Skip to main content

Advertisement

SpringerLink
Log in

Hospitalizations of children and adolescents with complex chronic conditions in Brazil: a temporal analysis from 2009 to 2020

  • RESEARCH
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Access to advanced and sophisticated health technologies made it possible to increase the survival of children with complex chronic conditions. Thus, the profile of pediatric patients admitted to hospitals has changed in recent decades. In Brazil, there are few epidemiological studies on this subject. This study aims to evaluate the main characteristics and temporal trend of hospital admissions of children and adolescents with complex chronic conditions in Brazil, 2009–2020. This is a cross-sectional study with data on hospitalizations of children and adolescents with complex chronic conditions, extracted from the Hospital Information System of the Unified Health System, 2009–2020, in the 26 Brazilian states and the Federal District. The analysis included descriptive statistics and a generalized linear model. From 2009 to 2020, there were 1,337,120 hospitalizations of children and adolescents with complex chronic conditions, and of these, 735,820 (55.0%) were male. The percentage of hospital deaths during the analyzed period was 4.0%. The most recurrent diagnostic category was malignancy (41.0%), with an annual incidence increase of 2.61 (95% CI: 1.16–4.05). Between 2009 and 2019, the increase in hospitalizations for complex chronic conditions was 27.4% for boys and 25.2% for girls, and the reductions in the number of hospitalizations for other causes were 15.4% and 11.9% for boys and girls, respectively.

  Conclusions: Hospitalizations for complex chronic conditions in pediatrics are increasing in Brazil. This increase is a new challenge for the Brazilian public health system.

What is Known:

• The profile of pediatric patients admitted to hospitals has changed in recent decades, with a reduction in the total number of hospitalizations, but with an increase in the complexity and costs of these hospitalizations.

• The world’s scientific production on CCC is concentrated in the United States health care system. Epidemiological studies on the topic in universal health care systems are scarce.

What is New:

• This is the first study that evaluated the temporal trend of hospitalizations of children and adolescents with CCC in Brazil.

• Hospitalizations for CCC in pediatrics are increasing in Brazil, with emphasis on the condition of malignancy, higher incidence in males and in children under one year of age. Furthermore, our study found a decrease in hospitalizations for other pediatric causes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

Data were extracted as described in the Methods section and are publicly available at https://datasus.saude.gov.br/transferencia-de-arquivos/.

Abbreviations

CCC:

Complex chronic conditions

CMC:

Children with medical complexity

CONEP:

National Ethics Committee in Research (Comissão Nacional de Ética em Pesquisa)

DATASUS:

SUS Informatics Department

IBGE:

Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística)

ICD-10:

International Classification of Diseases, Tenth Revision

PICU:

Pediatric intensive care unit

SIH:

Hospital information system (Sistema de Informações hospitalares)

SUS:

Unified health system (Sistema Único de Saúde)

References

  1. Moreira MCN, Albernaz LV, Sá MRC et al (2017) Recomendações para uma linha de cuidados para crianças e adolescentes com condições crônicas complexas de saúde. Cad Saude Publica 33(11):e00189516. https://doi.org/10.1590/0102-311X00189516

  2. Cohen E, Kuo DZ, Agrawal R et al (2011) Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics 127(3):529–538. https://doi.org/10.1542/peds.2010-0910

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brenner M, Alexander D, Quirke MB et al (2021) A systematic concept analysis of ‘technology dependent’: challenging the terminology. Eur J Pediatr 180:1–12. https://doi.org/10.1007/s00431-020-03737-x

    Article  PubMed  Google Scholar 

  4. Moreira MEL, Goldani MZ (2010) Child is the father of man: new challenges for child health. Cienc e Saude Coletiva 15(2):321–327. https://doi.org/10.1590/S1413-81232010000200002

    Article  Google Scholar 

  5. Bucholz EM, Toomey SL, Schuster MA (2019) Trends in pediatric hospitalizations and readmissions: 2010– 2016. Pediatrics 143(2):e20181958. https://doi.org/10.1542/peds.2018-1958

  6. Cohen E, Berry JG, Camacho X et al (2012) Patterns and costs of health care use of children with medical complexity. Pediatrics 130(6):e1463–e1470. https://doi.org/10.1542/peds.2012-0175

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zorko DJ, McNally JD, Rochwerg B et al (2023) Defining pediatric chronic critical illness: a scoping review. Pediatr Crit Care Med 24(2):e91–e103. https://doi.org/10.1097/PCC.0000000000003125

    Article  PubMed  Google Scholar 

  8. Oliveira PV, Enes CC, Nucci LB (2022) How are children with medical complexity being identified in epidemiological studies? World J Pediatr. Advance online publication, A systematic review. https://doi.org/10.1007/s12519-022-00672-9

    Book  Google Scholar 

  9. Carvalho KM, Carvalho MSN, Grando RL et al (2021) Children with complex chronic conditions: an evaluation from the standpoint of academic publications. Int J Contemp Pediatr 8(3):594. https://doi.org/10.18203/2349-3291.ijcp20210674

  10. Moura EC, Moreira MCN, Menezes LA et al (2013) (2017) Condições crônicas complexas em crianças e adolescents: Internações no Brasil. Cienc e Saude Coletiva 22(8):2727–2734. https://doi.org/10.1590/1413-81232017228.01992016

    Article  Google Scholar 

  11. Feudtner C, Feinstein JA, Zhong W et al (2014) Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 14(1):1–7. https://doi.org/10.1186/1471-2431-14-199

    Article  Google Scholar 

  12. Saldanha RF, Bastos RR, Barcellos C (2019) Microdatasus: a package for downloading and preprocessing microdata from Brazilian Health Informatics Department (DATASUS). Cad Saude Publica 35(9):1–9. https://doi.org/10.1590/0102-311X00032419

    Article  Google Scholar 

  13. Feinstein JA, Russell S, DeWitt PE et al (2018) R package for pediatric complex chronic condition classification. JAMA Pediatr 172(6):594–596. https://doi.org/10.1001/jamapediatrics.2018.0256

    Article  Google Scholar 

  14. Instituto Brasileiro de Geografia e Estatística: Projeções da população. Available at: https://www.ibge.gov.br/estatisticas/sociais/populacao/9109-projecao-da-populacao.html. Accessed October 1, 2021

  15. Antunes JLF, Cardoso MRA (2015) Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol e Serviços Saúde 24(3):565–576. https://doi.org/10.5123/S1679-49742015000300024

    Article  Google Scholar 

  16. Brasil, Ministério da Saúde (2021) Departamento de Informática do Sistema Único de Saúde. Available at: https://datasus.saude.gov.br/. Accessed February 1, 2021

  17. Alves JCT, Lopes CRC, Guzzi GP et al (2020) Impact of the COVID-19 pandemic on pediatrics epidemiology. Resid Pediatr 10(3):1–4. https://doi.org/10.25060/residpediatr-2020.v10n3-382

  18. Hoang A, Chorath K, Moreira A, et al (2020) COVID-19 in 7780 pediatric patients: a systematic review. EClinical Medicine 24:100433. https://doi.org/10.1016/j.eclinm.2020.100433

  19. Lacerda AF, Oliveira G, Cancelinha C et al (2019) Hospital inpatient use in mainland Portugal by children with complex chronic conditions (2011 – 2015). Acta Med Port 32(7–8):488–498. https://doi.org/10.20344/amp.10437

  20. Grabois MF, Oliveira EXG, Carvalho MS (2011) Childhood cancer and pediatric oncologic care in Brazil: access and equity. Cad Saude Publica 27(9):1711–1720. https://doi.org/10.1590/S0102-311X2011000900005

    Article  PubMed  Google Scholar 

  21. Brasil (2022) Lei No 14.308, de 8 de Março de 2022. Diário Oficial da União. Available at: https://www.in.gov.br/en/web/dou/-/lei-n-14.308-de-8-de-marco-de-2022-384520885. Accessed July 1, 2022

  22. Amorim MS, Guimarães Filho GC, Fernandes NA et al (2021) The reality of congenital heart disease in Brazil: bibliographic review. Brazilian J Heal Rev 4(5):19378–19388. https://doi.org/10.34119/bjhrv4n5-071

  23. Rasella D, Aquino R, Barreto ML (2010) Reducing childhood mortality from diarrhea and lower respiratory tract infections in Brazil. Pediatrics 126(3):e534–e540. https://doi.org/10.1542/peds.2009-3197

    Article  PubMed  Google Scholar 

  24. Pinto Junior EP, Aquino R, Dourado I et al (2020) Primary care-sensitive hospitalization conditions in children under the age of 1 in Brazil. Cienc e Saude Coletiva 25(7):2883–2890. https://doi.org/10.1590/1413-81232020257.25002018

    Article  Google Scholar 

  25. Husny ASE, Fernandes-Caldato MC (2006) Erros inatos do metabolismo: revisão de literatura. Rev Para Med 20(2):41–45

    Google Scholar 

  26. Brasil, Ministério da Saúde (2002) Padronização da Nomenclatura do Censo Hospitalar. Second edition. Brasília, Ministério da Saúde. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/padronizacao_censo.pdf. Accessed July 1, 2022

  27. Gold JM, Hall M, Shah SS et al (2016) Long length of hospital stay in children with medical complexity. J Hosp Med 11(11):750–756. https://doi.org/10.1002/jhm.2633

    Article  PubMed  Google Scholar 

  28. Brasil (2016) Nota Informativa do Ministério da Saúde: Atenção Domiciliar Neonatal e Pediátrica no Brasil. Available at: https://www.gov.br/saude/pt-br/composicao/saes/dahu/arquivos/2016/nota-informativa-atencao-domiciliar-neonatal-e-pediatrica-no-brasil.pdf. Accessed July 1, 2022

  29. Brasil (2018) Política Nacional de Atenção Integral à Saúde Da Criança: Orientações Para Implementação. Brasília, Ministério da Saúde. Available at: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2018/07/Política-Nacional-de-Atenção-Integral-à-Saúde-da-Criança-PNAISC-Versão-Eletrônica.pdf. Accessed July 1, 2022

  30. Pinto M, Gomes R, Tanabe RF et al (2019) Analysis of the cost of care for children and adolescents with medical complex chronic conditions. Cienc e Saude Coletiva 24(11):4043–4052. https://doi.org/10.1590/1413-812320182411.08912018

    Article  Google Scholar 

  31. Cohen E, Berry JG, Sanders L et al (2018) Status complexicus? The emergence of pediatric complex care. Pediatrics 141(Suppl 3):S202–S211. https://doi.org/10.1542/peds.2017-1284E

    Article  PubMed  Google Scholar 

  32. Mattiello RMA, Pazin-Filho A, Aragon DC et al (2022) Impact of children with complex chronic conditions on costs in a tertiary referral hospital. Revista de Saúde Pública 56:89. https://doi.org/10.11606/s1518-8787.2022056004656.

  33. Lin E, Scharbach K, Liu B et al (2020) A multidisciplinary home visiting program for children with medical complexity. Hosp Pediatr 10(11):925–931. https://doi.org/10.1542/hpeds.2020-0093

    Article  PubMed  Google Scholar 

  34. Auger KA, Kenyon CC, Feudtner C et al (2014) Pediatric hospital discharge interventions to reduce subsequent utilization: a systematic review. J Hosp Med 9(4):251–260. https://doi.org/10.1002/jhm.2134

    Article  PubMed  Google Scholar 

  35. Kobussen TA, Hansen G, Brockman RJ et al (2020) Perspectives of pediatric providers on patients with complex chronic conditions: a mixed-methods sequential explanatory study. Crit Care Nurse 40(5):e10–e17. https://doi.org/10.4037/ccn2020710

    Article  PubMed  Google Scholar 

  36. Bogetz JF, Bogetz AL, Rassbach CE et al (2015) Caring for children with medical complexity: challenges and educational opportunities identified by pediatric residents. Acad Pediatr 15(6):621–625. https://doi.org/10.1016/j.acap.2015.08.004

    Article  PubMed  Google Scholar 

  37. Viacava F (2002) Informações em saúde: a importância dos inquéritos populacionais. Cien Saude Colet 7(4):607–621. https://doi.org/10.1590/S1413-81232002000400002

    Article  Google Scholar 

  38. Cunha EM, Vargens JMC (2017) Sistemas de informação do Sistema Único de Saúde. In: Técnico de vigilância em saúde: Fundamentos 2. Gondim GMM, Christófaro MAC, Miyashiro GM (Org.). Rio de Janeiro, EPSJV, pp 71–112. Available at: https://www.epsjv.fiocruz.br/sites/default/files/livro2.pdf. Accessed July 1, 2022.

  39. Coelho Neto GC, Chioro A (2021) After all, how many nationwide health information systems are there in Brazil? Cad Saude Publica 37(7): e00182119. https://doi.org/10.1590/0102-311X00182119

  40. Berry JG, Hall M, Cohen E et al (2015) Ways to identify children with medical complexity and the importance of why. J Pediatr 167(2):229–237. https://doi.org/10.1016/j.jpeds.2015.04.068

    Article  PubMed  PubMed Central  Google Scholar 

  41. Silva MF, Moreira MCN (2021) Dilemmas in regulating access to specialized care for children with complex chronic health conditions. Cienc e Saude Coletiva 26(6):2215–2224. https://doi.org/10.1590/1413-81232021266.11992019

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas, São Paulo, Brazil

    Patrícia V. Oliveira, Carla C. Enes & Luciana B. Nucci

  2. School of Life Sciences, Department of Speech, Language, and Hearing Sciences, Pontifical Catholic University of Campinas, São Paulo, Brazil

    Beatriz S. Brocchi

Authors
  1. Patrícia V. Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Beatriz S. Brocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carla C. Enes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luciana B. Nucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

P.V. Oliveira contributed to the design, analysis, and interpretation of data for the paper and drafted the final version of the manuscript. B. S. Brocchi contributed in the interpretation of data for the paper and critically reviewed and approved the final version of the manuscript. C. C. Enes contributed in interpreting data for the paper and critically reviewed and approved the final version of the manuscript. L. B. Nucci contributed to the design, analysis, and interpretation of data for the paper, provided guidance, and approved the final version of the manuscript. All authors agreed to be responsible for all aspects concerning the integrity of the study.

Corresponding author

Correspondence to Patrícia V. Oliveira.

Ethics declarations

Ethics approval

Not applicable. This is an observational study. All data are publicly available and can be accessed on the DATASUS and IBGE platforms. Ethical approval was not required, according to the terms of Resolution No. 510 of April 7, 2016, of the National Health Council that regulates the National Ethics Committee in Research (CONEP).

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Milani

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 28 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oliveira, P.V., Brocchi, B.S., Enes, C.C. et al. Hospitalizations of children and adolescents with complex chronic conditions in Brazil: a temporal analysis from 2009 to 2020. Eur J Pediatr 182, 4153–4161 (2023). https://doi.org/10.1007/s00431-023-05071-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-023-05071-4

Keywords

Search

Navigation