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Doctoral Thesis
DOI
https://doi.org/10.11606/T.17.2021.tde-11042022-143023
Document
Author
Full name
Vinicius Cesar Moterani
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Reis, Francisco José Cândido dos (President)
Carrara, Helio Humberto Angotti
Nadai, Mariane Nunes de
Nomelini, Rosekeila Simões
Title in Portuguese
Taxas de hospitalização por câncer de ovário durante a pandemia de COVID-19 no Estado de São Paulo e correlação com variáveis associadas a pandemia
Keywords in Portuguese
Câncer de ovário
Cirurgia
COVID-19
Taxa de hospitalização
Abstract in Portuguese
Introdução: A pandemia de COVID-19 que teve início em 2020 prejudicou o funcionamento de serviços de saúde e modificou o comportamento de pacientes. Há relatos de mudanças na atividade cirúrgica coincidindo com o período do surto Nós buscamos verificar se houve mudanças na taxa de hospitalização dentre pacientes portadoras de câncer de ovário no Estado de São Paulo, no Brasil. Objetivos: Nosso objetivo foi identificar se mudanças poderiam ser encontradas na taxa de hospitalização de pacientes com câncer de ovário entre 2016 e 2020, comparando níveis pré-pandemia e na pandemia. Nós também buscamos determinar, caso essas mudanças tenham acontecido, se elas estavam correlacionadas com variáveis relativas a pandemia. Métodos: Dados agregados foram obtidos na Secretaria de Saúde do Estado de São Paulo relativas a hospitalização por câncer de ovário, taxa média de distanciamento social, incidência, mortalidade e letalidade por COVID-19 e taxa de ocupação de leitos específicos para COVID-19 tanto de enfermaria quanto de UTI. Hospitalizações por câncer de ovário foram categorizadas como para tratamento clínico ou cirúrgico. Esses dados foram avaliados tanto em nível estadual quando para cada subdivisão do Estado. Nós realizamos uma análise Joinpoint para verificar se havia mudanças na taxa de hospitalização durante o período do estudo. Nós também calculamos razões de taxa de hospitalização e verificamos se eles se correlacionavam com variáveis relativas a pandemia. Resultado: Taxas de hospitalização gerais para câncer de ovário cairiam no Estado coincidindo com o início da pandemia. Em nível estadual, taxas de hospitalização clínicas não exibiram mudanças no período do estudo, enquanto taxas de hospitalização cirúrgicas caíram dois trimestres antes do início da pandemia e mantiveram-se em queda. Razões de taxas de hospitalização cirúrgicas apresentavam correlação inversa com taxa de ocupação de leitos de UTI específicos para COVID no terceiro trimestre de 2020, com um coeficiente de correlação de Pearson de -0,50 (IC 95%: -0,78 a -0,05, p = 0,03). Um aumento no número de indivíduos exclusivamente dependentes do SUS foram identificados no Estado, com um coeficientes de correlação de Pearson de 0,95 (IC 95%: 0,88-0,98, p < 0,001). Conclusão: Razões de taxa de hospitalização cirúrgicas caíram no terceiro trimestre de 2020 e estiveram inversamente correlacionados com taxa de ocupação de UTI. Isso demonstra o impacto da pandemia por COVID-19 no tratamento de condições que competem pelos mesmos recursos de saúde.
Title in English
Ovarian cancer hospitalization rates during the COVID-19 pandemic in the state of Sao Paulo and correlation with pandemic-related variables
Keywords in English
COVID-19
Hospitalization rate
Ovarian cancer
Surgery
Abstract in English
Abstract: The COVID-19 pandemic which began in 2020 disrupted healthcare services and changed patient behavior. There are reports of changes in surgical activity coinciding with the outbreak period. We aimed to assess whether any changes happened in hospitalization rates among ovarian cancer patients in the state of Sao Paulo, Brazil. Objectives: Our goal was to identify if any changes could be determined in hospitalization rates of ovarian cancer patients from 2016 to 2020, comparing pre-pandemic and pandemic levels. We also aimed to assess, if these changes happened, whether they were correlated with pandemic-related variables. Methods: Aggregated data was obtained from the State of Sao Paulo Secretary of Health regarding both ovarian cancer hospitalization and average social distancing rates, COVID-19 incidence, mortality, lethality and both COVID-specific infirmary and ICU bed occupation rates. Hospitalizations for ovarian cancer could be categorized as either for clinical or surgical treatments. These data were available both for state level and for each of the state's subdivisions. We performed a Joinpoint analysis in order to verify if there were changes regarding hospitalization rates during the study period. We also calculated hospitalization rate ratios and verified if they were correlated with pandemic-related variables. Results: Overall hospitalization rates in the state fell coinciding with the start of the pandemic. At state-level, clinical hospitalization rates did not show changes in its trend during the study period, while surgical hospitalization rates started to decrease two trimesters before the pandemic began and remained decreasing. Surgical hospitalization rate ratios were inversely correlated with COVID-specific ICU bed occupation rates during the third trimester of 2020, with a Pearson Correlation coefficient of -0.50 (95% CI: -0.78 to -0.05, p = 0.03). An increasing number of exclusively public-insured persons were identified in the state, with a Pearson Correlation coefficient of 0.95 (95% CI: 0.88-0,98, p < 0.001). Conclusion: Surgical hospitalization rate ratios fell during the third trimester of 2020 and were inversely correlated with ICU occupation. This demonstrates the impact of COVID-19 pandemic on the treatment of conditions which compete for the same healthcare resources.
 
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Publishing Date
2022-04-14
 
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