兴热点聚类、时间序列聚类，用于分析时空趋势（alpha = 5%）。
在巴西，共有 1850776 例孕妇、产褥期妇女和 2 岁以下儿童发生 PCSC，占该时期住院总人数的 1.7%。当评估女性和儿童这两个群体时，PCSC 率表现出不同的行为，第一组的住院人数呈 109%的增长趋势，而第二组则下降了 34.4%。北部、东北部和中西部地区的高危聚类较大，两个研究亚群的 PCSC 呈显著增长趋势。
初级保健中的卫生行动和服务可能降低了儿童的住院率，但对于与产前护理和分娩相关的原因导致的女性住院率并没有降低，尤其是在巴西的北部、东北部和中西部地区。该国迫切需要对千日护理进行投资以提高质量。
