Abstract
To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with in-hospital mortality related to the disease. Cross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in the SUS between late February through June. Patients aged 18 years or older with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization. 89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in the SUS were predominantly male (56.5%) with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (±6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The odds on in-hospital death were 16.8% higher among men than among women and increased with age. Black individuals had a higher likelihood of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states, such as Amazonas and Rio de Janeiro, had a higher risk of in-hospital death from COVID-19. The odds on in-hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants, though being hospitalized in the municipality of residence was a protective factor. There was broad variation in COVID-19 in-hospital mortality in the SUS, associated with demographic and clinical factors, social inequality, and differences in the structure of services and quality of health care.
Highlights
The Covid-19 pandemic caused by the SARS-CoV-2 virus has severely affected Brazil, which has become the country with the second highest number of cases and deaths in the world [1]
In Brazil, a cross-sectional observational study conducted with hospitalized COVID-19 patients identified a lower likelihood of death in young, female patients with fewer comorbidities, commensurable with what has been observed in other countries
The following question arises: How does the profile of patients and hospitalizations observed in the international literature compare with hospitalizations that occurred in Brazil’s public health system in different regions of the country? The scope of this paper is to understand the profile of COVID-19 hospital admissions in the Unified Health System (SUS) and to identify associated factors with the occurrence of in-hospital deaths related to the disease, considering patient characteristics and the care offered, with a focus on regional variations
Summary
To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with in-hospital mortality related to the disease. Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; we enable the publication of all of the content of peer review and author responses alongside final, published articles. Data Availability Statement: All relevant data are within the manuscript.
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