Abstract
To analyze the geographical variation in the provision of health services, namely in demand, patterns of utilization, and effectiveness in the Brazilian Health Regions in four different periods of the COVID-19 pandemic, from February 2020 to March 2021. Descriptive serial cross-sectional study based on secondary data on COVID-19 hospitalizations from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records collected by the Brazilian Ministry of Health, and COVID-19 case notification data from Brasil.io, a repository of public data. Fifty-six epidemiological weeks were split into four periods. The following variables were considered for each Brazilian Health Region, per period: number of hospitalizations, hospitalizations per 100,000 inhabitants, hospitalizations per 100 new cases notified in the Health Region, percentage of hospitalizations with ICU use, percentages of hospitalizations with invasive and non-invasive ventilatory support, percentage of hospitalizations resulting in death and percentage of hospitalizations with ICU use resulting in death. Descriptive statistics of the variables were obtained across all 450 Health Regions in Brazil over the four defined pandemic periods. Maps were generated to capture the spatiotemporal variation and trends during the first year of the COVID-19 pandemic in Brazil. There was great variation in how COVID-19 hospitalizations grew and spread among Health Regions, with higher numbers between June and August 2020, and, especially, from mid-December 2020 to March 2021. The variation pattern in the proportion of ICU use in the hospitalizations across the Health Regions was broad, with no intensive care provision in large areas in the North, Northeast, and Midwest. The proportions of hospitalizations and hospitalizations with ICU use resulting in deaths were remarkably high, reaching medians of 34.0% and 62.0% across Health Regions, respectively. The Heath Regions in Brazil are highly diverse, showing broad disparities in the capacity to respond to the demands imposed by COVID-19, services provided, use and outcomes.
Highlights
Geographical variation in demand, utilization, and effectiveness of inpatient care is associated with a broad range of individual and contextual factors, among which health needs and service provision preponderate.In Brazil, there are severe disparities in the provision of health services, in health needs across different segments of the population, and in the access to healthcare, despite the existence of an equitable universal public health system [1]
The variation pattern in the proportion of intensive care unit (ICU) use in the hospitalizations across the Health Regions was broad, with no intensive care provision in large
Severe Acute Respiratory Illness records collected by the Brazilian Ministry of Health and COVID-19 case notification data from Brasil.io, a repository of public data
Summary
Geographical variation in demand, utilization, and effectiveness of inpatient care is associated with a broad range of individual and contextual factors, among which health needs and service provision preponderate. In Brazil, there are severe disparities in the provision of health services, in health needs across different segments of the population, and in the access to healthcare, despite the existence of an equitable universal public health system [1]. From the end of 2020, the evolution of the pandemic attained national scale, geographically broad and widespread, with transmission rates reaching around 1.20 [5] by March 2021. The uncontrolled virus circulation had enabled new strains, such as P.1, with estimated transmissibility of 1.4 to 2.2 higher than the original one, contributing to the chaotic pandemic situation in the country [7]
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