Hospitalizations among older adults: results from ELSI-Brazil

Melo-Silva, Alexandre Moreira de; Mambrini, Juliana Vaz de Melo; Souza Junior, Paulo Roberto Borges de; Andrade, Fabíola Bof de; Lima-Costa, Maria Fernanda

doi:10.11606/S1518-8787.2018052000639

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Sumário

Supplement ELSI-Brazil, Original Article • Rev. Saúde Pública 52 (Suppl 2) • 2018 • https://doi.org/10.11606/S1518-8787.2018052000639 copy

Hospitalizations among older adults: results from ELSI-Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To examine the factors associated with hospital use and their frequency in a nationally representative sample of the Brazilian population aged 50 years or older.

METHODS

Data from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, were used. Predisposing, enabling and need factors for the use of health services were considered. The analyzes were based on the Hurdle regression model and on estimates of population attributable risks.

RESULTS

Among 9,389 participants, 10.2% had been hospitalized in the previous 12 months. After adjusting for potential confounding variables, statistically significant associations (p < 0.05) were observed for need factors (previous medical diagnosis for chronic diseases and limitation to perform basic activities of daily living) and for enabling factors (living in a rural area and in the North and Midwest regions of the country). The analysis of population attributable risks (PAR) showed a hierarchy of the need factors for the occurrence of hospitalizations, with higher contributions by stroke (PAR = 10.7%) and cardiovascular disease (PAR = 10.0%), followed by cancer (PAR = 8.9%), difficulty to perform basic activities of daily living (PAR = 6.8%), depression (PAR = 5.5%), diabetes (PAR = 4.4% ) and hypertension (PAR = 2.2%).

CONCLUSIONS

Four of the major diseases associated with hospitalizations (stroke, cardiovascular disease, diabetes and hypertension) are part of the Brazilian list of primary care-sensitive hospitalizations. These results show that there is a window of opportunity to reduce unnecessary hospitalizations among older Brazilian adults through effective primary care actions.

Aged; Hospitalization; Chronic Disease; Cardiovascular Diseases, epidemiology

Characteristic	%	95%CI
Female Gender	54.0	51.0–57.0
Age group (years)
50–59	47.7	43.6–51.8
60–69	29.7	27.9–31.5
70–79	15.6	13.8–17.6
80 or older	7.0	5.9–8.4
Urban place of residence	84.7	79.4–88.8
Residence in the regions
Southeast	47.2	35.6–59.1
South	16.5	8.7–29.0
Midwest	6.6	3.0–13.8
North	5.5	2.3–12.8
Northeast	24.1	15.9–34.9
Education (years)
None	13.3	11.0–16.0
1 to 4	38.2	36.0–40.5
5 to 8	21.5	19.3–23.8
9 or more	27.0	24.7–29.4
Asset score^a
1st quartile	25.1	20.8–30.0
2nd quartile	24.9	23.1–26.7
3rd quartile	25.0	22.7–27.5
4th quartile	25.0	21.8–28.5
Domestic arrangement
Lives alone	9.0	8.1–10.0
Lives with 1 person	32.2	30.1–34.2
Lives with 2 or more people	58.8	56.3–61.4
Has a private health plan	24.7	22.1–27.4
Hospitalization in the last 12 months (at least one)	10.2	9.3–11.1
Limitation to basic activities of daily living (BADL)^b	16.2	14.9–17.6
History of medical diagnosis of:
High blood pressure	52.2	50.3–54.2
Diabetes	15.8	14.6–17.1
Stroke	5.3	4.7–6.0
Cardiovascular disease^c	11.7	10.6–12.9
Depression	18.6	16.8–20.5
Cancer	5.3	4.7–6.0

Characteristic	Hospitalization in the last 12 months

	Yes (%)	95%CI	p^d
Predisposing factors

Gender
Female	9.9	8.9–11.0	0.404
Male	10.7	9.2–12.3
Age group (years)
50–59	8.7	7.6–10.0	< 0.001
60–69	11.2	9.8–12.8
70–79	11.6	9.5–14.0
80 or older	13.6	11.1–16.5

Enabling factors

Place of residence
Urban area	10.1	9.3–10.9	0.455
Rural area	11.2	8.4–14.8
Residence in the regions
Southeast	9.9	8.9–11.0	0.044
South	12.1	9.0–15.9
Midwest	12.4	10.6–14.4
North	12.7	10.1–15.8
Northeast	8.6	7.3–10.0
Education (years)
None	13.0	11.2–15.1	0.040
1 to 4	9.5	8.1–11.1
5 to 8	10.5	9.0–12.2
9 or more	9.6	8.2–11.3
Asset score^a
1st quartile	9.8	8.4–11.4	0.287
2nd quartile	11.2	9.4–13.4
3rd quartile	10.6	9.2–12.1
4th quartile	9.3	7.9–10.8
Domestic arrangement
Lives alone	10.1	8.5–11.8	0.307
Lives with 1 person	10.9	9.6–12.3
Lives with 2 or more people	9.9	8.9–11.0
Healthcare plan
Yes	11.5	10.1–13.2	0.061
No	9.8	8.8–10.9

Need factors

Limitation to basic activities of daily living (BADL)^b
Yes	19.0	17.1–21.2	< 0.001
No	8.5	7.7–9.5
History of medical diagnosis of:
Hypertension
Yes	12.5	11.2–13.8	< 0.001
No	7.8	6.9–8.9
Diabetes
Yes	15.9	13.8–18.2	< 0.001
No	9.2	8.2–10.2
Stroke
Yes	25.8	21.5–30.6	< 0.001
No	9.4	8.5–10.3
Cardiovascular disease^c
Yes	22.5	19.2–26.3	< 0.001
No	8.6	7.8–9.6
Depression
Yes	16.2	14.4–18.2	< 0.001
No	8.8	8.0–9.8
Cancer
Yes	20.6	17.3–24.7	< 0.001
No	9.6	8.8–10.6

Characteristic	Hospitalization (yes or no)		Number of hospitalizations (at least one)

	OR	95%CI	RR	95%CI
Predisposing factors

Gender (versus female)
Male	1.21	0.99–1.47	1.12	0.76–1.64
Age group (versus 50–59)
60–69	1.13	0.93–1.37	0.99	0.70–1.38
70–79	1.06	0.81–1.39	0.78	0.53–1.16
80 or older	1.10	0.79–1.53	0.59^d	0.36–0.99

Enabling factors

Residence (versus urban area)
Rural area	1.34^d	1.02–1.76	1.19	0.85–1.67
Regions (versus Southeast)
South	1.14	0.80–1.63	1.10	0.77–1.59
Midwest	1.30^d	1.05–1.62	1.10	0.75–1.62
North	1.50^d	1.08–2.08	0.74	0.40–1.37
Northeast	0.84	0.67–1.06	1.22	0.81–1.85
Education (versus 9 years or more)
None	1.15	0.85–1.54	1.14	0.60–2.16
1 to 4	0.79	0.59–1.06	1.11	0.67–1.84
5 to 8	1.04	0.82–1.31	0.72	0.44–1.18
Asset score^a (versus 1st quartile)
2nd quartile	1.08	0.79–1.46	0.71	0.48–1.04
3rd quartile	1.07	0.82–1.41	0.77	0.47–1.28
4th quartile	0.90	0.67–1.21	0.70	0.33–1.47
Domestic arrangements (versus lives alone)
Lives with 1 person	1.09	0.88–1.34	1.00	0.62–1.62
Lives with 2 or more people	1.11	0.88–1.39	1.58^d	1.04–2.42
Healthcare plan (versus yes)
No	0.79	0.62–1.02	0.89	0.48–1.66

Need factors

Limitation to basic activities of daily living (BADL)^b	1.77^d	1.50–2.10	1.10	0.85–1.44
History of medical diagnosis of:
High blood pressure	1.27^d	1.08–1.49	1.23	0.94–1.61
Diabetes	1.51^d	1.25–1.83	1.11	0.82–1.51
Stroke	2.10^d	1.49–2.97	1.03	0.70–1.50
Cardiovascular disease^c	2.16^d	1.70–2.75	1.14	0.85–1.52
Depression	1.66^d	1.39–1.97	1.35^d	1.02–1.80
Cancer	2.10^d	1.63–2.70	1.22	0.80–1.85

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[1] Correspondence: Maria Fernanda Lima-Costa. Av. Augusto de Lima, 1715. 30190-002 Belo Horizonte, MG, Brasil. E-mail: lima-costa@cpqrr.fiocruz.br