Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia

Abstract

Objective:The study evaluated the trend of hospitalization for ischemic stroke (HIS) and its hospital mortality in Brazil over the last 15 years as well as the impact of the Hiperdia program in this scenario. Methods: An ecological study was designed with analytical approach and data collected in the Hospital Admission System on episodes of stroke, over the years 1998 to 2012. All data were stratified by sex and age, creating an indicator for HIS and proportion of hospital mortality. To estimate the trend of the data a polynomial curve fitting was created; and the Generalized Linear Model was applied to investigate the impact of Hiperdia on the endpoint HIS and hospital mortality. We adopted a 5% significance level to minimize an error type I. Results: We observed a reduction of HIS from 37.57/10 5 inhabitants in 1998 to 2001 to 10.33/10 5 inhabitants in 2002 to 2005, declining 73.64%. The reduction occurred in both sexes and for all age groups. The mortality rate of ischemic stroke also declined in Brazil since 2002, in both men and women, therefore in less than 3%; and only in the groups aged between 0 and 14 and above 80 years, we did not detect trend. Conclusion: Therefore, the decline of HIS temporally coincided with the implementation of Hiperdia in 2002 and this trend continues today.

Morbidade hospitalar por acidente vascular encefálico e cobertura fonoaudiológica no Estado da Paraíba, Brasil

“…According to the literature, with regard to sex, the incidence of stroke is higher in men (18) , a feature not observed in study because, in both years, the proportion of incidence of stroke, between the sexes was approximately 1:1, similar to the data observed in studies conducted in Brazil (13) , specifically in the Northeast (12) . Previous study, which found similar results in relation to sex and hospitalization for ischemic stroke, presented: "there is no need to elaborate strategies aimed at specific subpopulation of men and women in regard to adherence measures and behavior change" (13) .…”

“…Overall, the results showed a reduction in the number of hospitalizations from stroke between 2010 and 2014 confirming the trend of decline in the incidence of stroke in northeastern Brazil (12) mainly in Paraiba (13) , a trend observed since 2002 (12,13) . As regards the number of IHA by region, a higher concentration of hospitalization for stroke in municipalities outside João Pessoa MR, especially Patos, Campina Grande and Cajazeiras.…”

“…The decline in stroke hospitalizations in the State of Paraiba may also be related to the introduction of the control (12,13,14) and in the present study. The Hiperdia is characterized by continuous monitoring of users with high blood pressure (hypertension) and diabetes mellitus (DM), with distribution of medicine and encouraging the promotion of healthy lifestyles (14) , such as regular physical activity, for example (15) .…”

“…Previous study, which found similar results in relation to sex and hospitalization for ischemic stroke, presented: "there is no need to elaborate strategies aimed at specific subpopulation of men and women in regard to adherence measures and behavior change" (13) . However, it is still necessary to investigate in greater detail the differences and similarities inherent in the relationship between stroke and sex, considering the particularities of the many national territories.…”

“…The Hiperdia is characterized by continuous monitoring of users with high blood pressure (hypertension) and diabetes mellitus (DM), with distribution of medicine and encouraging the promotion of healthy lifestyles (14) , such as regular physical activity, for example (15) . In Brazil, there is evidence of decline over 70% of cases of ischemic stroke after the implementation of Hiperdia in 2002 (13,14) in all age groups and sexes, most of the federal units (FU), except Goias, Roraima and Ceara, which were stable (13) . Therefore, the trend of reduction of hospitalizations for ischemic stroke is not regionalized and reaches throughout Brazil, including the State of Paraiba.…”