Febre reumática aguda: uma doença da atenção básica, um estudo ecológico

Abstract

Background: Acute rheumatic fever is a complication of group A streptococcus pharyngotonsillitis. Its higher incidence can be observed in countries with socioeconomic and environmental weaknesses, such as Brazil, where Acute Rheumatic Fever (ARF) is still present. For this reason, it is a disease that lacks regional epidemiological studies, with the purpose of supporting coping and prevention actions. Objectives: To investigate the profile of hospital admissions, deaths and costs of ARF in Brazil, focusing on the macro-regions of health in the southern region of the country, with the purpose of understanding the regional panorama of the disease and, therefore, encouraging the development of strategies that prioritize prevention, rapid diagnosis and treatment to stop the natural course of the disease. Methodology: Ecological study with mixed design, aggregating time series and multiple groups. Data were obtained from the Hospital Information System of the Unified Health System (SIH/SUS) in the period from 2010 to 2021, related to FRA. The following variables were considered: hospitalization, deaths, general mortality coefficient, days of stay, average stay, sex, total value and health macro-regions of the southern region. Results: There was a 77.3% reduction in hospitalizations due to ARF, while deaths due to ARF showed a retraction of 55%, when comparing the years 2010 and 2021. The only region that showed an increase in the number of deaths due to ARF was the southern region , with a 100% increase in fatalities, even with the decline in hospitalizations. The health macro-regions of the state of Paraná had the lowest mortality rates, while the Missioneira/RS health macro-region had the highest overall mortality rate, with 1.6 deaths/100,000 inhabitants. Conclusion: There was a significant retraction in the number of hospitalizations due to ARF, this phenomenon had an impact on a significant reduction in the number of deaths and in the cost of ARF. However, in the southern region, the same dynamic was not observed, because even with the significant drop in hospitalizations and costs, there was an increase in the number of deaths from ARF. This demonstrates that the isolated analysis of hospital admissions is not enough to infer a reduction in deaths.