Study of inequalities in hospital mortality using the Charlson comorbidity index
Autor(a) principal: | |
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Data de Publicação: | 2004 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Revista de Saúde Pública |
Texto Completo: | https://www.revistas.usp.br/rsp/article/view/31814 |
Resumo: | OBJECTIVE: The evaluation of quality and equity in healthcare attendance requires adequate study methods and information systems. Thus, this study was performed with the objective of comparing mortality among elderly patients attended within the private network and within the Brazilian national health system (SUS). METHOD: An information system that recorded causes of hospitalization and associated diseases (comorbidity) in relation to public and private hospital admissions was utilized. The hospitalization of 21,695 patients in Ribeirão Preto, State of São Paulo, in 1998 and 1999 was studied. These patients had diseases of the circulatory and respiratory systems. Analysis was done via the methodology put forward by Charlson, in which comorbidities are scored to give the Charlson comorbidity index and age over 50 years (per decade) is scored to give the Charlson comorbidity-age index. The patients were stratified according to comorbidity and decade of age over 50 years, with separation of hospitalizations via SUS from those via the private network (non-SUS). The coefficient of hospital mortality was calculated for each stratum. RESULTS: It was observed that the risk of death increased almost sixfold when the number of associated diseases increased. The risk of death for SUS patients was more than twice the risk for non-SUS patients (relative risk: 2.12). Significant differences between SUS and non-SUS patients were found by associating the patient's comorbidity with decade of age. When the risk of death was very low or very high, there were no statistical differences between SUS and non-SUS patients. In other, intermediate situations, precisely where the attendance might make a difference, the mortality among SUS patients was more than twice as great (relative risk: 2.14). CONCLUSIONS: The difference in mortality between SUS and non-SUS patients, according to Charlson's criteria, is significant among patients of intermediate risk, for whom the care is most important. The Charlson comorbidity index correlates with hospital mortality. |
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Study of inequalities in hospital mortality using the Charlson comorbidity index Estudo da desigualdade na mortalidade hospitalar pelo índice de comorbidade de Charlson Mortalidade hospitalarSistemas de informaçãoIdosoMortalidade diferencialIniqüidade socialPrestação de cuidados de saúdePacientes internadosSUS^i1^Hospitais privadosHospital mortalityInformation systemsAgedDifferential mortalitySocial inequityDelivery of health careInpatientsSUS^i2^Hospitalsprivate OBJECTIVE: The evaluation of quality and equity in healthcare attendance requires adequate study methods and information systems. Thus, this study was performed with the objective of comparing mortality among elderly patients attended within the private network and within the Brazilian national health system (SUS). METHOD: An information system that recorded causes of hospitalization and associated diseases (comorbidity) in relation to public and private hospital admissions was utilized. The hospitalization of 21,695 patients in Ribeirão Preto, State of São Paulo, in 1998 and 1999 was studied. These patients had diseases of the circulatory and respiratory systems. Analysis was done via the methodology put forward by Charlson, in which comorbidities are scored to give the Charlson comorbidity index and age over 50 years (per decade) is scored to give the Charlson comorbidity-age index. The patients were stratified according to comorbidity and decade of age over 50 years, with separation of hospitalizations via SUS from those via the private network (non-SUS). The coefficient of hospital mortality was calculated for each stratum. RESULTS: It was observed that the risk of death increased almost sixfold when the number of associated diseases increased. The risk of death for SUS patients was more than twice the risk for non-SUS patients (relative risk: 2.12). Significant differences between SUS and non-SUS patients were found by associating the patient's comorbidity with decade of age. When the risk of death was very low or very high, there were no statistical differences between SUS and non-SUS patients. In other, intermediate situations, precisely where the attendance might make a difference, the mortality among SUS patients was more than twice as great (relative risk: 2.14). CONCLUSIONS: The difference in mortality between SUS and non-SUS patients, according to Charlson's criteria, is significant among patients of intermediate risk, for whom the care is most important. The Charlson comorbidity index correlates with hospital mortality. OBJETIVO: Avaliar qualidade e eqüidade na assistência à saúde requer métodos de estudo e sistemas de informações adequados. Assim, realizou-se estudo com o objetivo de comparar a mortalidade entre os pacientes idosos atendidos pela rede privada com a dos atendidos pelo Sistema Único de Saúde. MÉTODOS: Foi utilizado um sistema de informações de egressos hospitalares de instituições públicas e privadas e o registro de doenças associadas (comorbidade) além da causa da internação. Foram estudadas 21.695 hospitalizações de pacientes de Ribeirão Preto, SP, internados em 1998 ou 1999, por doenças dos aparelhos circulatório e respiratório. Para análise, segui-se a metodologia preconizada por Charlson, que atribui pontuação para as comorbidades (ICC) e índice comorbidade-idade de Charlson (ICIC) que acrescenta pontuação por década, a partir dos 50 anos de idade. Os pacientes foram estratificados segundo a comorbidade e a década de idade acima de 50 anos, separados os internados pelo SUS dos internados pela rede privada (não-SUS); foi calculado o coeficiente de mortalidade hospitalar para cada estrato. RESULTADOS: Foi observado que o risco de morte aumenta quase seis vezes quando aumenta o número de doenças associadas; o risco de morte é mais do que o dobro para os pacientes do SUS comparados com os do não-SUS - risco relativo 2,12. Associando a comorbidade com a década de idade do paciente foram encontradas diferenças significativas entre pacientes SUS e não-SUS. Quando o risco de morte foi muito baixo ou muito alto não houve diferenças estatísticas entre os pacientes SUS e não-SUS; nas outras situações intermediárias, justamente onde a assistência poderia fazer a diferença, a mortalidade para os pacientes SUS foi maior que o dobro - risco relativo, 2,14. CONCLUSÕES: O diferencial de mortalidade entre os pacientes SUS e não-SUS, segundo os critérios de Charlson, é significativo nos pacientes de risco intermediário, onde o cuidado é mais importante. O Índice de Comorbidade de Charlson tem correlação com a mortalidade hospitalar. Universidade de São Paulo. Faculdade de Saúde Pública2004-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://www.revistas.usp.br/rsp/article/view/3181410.1590/S0034-89102004000600005Revista de Saúde Pública; Vol. 38 No. 6 (2004); 780-786 Revista de Saúde Pública; Vol. 38 Núm. 6 (2004); 780-786 Revista de Saúde Pública; v. 38 n. 6 (2004); 780-786 1518-87870034-8910reponame:Revista de Saúde Públicainstname:Universidade de São Paulo (USP)instacron:USPporenghttps://www.revistas.usp.br/rsp/article/view/31814/33746https://www.revistas.usp.br/rsp/article/view/31814/33747Copyright (c) 2017 Revista de Saúde Públicainfo:eu-repo/semantics/openAccessIucif Jr, NelsonRocha, Juan S Yazlle2012-07-08T22:13:04Zoai:revistas.usp.br:article/31814Revistahttps://www.revistas.usp.br/rsp/indexONGhttps://www.revistas.usp.br/rsp/oairevsp@org.usp.br||revsp1@usp.br1518-87870034-8910opendoar:2012-07-08T22:13:04Revista de Saúde Pública - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Study of inequalities in hospital mortality using the Charlson comorbidity index Estudo da desigualdade na mortalidade hospitalar pelo índice de comorbidade de Charlson |
title |
Study of inequalities in hospital mortality using the Charlson comorbidity index |
spellingShingle |
Study of inequalities in hospital mortality using the Charlson comorbidity index Iucif Jr, Nelson Mortalidade hospitalar Sistemas de informação Idoso Mortalidade diferencial Iniqüidade social Prestação de cuidados de saúde Pacientes internados SUS^i1^ Hospitais privados Hospital mortality Information systems Aged Differential mortality Social inequity Delivery of health care Inpatients SUS^i2^ Hospitals private |
title_short |
Study of inequalities in hospital mortality using the Charlson comorbidity index |
title_full |
Study of inequalities in hospital mortality using the Charlson comorbidity index |
title_fullStr |
Study of inequalities in hospital mortality using the Charlson comorbidity index |
title_full_unstemmed |
Study of inequalities in hospital mortality using the Charlson comorbidity index |
title_sort |
Study of inequalities in hospital mortality using the Charlson comorbidity index |
author |
Iucif Jr, Nelson |
author_facet |
Iucif Jr, Nelson Rocha, Juan S Yazlle |
author_role |
author |
author2 |
Rocha, Juan S Yazlle |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Iucif Jr, Nelson Rocha, Juan S Yazlle |
dc.subject.por.fl_str_mv |
Mortalidade hospitalar Sistemas de informação Idoso Mortalidade diferencial Iniqüidade social Prestação de cuidados de saúde Pacientes internados SUS^i1^ Hospitais privados Hospital mortality Information systems Aged Differential mortality Social inequity Delivery of health care Inpatients SUS^i2^ Hospitals private |
topic |
Mortalidade hospitalar Sistemas de informação Idoso Mortalidade diferencial Iniqüidade social Prestação de cuidados de saúde Pacientes internados SUS^i1^ Hospitais privados Hospital mortality Information systems Aged Differential mortality Social inequity Delivery of health care Inpatients SUS^i2^ Hospitals private |
description |
OBJECTIVE: The evaluation of quality and equity in healthcare attendance requires adequate study methods and information systems. Thus, this study was performed with the objective of comparing mortality among elderly patients attended within the private network and within the Brazilian national health system (SUS). METHOD: An information system that recorded causes of hospitalization and associated diseases (comorbidity) in relation to public and private hospital admissions was utilized. The hospitalization of 21,695 patients in Ribeirão Preto, State of São Paulo, in 1998 and 1999 was studied. These patients had diseases of the circulatory and respiratory systems. Analysis was done via the methodology put forward by Charlson, in which comorbidities are scored to give the Charlson comorbidity index and age over 50 years (per decade) is scored to give the Charlson comorbidity-age index. The patients were stratified according to comorbidity and decade of age over 50 years, with separation of hospitalizations via SUS from those via the private network (non-SUS). The coefficient of hospital mortality was calculated for each stratum. RESULTS: It was observed that the risk of death increased almost sixfold when the number of associated diseases increased. The risk of death for SUS patients was more than twice the risk for non-SUS patients (relative risk: 2.12). Significant differences between SUS and non-SUS patients were found by associating the patient's comorbidity with decade of age. When the risk of death was very low or very high, there were no statistical differences between SUS and non-SUS patients. In other, intermediate situations, precisely where the attendance might make a difference, the mortality among SUS patients was more than twice as great (relative risk: 2.14). CONCLUSIONS: The difference in mortality between SUS and non-SUS patients, according to Charlson's criteria, is significant among patients of intermediate risk, for whom the care is most important. The Charlson comorbidity index correlates with hospital mortality. |
publishDate |
2004 |
dc.date.none.fl_str_mv |
2004-12-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/31814 10.1590/S0034-89102004000600005 |
url |
https://www.revistas.usp.br/rsp/article/view/31814 |
identifier_str_mv |
10.1590/S0034-89102004000600005 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/31814/33746 https://www.revistas.usp.br/rsp/article/view/31814/33747 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Revista de Saúde Pública info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Revista de Saúde Pública |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
dc.source.none.fl_str_mv |
Revista de Saúde Pública; Vol. 38 No. 6 (2004); 780-786 Revista de Saúde Pública; Vol. 38 Núm. 6 (2004); 780-786 Revista de Saúde Pública; v. 38 n. 6 (2004); 780-786 1518-8787 0034-8910 reponame:Revista de Saúde Pública instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Revista de Saúde Pública |
collection |
Revista de Saúde Pública |
repository.name.fl_str_mv |
Revista de Saúde Pública - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
revsp@org.usp.br||revsp1@usp.br |
_version_ |
1800221782999826432 |