Abstract
This study analyzed the delay in the primary surgical treatment of patients with cleft lip and palate in Brazil performed under the Unified Health System (SUS), and the effect of the sociodemographic context and municipal socioeconomic indicators on access to this treatment (2009-2013). Data from the Decentralized Hospital Information System relating to all hospital authorization forms paid for primary cleft lip and/or palate surgeries and socioeconomic data (2010) was used. The ages recommended by the American Cleft Palate-Craniofacial Association (12 months for lip surgeries and 18 months for palate surgeries) were used as parameters. The prevalence of delay observed in primary lip surgeries was 66.4% and in palate surgeries was 71.2%. The North and Northeast regions had the worst percentages of delay. Non-whites had a greater prevalence of delay in cleft lip surgeries with PR = 1.40 (1.30-1.50) and cleft palate surgeries with PR = 1.27 (1.21-1.33). The multilevel analysis identified the influence of self-reported skin color and Human Development Index (HDI) on the delay of primary lip surgery, and of HDI on the delay of palate surgery. The importance of social determination on the access to primary cleft lip and palate surgeries was evident.
Highlights
Resumo Investigou-se o atraso no tratamento cirúrgico primário de fissuras labiopalatinas no âmbito do Sistema Único de Saúde (SUS) do Brasil e o efeito do contexto sociodemográfico e de indicadores socioeconômicos municipais no acesso a esse tratamento (2009-2013)
This study analyzed the delay in the primary surgical treatment of patients with cleft lip and palate in Brazil performed under the Unified Health System (SUS), and the effect of the sociodemographic context and municipal socioeconomic indicators on access to this treatment (2009-2013)
Data from the Decentralized Hospital Information System relating to all hospital authorization forms paid for primary cleft lip and/or palate surgeries and socioeconomic data (2010) was used
Summary
Prevalência de atraso na cirurgia primária de fissura labiopalatina entre 2009 e 2013, de acordo com a região e tipo de fissura. Os resultados reforçam ainda um forte efeito da variável raça sobre o atraso no tratamento cirúrgico das fissuras labiopalatinas no período avaliado. Apesar do alto número de informações perdidas no registro da variável raça observado neste estudo (36,4% para procedimentos de queiloplastia e 29,5% para procedimentos de palatoplastia), a grande diferença em relação à prevalência observada no atraso da cirurgia primária das fissuras labiopalatinas entre os pacientes não brancos e brancos deixa evidente a desigualdade étnico-racial no acesso ao tratamento, resultante de diferenças socioeconômicas neste grupo. A desigualdade entre grupos raciais em relação ao atraso no tratamento cirúrgico primário das fissuras labiopalatinas também foi observada nos Estados Unidos, em estudo realizado por Cassel e colaboradores[25].
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