Social determinants of intra-urban differentials of
               admissions by respiratory diseases in Salvador (BA), Brazil

Antunes, Fernanda Pedro; Costa, Maria da Conceição Nascimento; Paim, Jairnilson Silva; Cruz, Álvaro; Silva, Ligia Maria Vieira da; Barreto, Mauricio

doi:10.1590/1809-4503201400060003

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Original Articles • Rev. bras. epidemiol. 17 (Suppl 2) • 2014 • https://doi.org/10.1590/1809-4503201400060003 copy

Social determinants of intra-urban differentials of admissions by respiratory diseases in Salvador (BA), Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

INTRODUCTION:

Respiratory diseases (RD) represent a significant cause of hospitalization in Brazil, occupying the first position in the rank by group of diseases.

OBJECTIVE:

To identify social determinants (SD) of intra-urban differentials of hospitalizations by RD and their main types (asthma and pneumonia) a study of spatial aggregation was carried out in Salvador (BA), between 2001 and 2007, taking Information Zones (IZ) as unit of analysis.

METHODS:

Data on hospitalizations were provided by the Health Department of Bahia State. Socioeconomic indicators were obtained from the Demographic Census carried out in 2000, and the number of health centers was acquired from the National Register of Health Services.

RESULTS:

Multiple linear regression analysis indicated association between spatial variation of the rates of hospitalization due to RD and income (β = 0.54, p < 0.001) and rate of health facilities per 10,000 inhabitants (β = 2.91, p < 0.001). Crowding was not associated.

CONCLUSION:

The identification of variation in SD in hospitalizations by RD in the IZ of Salvador will help in the decision-making process by public managers in defining goals and effective measures to reduce inequities in health.

Social determinants of health; Respiratory tract diseases; Hospitalization; Asthma; Pneumonia; Social Inequity

IZ	RD Rate	Asthma Rate	Pneumonia Rate	IZ	RD Rate	Asthma Rate	Pneumonia Rate
1	10.16	1.12	3.94	37	33.30	5.23	18.18
2	16.95	2.64	5.79	37A	15.93	2.02	5.56
3	9.3	1.03	4.39	38	70.04	9.23	22.74
4	14.54	2.58	6.97	38A	11.92	0.96	5.89
4A	9.53	0.56	3.36	38B	37.54	4.29	21.99
5	16.71	1.70	4.90	39	50.74	6.42	20.74
6	39.24	7.18	18.03	40	26.31	2.89	9.95
7	29.82	5.25	14.81	41	42.45	6.27	17.49
8	6.54	0.27	2.25	42	40.74	5.04	18.63
9	7.56	0.50	2.35	43	30.26	4.89	15.29
10	4.08	0.29	1.36	44	32.27	5.66	14.97
11	30.72	4.97	12.87	45	6.07	1.78	2.83
12	36.00	6.24	14.67	46	3.36	0	1.18
13	13.35	2.21	6.07	47	24.38	3.50	10.98
14	15.28	1.49	5.52	48	32.47	6.75	15.35
15	46.44	6.24	18.60	49	40.96	9.07	19.45
15A	15.12	1.26	6.84	49A	5.46	1.44	3.16
15B	51.76	9.66	17.25	50	29.49	4.06	12.70
16	22.23	2.77	7.74	51	33.92	4.89	15.13
17	23.42	3.93	10.55	52	33.67	6.86	16.05
17A	24.62	4.88	8.49	53	61.37	13.99	30.78
18	29.19	5.66	12.81	53A	11.81	1.71	6.57
19	21.02	3.95	9.13	54	24.03	4.48	12.02
20	30.29	5.54	12.51	55	21.65	3.10	9.34
21	3.42	0.17	1.31	56	9.11	0.90	3.20
21A	25.98	5.20	10.39	57	34.81	7.30	16.69
22	12.54	1.67	6.19	58	33.14	4.61	16.63
23	67.81	15.58	32.07	59	55.18	10.86	28.64
23A	47.57	6.56	19.68	60	38.74	5.99	20.18
24	81.01	10.13	46.58	61	25.50	4.02	11.61
24A	19.48	7.08	7.08	61A	14.62	1.78	7.52
24C	45.32	4.82	5.79	62	32.42	5.96	17.36
24D	31.85	5.06	11.61	63	35.66	4.07	17.37
24E	39.65	12.15	15.99	64	29.75	4.44	15.25
25	28.35	4.20	9.97	64A	5.36	1.79	1.79
26	11.37	1.78	3.57	65	30.42	4.91	16.08
27	39.94	7.77	18.42	66	36.73	5.93	19.73
28	23.50	4.95	8.82	67	25.24	4.21	14.69
29	15.50	2.65	6.73	67A	1.03	0	0
30	40.91	7.51	19.32	68	51.81	13.29	24.99
31	31.12	4.66	16.85	69	36.08	7.31	18.55
31A	14.89	1.92	7.44	70	4.77	0.71	2.52
32	36.23	6.83	14.50	71	41.14	8.79	24.28
33	34.07	5.05	12.74	71A	28.11	4.11	18.00
34	43.30	6.77	18.43	72	22.85	3.54	13.27
35	25.44	4.54	12.72	73	50.60	11.23	26.20
36	38.29	7.6	16.96

Determinants	Bivariate analysis		Multivariate analysis *
Determinants	β	p-value	β	p-value
Schooling	0.43	0.000
Income	0.46	0.000	0.54	0.000
Water supply	0.31	0.273	1.40	0.000
Sewer network	0.02	0.762
Garbage collection	-0.08	0.620	-0.27	0.169
Gini Index	102.88	0.000	23.50	0.358
Slums	0.14	0.443
Occupant/room	-1.58	0.402	-1.94	0.152
Basic health units and health centers/10.000 inhabitants	2.84	0.002	2.91	0.000

Determinants	Pneumonia				Asthma
	Bivariate		Multivariate*		Bivariate		Multivariate*
	β	p-value	β	p-value	β	p-value	β	p-value
Schooling	0.26	0.000			0.09	0.000
Income	0.26	0.000	0.33	0.000	0.09	0.000	0.08	0.002
Water supply	0.03	0.811	0.63	0.000	0.01	0.853	0.27	0.000
Sewer network	-0.03	0.287			-0.01	0.284
Garbage collection	-0.11	0.171	-0.14	0.172	-0.05	0.088	-0.09	0.032
Gini Index	56.49	0.000			20.52	0.000	5.55	0.319
Slums	0.16	0.092			0.07	0.046
Occupant/Room	-0.14	0.877			0.03	0.992
Basic health units and health centers/10.000 inhabitants	0.84	0.007	1.04	0.003	0.35	0.053	0.42	0.005

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[1] Corresponding author: Fernanda Pedro Antunes. Rua Politeama de Baixo, 69, apartamento 927, Bl G, Politeama, Salvador, BA, Brasil, CEP 40080-166. E-mail: fp.antunes@yahoo.com.br