Abstract
There has been a global increase in hospital admissions for primary care-sensitive conditions (PCSCs) as an indicator of effectiveness in primary health care. This article analyzes ethnic and racial inequalities in cause-related hospitalizations in under-five children in Brazil as a whole and the country's five major geographic regions, with an emphasis on PCSCs and acute respiratory infections (ARIs). Using data from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS), 2009-2014, the authors calculated proportions, rates, and rate ratios for PCSCs, adjusted by sex and age after multiple imputation of missing data on color/race. The principal causes of hospitalization were respiratory tract infections (37.4%) and infectious and parasitic diseases (19.3%), and indigenous children were proportionally the most affected. Crude PCSC rates (per 1,000) were highest in indigenous children (97.3; 95%CI: 95.3-99.2), followed by brown or mixed-raced children (40.0; 95%CI: 39.8-40.1), while the lowest rates were in Asiandescendant children (14.8; 95%CI: 14.1-15.5). The highest adjusted rate ratios for PCSCs were seen among indigenous children compared to white children - 5.7 (95%CI: 3.9-8.4) for Brazil as a whole, reaching 5.9 (95%CI: 5.0-7.1) and 18.5 (95%CI: 16.5-20.7) in the North and Central, respectively, compared to white children. ARIs remained as important causes of pediatric hospitalizations in Brazil. Alarming ethnic and racial inequalities were observed in PCSCs, with indigenous children at a disadvantage. Improvements are needed in living conditions, sanitation, and subsistence, as well as guaranteed timely access to high-quality primary health care in the more vulnerable population groups, especially the indigenous peoples of the North and Central, in order to mitigate the health inequalities and meet the guidelines of the SUS and the Brazilian Constitution.
Highlights
As crianças indígenas foram proporcionalmente mais acometidas por causas respiratórias (53%), seguidas pelas crianças pretas (40,8%), pardas (39,3%), brancas (38,6%) e amarelas (31,1%)
O mesmo foi verificado para crianças indígenas (53% e 26,1%), pretas (40,8% e 17,3%) e pardas (39,3% e 24,3%), nas quais essas duas causas respondem, em conjunto, respectivamente, por 79,1%, 58,1% e 63,6% das internações
A análise por cor/raça revelou predomínio de internações por infecções respiratórias agudas (IRA) entre as crianças indígenas (47%), sobretudo por pneumonia e influenza (P&I) (43,3%), e as demais categorias registraram cerca de 29% ou menos de internações por esta causa
Summary
Ethnic and racial inequalities in hospital admissions due to avoidable causes in under-five Brazilian children, 2009-2014. Eles são restritos a recortes geográficos locais ou a grupos étnicos específicos, e revelam padrões de morbidade indígena compatíveis com aqueles verificados nos segmentos sociais mais vulneráveis, sobressaindo as internações por causas infecciosas, com destaque para as infecções respiratórias agudas (IRA) e diarreia, além de apresentarem elevada carga de ICSAP 12,13. O presente estudo tem por objetivo analisar as hospitalizações de crianças menores de cinco anos no Brasil registradas no SIH/SUS no período de 2009 a 2014, segundo cor/raça, com vistas a identificar a relevância dos principais grupos de causas de internação e a importância relativa das IRA, a magnitude das taxas de ICSAP segundo cor/raça e as iniquidades étnico-raciais nos perfis das hospitalizações por causas, com ênfase nas doenças respiratórias agudas e ICSAP, agravos mais frequentes em grupos sociais mais vulneráveis da população brasileira
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