Hospital readmissions for ambulatory care sensitive conditions in children under 5 years old in the Unified Health System

Ferreira, Jéssica; Rocha, Hugo André da; Cherchiglia, Mariangela Leal; Reis, Ilka Afonso

doi:10.1590/1413-812320242911.17262023

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THEMATIC ARTICLE • Ciênc. saúde coletiva 30 (suppl 1) • 2025 • https://doi.org/10.1590/1413-812320242911.17262023EN linkcopy

Hospital readmissions for ambulatory care sensitive conditions in children under 5 years old in the Unified Health System

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to analyze readmissions for Ambulatory Care Sensitive Conditions (ACSC) in children under 5 years in the Unified Health System (SUS) between the years 2009 and 2015, to identify the main cause groups and associated factors. This retrospective cohort study used data from the National Health Database, an individual-centered database constructed from deterministic-probabilistic data matching from the main information systems of SUS. The study population consisted of children under 5 years old hospitalized within the SUS with a primary diagnosis listed in the Brazilian Ambulatory Care Sensitive Conditions. Sociodemographic, clinical, hospitalization-related, and hospital service-related factors were considered. Factors associated with readmission included being an infant (between 28 days and 2 years of age), being male, having been initially hospitalized in a private or non-profit institution, residing in the same municipality as the hospital, and the initial hospitalization cause being related to epilepsy, asthma, nutritional deficiencies, pulmonary diseases, bacterial pneumonia and nose, ear, and throat infections.

Keywords:
Primary Health Care; Child Health; Hospital Readmission; Ambulatory Care Sensitive Conditions

Characteristics	Patients n= 1,559,880 (100%)	Readmission n= 194,788 (12.5%)
Age
Neonates	46,521 (3.0%)	4,699 (2.4%)
Infants	953,179 (61.1%)	145,023 (74.5%)
Preschoolers	560,180 (35.9%)	45,066 (23.1%)
Sex
Female	723,811 (46.4%)	86,556 (44.4%)
Male	836,069 (53.6%)	108,232 (55.6%)
Region
North	244,151 (15.7%)	29,638 (15.2%)
Northeast	536,268 (34.4%)	66,104 (33.9%)
Southeast	464,180 (29.8%)	58,641 (30.1%)
South	189,174 (12.1%)	25,781 (13.2%)
Midwest	126,107 (8.1%)	14,624 (7.51%)
Race/skin color
White	395,661 (25.4%)	52,833 (27.1%)
Black	28,870 (1.8%)	3,792 (1.9%)
Brown	647,148 (41.5%)	96,239 (49.4%)
Yellow	6,094 (0.4%)	920 (0,5%)
Indigenous	13,272 (0.9%)	2,649 (1.4%)
Ignored	469,835 (30.1%)	38,355 (19.7%)
Lives in the municipality of readmission
Non-resident	268,472 (17.2%)	34,433 (17.7%)
Resident	1,291,408 (82.8%)	160,355 (82.3%)
CSAP Group
2 - Infectious gastroenteritis	624,683 (40.0%)	65,903 (33.8%)
6 - Bacterial pneumonia	215,796 (13.8%)	31,424 (16.1%)
8 - Lung diseases	213,034 (13.7%)	33,972 (17.4%)
7 - Asthma	206,947 (13.3%)	30,525 (15.7%)
15 - Kidney and Urinary Tract Infection	86,578 (5.6%)	9,033 (4.7%)
16 - Infection of the skin and subcutaneous tissue	67,418 (4.3%)	3,961 (2.0%)
5 - Nose, ear and throat infections	51,226 (3.3%)	5,352 (2.8%)
14 - Epilepsies	40,222 (2.6%)	7,221(3.7%)
4 - Nutritional Deficiencies	15,105 (1.0%)	2,346 (1.2%)
Others	38,871 (2.4%)	5,051 (2.6%)
Death
No	1,540,558 (98.8%)	190,400 (97.7%)
Yes	19,322 (1.2%)	4,388 (2.3%)
Number of readmissions
One	-	145,471 (74,.7%)
Two	-	31,568 (16.2%)
Three	-	9,997 (5.1 Idade%)
Four or more	-	7,752 (4.0%)
Readmission by the same CSAP group
Yes	-	112,504 (57.8%)
No	-	82,284 (42.2%)
Number of readmissions by the same CSAP group
One	-	91,805 (81.6%)
Two	-	14,648 (13.0%)
Three	-	3,622 (3.2%)
Four or more	-	2,429 (2.2%)

	Individual models		Multiple models
Variables	OR (95% CI)	p-value	OR (95% CI)	p-value
Age group
Preschoolers	1		1
Infants	2.05 (2.03-2.07)	< 0.001	2.00 (1.98-2.02)	< 0.001
Neonates	1.29 (1.25-1.33)	< 0.001	1.30 (1.23-1.31)	< 0.001
Sex
Female	1		1
Male	1.09 (1.08-1.11)	< 0.001	1.06 (1.05-1.07)	< 0.001
Region
Southeast	1		1
Northeast	0.97 (0.96-0.99)	< 0.001	1.10 (1.09-1.12)	< 0.001
North	0.96 (1.08-1.11)	< 0.001	1.07 (1.06-1.09)	< 0.001
South	1.09 (1.08-1.11)	< 0.001	1.04 (1.02-1.05)	< 0.001
Midwest	0.91 (0.89-0.93)	0.003	0.97 (0.95-0.99)	0.003
Residence in the same municipality as the hospital
Non-resident	1		1
Resident	0.96 (0.95-0.98)	< 0.001	1.02 (1.01-1.04)	< 0.001
Legal nature of the hospital
Public	1		1
Private	1.13 (1.11-1.14)	< 0.001	1.16 (1.15-1.18)	< 0.001
Private Non-profit	1.14 (1.12-1.15)	< 0.001	1.12 (1.11-1.13)	< 0.001
Reason for initial admission
2 - Infectious gastroenteritis	1		1
6 - Bacterial pneumonia	1.45 (1.42-1.47)	< 0.001	1.41 (1.39-1.43)	< 0.001
8 - Lung diseases	1.61 (1.58-1.63)	< 0.001	1.43 (1.41-1.46)	< 0.001
7 - Asthma	1.47 (1.44-1.49)	< 0.001	1.54 (1.52-1.56)	< 0.001
15 - Kidney and urinary tract infections	0.98 (0.96-1.01)	0.459	1.01 (0.98-1.03)	0.459
16 - Skin and subcutaneous tissue infections	0.53 (0.51-0.55)	< 0.001	0.59 (0.57-0.61)	< 0.001
5 - Nose, ear, and throat infections	0.99 (0.96-1.02)	0.004	1.04 (1.01-1.08)	0.004
14 - Epilepsy	1.86 (1.81-1.91)	< 0.001	1.96 (1.91-2.01)	< 0.001
4 - Nutritional deficiencies	1.56 (1.49-1.63)	< 0.001	1.50 (1.43-1.56)	< 0.001
Others	1.27 (1.23-1.31)	< 0.001	1.31 (1.27-1.35)	< 0.001

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[TFN3n] Source: National Individual-Centered Health Database (Base Nacional de Saúde Centrada no Indivíduo), 2023.