Tendência temporal das internações hospitalares por doença inflamatória pélvica no Brasil e grandes regiões

Abstract

Pelvic inflammatory disease (PID) is an inflammatory process that affects structures of the upper genital tract such as: uterus, uterine tubes, ovaries and attached structures, causing endometritis, salpingitis, oophoritis, ovarian tube abscess, and peritonitis. This group of diseases affects women all over the world, bringing serious consequences for health, treatment costs and hospitalization.PID is considered one of the main causes of tubal infertility and a risk factor for ectopic pregnancy. PID infection is usually a consequence of Chlamydia trachomatis and Neisseria gonorrhoeae infection. The main risk factors are: multiple sexual partners, previous history of PID, pre-existing sexually transmitted infections (STI), immunosuppression or endometriosis. Thus, considering that in Brazil the gateway to the health system is primary care, the characteristics of PID classify it as a condition sensitive to this level of care. The objective of this study was to analyze the temporal trend of hospitalizations for pelvic inflammatory disease in women in Brazil and large regions. It was a longitudinal ecological study that covered women aged 10 years and older who were admitted to the Hospital Information System -SIH/SUS in Brazil from 2000 to 2019. At first, the Excel program was used to compute the standardized hospitalization rates. In a second moment the statistical program Joinpoint was used to estimate the segmented regression models. This regression model allowed to estimate the average annual variation for the period of the study and the points (years) of modification of the trend. The highest rates were recorded in the North and Northeast regions. The results found showed a general trend of decreasing hospitalizations in almost all age groups and in all regions. The 10 to 19 years old age group was the only one that presented a significant increase in the Southeast regions in the period of 2008 to 2019 and in the Northeast region in the period of 2014 to 2019. The analysis of the joinpoint models shows that the rate of hospitalization for PID in Brazil as a whole had an average reduction of 5.2% per year during the period from 2000 to 2019. The Midwest region had the highest average annual reduction (8 ,1%), followed by the Northeast (5,7%), Southeast (5,0%), North (4,6%) and South (4,3%) regions. The age groups with the greatest reduction in the period were 60 to 69 years in Brazil, the Northeast and the Southeast, 50 to 59 years in the North, 80 years and over in the South and 20 to 29 years in the Midwest. The reduction in hospitalization for PID is probably linked to increased access to primary care in the period studied. We also emphasize the need to expand public policies aimed at women's health, especially in the 10-19 age group. In this context, it is also included the creation of prevention and awareness programs regarding PID, as well as the consequences of risk behavior for STI.