ANÁLISE DE SOBREVIDA DE PACIENTES COM COVID-19 INTERNADOS EM HOSPITAIS DO BRASIL

Abstract

COVID-19 is an infectious disease caused by SARS-CoV-2. This virus has high transmissibility and can develop severe pneumonia that manifests as Severe Acute Respiratory Syndrome (SARS), which impacts patient survival. This thesis aimed to analyze the associated factors and potential interactions between predictors with the survival of patients hospitalized for SARS due to COVID-19 in Brazil. Data from adults and the elderly reported in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) of the Ministry of Health were used. The first article analyzed the survival of patients hospitalized with COVID-19- related Severe Acute Respiratory Syndrome (SARS) and identified risk groups for COVID-19 mortality based on potential interactions among predictors. This was a retrospective longitudinal study using data from 1,756,917 cases admitted between February 16, 2020, and December 31, 2022. Survival tree analysis was employed to identify potential interactions among predictors. A separate model was constructed for each study year. The case fatality rate was 33.2%. Lower survival was observed among those who underwent invasive mechanical ventilation and were 80 years or older during the three years of the pandemic. Black and mixedrace individuals were predictors of death in the years 2020 and 2021, coinciding with increased healthcare system demand due to a higher number of cases. The objective of the second article was to analyze the influence of individual and contextual factors related to hospital and municipality care on the survival of patients with COVID-19-related Severe Acute Respiratory Syndrome (SARS). This study involved a hospital-based cohort of 159,948 cases admitted in 2022. Contextual variables were derived from the National Registry of Health Establishments, indicators from the municipalities that contribute to the Sustainable Cities Development Index - Brazil, and the Social Inequalities Index for COVID-19 proposed by the Center for Data Integration and Knowledge for Health (Cidacs/Fiocruz). The outcome was hospital survival within 90 days. Survival tree analysis and Cox regression were used to analyze survival. The survival tree identified 8 groups with varying probabilities of survival. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax revenue percentages had a higher risk of death compared to adults (p < 0.001) who did not receive mechanical ventilation and were admitted to hospitals not affiliated with the Unified Health System (SUS). The objective of the third article was to analyze the influence of the organization and composition of hospital establishments - whether affiliated with the Unified Health System (SUS) or not - and their impact on the survival of patients with COVID-19-related Severe Acute Respiratory Syndrome (SARS). This study involved a hospital-based cohort of 159,948 cases admitted in 2022. In hospitals affiliated with the SUS, 32.7% of the patients progressed to death, compared to 21.4% in non-SUS services. The survival of patients hospitalized within the SUS was lower (p < 0.001), with predictors including invasive mechanical ventilation, age, hospital size, and ICU admission. Among patients in non-SUS hospitals, in addition to these variables, predictors also included region, ECG/bed monitoring rate, and physician/bed rate. It is concluded that individual and contextual factors influence the survival of these patients, revealing inequalities not only in direct patient care but also in the organization, functioning, and performance of hospital services. Therefore, it is necessary to review and modify the relationship between the Brazilian public and private healthcare systems and strengthen the public system further to reduce observed inequities.