Silveira Daniela Martins, Santos Hellen Geremias Dos
Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Brasil.
Cad Saude Publica. 2023 Jun 26;39(6):e00244422. doi: 10.1590/0102-311XPT244422. eCollection 2023.
This study aimed to characterize hospitalizations of residents in Paraná State, Brazil, that occurred during the neonatal period in a municipality different from their place of residence from 2008 to 2019, and to describe displacement networks for the first and last biennium of the series, corresponding to periods before and after initiatives to regionalize health services in the state. Admissions of children aged from 0 to 27 days were obtained from the Hospital Information System of the Brazilian National Unified Health System (SIH-SUS) database. For each biennium and health region, the proportion of admissions that occurred outside the municipality of residence, the weighted average distance traveled, and indicators of health and service provision were calculated. Mixed models were fitted to evaluate the biennial trend of the indicators and to investigate factors associated with the neonatal mortality rate (NMR). In total, 76,438 hospitalizations were selected, ranging from 9,030 in 2008-2009 to 17,076 in 2018-2019. The comparison of the networks obtained for 2008-2009 and 2018-2019 revealed an increase in the number of frequent destinations and in the proportion of displacements within the same health region. A decreasing trend was observed for distance, the proportion of live births with 5-minute Apgar ≤ 7, and for NMR. In the adjusted analysis for NMR, besides the biennial effect (-0.64; 95%CI: -0.95; -0.28), only the proportion of live birth with gestational age < 28 weeks showed statistical significance (4.26; 95%CI: 1.29; 7.06). The demand for neonatal hospital care increased over the study period. The displacement networks suggest a positive impact of regionalization, although investment in regions with the potential to become healthcare centers is necessary.
本研究旨在描述2008年至2019年期间巴西巴拉那州居民在与其居住地不同的城市新生儿期住院情况，并描述该系列第一个和最后一个两年期的转移网络，这两个时期分别对应该州卫生服务区域化举措实施前后。从巴西国家统一卫生系统（SIH-SUS）数据库的医院信息系统中获取0至27天儿童的入院数据。对于每个两年期和卫生区域，计算在居住城市以外发生的入院比例、加权平均旅行距离以及卫生和服务提供指标。采用混合模型评估指标的两年期趋势，并调查与新生儿死亡率（NMR）相关的因素。总共选择了76438例住院病例，从2008 - 2009年的9030例到2018 - 2019年的17076例。对2008 - 2009年和2018 - 2019年获得的网络进行比较，发现频繁目的地数量以及同一卫生区域内转移比例有所增加。观察到距离、5分钟阿氏评分≤7的活产比例以及新生儿死亡率呈下降趋势。在对新生儿死亡率的调整分析中，除了两年期效应（-0.64；95%置信区间：-0.95；-0.28）外，只有孕周<28周的活产比例具有统计学意义（4.26；95%置信区间：1.29；7.06）。在研究期间，新生儿住院护理需求增加。转移网络表明区域化产生了积极影响，尽管有必要对有潜力成为医疗中心的地区进行投资。
