Hospitalizations and re-hospitalizations due to tuberculosis: economic costs and spatial distribution analysis in an endemic Northeastern city, Brazil

Abstract

Introduction: In Brazil, preventable hospitalizations and re-hospitalizations due to tuberculosis represent increased costs for the health system. The aim was to analyze the sociodemographic and clinical profile of individuals who needed preventable hospitalizations and re-hospitalizations due to tuberculosis, the costs to the local health system, and the spatial pattern for the occurrence of these events in a Brazilian endemic city. Methods: Descriptive and exploratory study conducted in Natal, city located in the Northeast region of Brazil. The population comprised all cases of preventable hospitalizations and re-hospitalizations due to tuberculosis occurring between 2008 and 2013 obtained from the Hospital Information System. The neighborhoods and census tracts were chosen as the geographical units. Descriptive statistics and non-parametric tests were applied. Position and dispersion measures were used to analyze the costs. The gross rates were estimated, softened by the Global Empirical Bayesian Method. The Global and Local Moran indices were used to evaluate the spatial dependency. Results: 569 cases of hospitalizations due to tuberculosis were identified: 97.4 % were pulmonary form; 62.0% between 30 and 59 years old; 77.7% male; 87.3% mulatto. In the total group of hospitalizations, 13.4% died and 17.9% were readmitted. In total, US$ 470,370.07 was spent on preventable hospitalizations and re-hospitalizations due to tuberculosis, with an annual mean cost of US$ 78,395.01, median amounts of US$ 392.70 per hospitalization and US$ 1,342.19 per re-hospitalization. The spatial distribution of the events was not random, with high rates identified in neighborhoods of the East and West Health Districts. Conclusions: The non-randomness in the spatial pattern of preventable hospitalizations and re-hospitalizations cases due to tuberculosis suggests frailty in the access to Primary Health Care and appoints vulnerable spatial areas to these events. The recognition of these areas can contribute to public management in the improvement of health service access and to the equitable and efficient use of health resources, aiming to reduce the hospitalization costs.