Estudo da desigualdade na mortalidade hospitalar pelo índice de comorbidade de Charlson

Abstract

ObjectiveThe 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). Methods 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). ConclusionsThe 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.

Evaluation of comorbidity indices for inpatient mortality prediction models

“…Among these, the Charlson comorbidity index (CCI) [3,4] has been extensively utilized for inhospital mortality prediction models [5][6][7][8][9][10]. In Brazil, few studies [11,12] have applied the CCI, and there is no evaluation of weight validity. The objectives of the current study were: (1) to compare the predictive capacity of the original CCI, the CCI with new assigned diagnostic codes and estimated weights, and a new developed comorbidity index in a Brazilian population; (2) to study the effect of the number of comorbidity diseases recorded on the predictive capacity of the comorbidity indices.…”

Charlson comorbidity index applied to Internal Medicine patients: a multicenter study

“…La comorbilidad puede afectar la capacidad de funcionar de los individuos afectados y su supervivencia. Es un problema más frecuente en grupos etarios avanzados y contribuye a la aparición de eventos adversos de salud como discapacidad, mala (6) calidad de vida, deterioro funcional, dependencia, institucionalización, hospitalización y muerte .…”

“…Al índice de comorbilidad de Charlson se lo puede agrupar en base al rango etario de los pacientes pues se ha demostrado que a partir de los 50 años aumenta el riesgo de mortalidad (6,7) intrahospitalaria . En un estudio español, la mortalidad hospitalaria fue 9,1% en menores de 90 (13) años y 21,8% en los nonagenarios (p < 0,001) .…”

Estudo do risco de óbito por meio da análise de comorbidade nos pacientes internados nos hospitais gerais do DRS XIII em 2011

“…Ela expressa uma dimensão crucial da qualidade do cuidado prestado: o resultado final. Todavia, diferenças entre hospitais podem ser derivadas da prática médica, do perfil dos casos tratados ou da interação entre esses elementos (IUCIF JR;ROCHA, 2004). Assim, na realização de estudos comparativos, pacientes com características de saúde diferenciadas, que implicam diferentes tratamentos, não podem ser analisados como similares e um ajuste adequado na caracterização de tais pacientes é muito importante(BLUMBERG, 1986).…”

“…al. e o paciente se alocará em um estrato com pontuação variante de 0 a maior que 6 onde quanto maior o estrato de alocação, maior é sua chance de vir a óbito.No Brasil, o uso de medidas de risco para o ajuste de indicadores de resultado dos cuidados de saúde é pouco frequente, sendo também recente o emprego de base de dados administrativos para avaliar a qualidade dos serviços de saúde (IUCIF JR;ROCHA, 2004;…”