Desigualdade no tratamento à fratura proximal de fêmur no Rio de Janeiro Treatment inequity in hip fractures in Rio de Janeiro

OBJETIVO: O objetivo deste trabalho é analisar a existência de variações na indicação terapêutica a pacientes com fratura proximal de fêmur entre os hospitais conveniados com o SUS e entre pacientes socialmente distintos. MÉTODO: Foram analisados os dados do SIH-SUS dos hospitais do município do Rio de Janeiro, 1994-1995. RESULTADO: A análise multivariada mostrou que as chances de cirurgia foram maiores para as mulheres (OR=1,53, IC95%1,18-1,99); menores para os hospitais federais (OR = 0,21, IC95% 0,10-0,41), estaduais (OR =0,07, IC95% 0,04-0,12) e municipais (OR=0,11, IC95% 0,07-0,18), em comparação com o hospital privado contratado pelo SUS; foram menores nas emergências (OR=0,31, IC95% 0,19-0,48); e foram maiores nos hospitais localizados em áreas mais privilegiadas (OR=1,68, IC95% 1,52-1,86). CONCLUSÃO: A configuração dos mercados variou com o perfil dos hospitais e pacientes, e a indicação de cirurgia foi associada a fatores não relacionados com a necessidade, mostrando diferenças no acesso ao tratamento adequado.OBJECTIVE: The aim of this study was to analyze the variations in the surgical use of healthcare services for hip fracture patients, and the occurrence of inequity in the Rio de Janeiro Public Health Sector. METHODS: The Unified Health System Hospital Information System data from hospital records of Rio de Janeiro health services between 1994 and 1995 were analyzed. RESULTS: Multivariate analysis showed that women had a greater chance of surgery (OR=1.53, CI95%1.18-199). The chances of surgery were lower in federal hospitals (OR=0.21, CI95% 0.10-0.41), state hospitals (OR =0.07, CI95% 0.04-0.12), and city hospitals (OR=0.11, CI95% 0.07-0.18), compared with private hospitals hired by the SUS. The chances of surgery were lower in emergency departments (OR=0.31, CI95% 0.19-0.48) and in hospitals located in less deprived areas (OR=1.68, CI95% 1.52-1.86). CONCLUSION: The variation in the hospital market was related to patient and hospital profiles, and the surgical treatment for hip fracture was associated with factors unrelated to need, showing differences in access