Abstract
Contextual variables have been associated with the incidence of stroke, but their association with hospitalization of older persons remains unclear. This study evaluated the association between social context variables and hospitalization of 60 years old and older patients due to stroke in Rio de Janeiro, Brazil. An ecological cross-sectional study was conducted, with secondary data from the Brazilian Hospital Information System from 2006 to 2014. Hospitalization rates were calculated and categorized by tertiles. For subsequent analyzes, the polar extremes method was used to select the groups with extremes values. After that, Student t or Mann-Whitney tests were used to compare the contextual variables and the hospitalization rates clusters. Then, a Binary Logistic Regression analysis was used to assess the association between hospitalization rates clusters and the contextual variables. The total number of hospitalizations was 82 796; the hospitalization rate varied in extremes groups from the lowest (3.49) to the highest (11.95) (p<0.001). The highest rates group was positively associated with the proportion of elderly (p<0.001), the illiteracy rate of the aged (p = 0.01), primary care coverage (p<0.001) and ambulatory care for hypertension and diabetes, while the income ratio showed negative association with the highest rates of hospitalization (p = 0.01). In the multivariate analysis, only the proportion of elderly (OR = 1.55; 95%CI 1.07–2.25), primary care coverage (OR = 1.05; 95%CI 1.01–1.11) and income ratio (OR = 0.82; 95%CI 0.67–0.99) maintained the association. In conclusion, contextual variables in the three dimensions studied were associated with the rate of hospitalization of aged due to stroke in the municipalities in Rio de Janeiro State. Transitional care and other improvements in both the health care and social services are demanded.
Highlights
Social disadvantage affects both intellectual and social development
The aim of the present study was to investigate the association of contextual variables and hospitalizations due to stroke in Rio de Janeiro State, Brazil
A percentage of 64.66% did not receive an accurate diagnosis of stroke or Transient Ischemic Attacks (TIA) subtype at admission (Table 1)
Summary
Social disadvantage affects both intellectual and social development. Those who are privileged have better performance in measures of development due to the circumstances of social inequity [1]. There is a worldwide interest in identifying and solving the gaps in health inequities; especially those related to the impact of contextual factors on health and disease. The environment, culture, demographic and socioeconomic characteristics are factors that can impact the health and disease profile of the population, as well as the access to preventive and health care [3,4]. Stroke is a global health problem; it is the second most disabling disease in developing countries, and the third in developed countries [5]
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