Factors associated with lack of hospital care in deaths from cerebrovascular disease, São Paulo, Brazil: A comparative analysis of 1996-1998 and 2013-2015

Abstract

The objective was to assess sociodemographic and clinical factors related to the lack of hospital care in deaths from ischemic and hemorrhagic cerebrovascular disease (CVD) in the state of São Paulo, Brazil, in 1996-1998 and 2013-2015. The study used data on deaths from the Mortality Information System. Poisson regression was used to analyze the association between lack of hospital care and the study variables. Of the 127,319 individuals that died of CVD in the two three-years periods, 19,362 (15.2%) had failed to receive hospital care. Lack of hospital care in deaths from CVD remained practically unchanged in relation to sociodemographic and clinical characteristics, except for distributions by sex. The more recent three-year period showed higher risk of death from CVD without hospital care among Asian-descendant individuals (RR = 1.48), while lower risk of death from CVD without hospital care in the more recent period was associated with black color (RR = 0.85), brown color (RR = 0.86), married individuals (RR = 0.70), those living in the capital city of São Paulo (RR = 0.92), those who received medical care (RR = 0.17), and those with hemorrhagic CVD (RR = 0.47). In addition, lack of hospital care in deaths from hemorrhagic CVD was lower among married individuals (RR = 0.67), those living in the capital city of São Paulo (RR = 0.74), and those who received medical care (RR = 0.08). Sociodemographic and clinical characteristics were associated with the lack of hospital care in deaths from ischemic and hemorrhagic CVD, suggesting that there are differences in care for CVD patients.