# Time series of hospitalizations for primary care-sensitive conditions in children in the state of Roraima, Brazil, 2010 to 2023

## TL;DR

This study examines hospitalization trends for preventable conditions in children in Roraima, Brazil, from 2010 to 2023, revealing concerning patterns linked to weak primary healthcare.

## Contribution

The paper provides a detailed time-series analysis of hospitalizations for primary care-sensitive conditions in children, highlighting regional healthcare challenges.

## Key findings

- Hospitalization rates peaked in 2021, with the highest rates in children under 1 year old.
- Bacterial pneumonia was the leading cause of hospitalization across all age groups.
- Primary healthcare weaknesses are likely exacerbated by the migratory crisis in Roraima.

## Abstract

To analyze the trend of hospitalizations for primary care-sensitive conditions in children in the state of Roraima, Brazil.

Ecological time series study with secondary data collected from the Hospital Information System, on hospitalizations for primary care-sensitive conditions in children between 2010 and 2023.

The highest hospitalization rates were in 2021 (265.9/10,000 inhabitants/year) and the under 1 age group had the highest rates. There was a reduction in ambulatory care-sensitive conditions in group 1, in the first and second segments (MPC=-1.50; 95%CI -3.79-0.32 p=0.016 and MPC=-1.91; 95%CI -3.44--0.81 and p=0.007), group 2, with a constant drop throughout the series of 0.57% per month (95%CI -0.70--0.43 and p<0.001) and in group 16 (MPC=-0.38; 95%CI -0.55--0.21 and p<0.001). Bacterial pneumonia was the main cause of hospitalization in all age groups. Group 4 showed a uniform increase in rates of 1.56% per month (95%CI 0.27-2.80 and p=0.018). There was a drop in rates in the first segment at all ages: <1 year: -2.90% and p=0.019; 1 to 4 years: -1.75% (p=0.011) and 5 to 9 years: -0.79% (p=0.053), followed by an increase and then a drop again. In the last segment, all the age groups showed an increase in rates.

The scenario in Roraima is worrisome and requires urgent interventions, as there is evidence of weaknesses in primary health care, probably aggravated by the migratory crisis. The strategies sought are still insufficient.

Analisar a tendência das internações por condições sensíveis à atenção primária em crianças no estado de Roraima.

Estudo ecológico de série temporal, com dados secundários do Sistema de Informações Hospitalares sobre as internações ocorridas em menores de 10 anos no período de janeiro de 2010 a julho de 2023, analisados pelo método de regressão linear segmentada joinpoint.

A análise de tendência no período mostrou crescimento das internações em todas as faixas etárias. Houve redução dessas hospitalizações no grupo das doenças imunopreveníveis e condições sensíveis, no primeiro e no segundo segmento (mudança percentual mensal - MPC=-1.50; intervalo de confiança de 95% - IC95% -3,79-0,32; p=0,016; MPC=-1,91; IC95% -3,44--0,81 e p=0,007), das gastroenterites infecciosas, com queda constante em toda a série de 0,57% ao mês (IC95% -0,70--0,43 e p<0,001) e no grupo das infecções de pele e tecido subcutâneo (MPC=-0,38; IC95% -0,55--0,21 e p<0,001). A pneumonia bacteriana foi a principal causa de internação em todas as faixas etárias. O grupo das deficiências nutricionais apresentou crescimento uniforme das taxas de 1,56% ao mês (IC95% 0,27-2,80 e p=0,018). Houve queda das taxas no primeiro segmento em todas as idades: menor de 1 ano: -2,90% e p=0,019; 1 a 4 anos: -1,75% (p=0,011); e 5 a 9 anos: -0,79% (p=0,053), seguida por aumento e novamente queda.

O cenário em Roraima é preocupante e necessita de intervenções urgentes, pois há indícios de fragilidades na atenção primária à saúde, provavelmente agravadas pela crise migratória. As estratégias buscadas ainda são insuficientes.