COVID in women in Brazil: length of stay and outcomes of first hospitalizations

Objective: to analyze the length of hospital stay and outcomes of the first hospitalizations due to COVID-19 of women at the beginning of the pandemic. Methods: ecological study with data on COVID-19 hospitalizations of women. Data classification was done by states, regions, age, length of hospital stay, main and secondary diagnosis (underlying diseases), and outcome. Kruskal-Wallis, Mann-Whitney, and chi-square tests were used for the analysis. Results: the Southeast region had the highest number of hospitalizations (0.6%). Of the total number of hospitalizations, 14.6% required an intensive care unit. The length of hospital stay of women over 50 years was significant for Brazil (p<0.001). There was an association between length of hospital stay and levels 2 and 3 of comorbidity. Deaths in women over 50 years old were significant in Brazil, Northeast, and Southeast (p<0.001). Conclusion: women over 50 years old with comorbidities are associated with longer hospital stays and deaths. Descriptors: Hospitalization; Length of Stay; Coronavirus Infections; Intensive Care Units; Women. RESUMO Objetivo: analisar o tempo de permanência hospitalar e status das primeiras internações por COVID-19 em mulheres no início da pandemia. Métodos: estudo ecológico com dados das internações por COVID-19 em mulheres. Os dados foram estratificados por estados, regiões, idade, tempo de permanência hospitalar, diagnóstico principal e secundários (comorbidades) e desfecho da internação. Utilizaram-se os testes de Kruskall-Wallis, Mann-Whitney e qui-quadrado para a análise. Resultados: a região Sudeste teve o maior número de internações (0,6%). Do total de internações, 14,6% necessitaram de unidade intensiva. O tempo de permanência hospitalar em mulheres acima de 50 anos foi significativo para o Brasil (p<0,001). Houve associação entre tempo de permanência hospitalar e níveis 2 e 3 de comorbidade. Óbitos em mulheres com mais de 50 anos foi significativo no Brasil, Nordeste e Sudeste (p<0,001). Conclusão: mulheres com mais de 50 anos e com comorbidades estão associadas ao maior tempo de internação hospitalar e óbitos. Descritores: Hospitalização; Tempo de Internação; Infecções por Coronavírus; Unidades de Terapia Intensiva; Mulheres. 1Universidade Federal da Fronteira Sul. Chapecó, SC, Brazil. 2Universidade Estadual do Centro-Oeste. Paraná, PR, Brazil. 3Universidade do Estado de Santa Catarina. Chapecó, SC, Brazil. 4Universidade de São Paulo. São Paulo, SP, Brazil. 5Universidade Comunitária de Chapecó. Chapecó, SC, Brazil. Autor correspondente: Erica de Brito Pitilin Avenida Fernando Machado, 108 E, Centro CEP: 89801-501. Chapecó, SC, Brazil. E-mail: erica.pitilin@uffs.edu. br EDITOR IN CHIEF: Ana Fatima Carvalho Fernandes ASSOCIATE EDITOR: Viviane Martins da Silva Erica de Brito Pitilin1 Maicon Henrique Lentsck2 Vanessa Aparecida Gasparin3 Larissa Pereira Falavina4 Vander Monteiro da Conceição1 Patrícia Pereira de Oliveira5 Tatiane Baratieri2 How to cite this article: Pitilin EB, Lentsck MH, Gasparin VA, Falavina LP, Conceição VM, Oliveira PP, et al. COVID in women in Brazil: length of stay and outcomes of first hospitalizations. Rev Rene. 2021;22:e61049. DOI: https://doi.org/10.15253/2175-6783.20212261049 Pitilin EB, Lentsck MH, Gasparin VA, Falavina LP, Conceição VM, Oliveira PP, et al Rev Rene. 2021;22:e61049. 2 Introduction Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections have spread fast from China in Wuhan, Hubei province, to other parts of the world(1), creating concerns among health authorities in several countries on how to ensure care for the population in their health services. The virus causing coronavirus disease (COVID-19) has already infected more than 30.6 million people and 950,000 deaths have been reported to the World Health Organization by September 20th, 2020, emphasizing the need for mass testing and control actions(2). Evidence suggests that person-to-person infection has been in progress without effective drugs or vaccines so far, and the incubation period can reach up to 15 days(3-4). When the cases were partially controlled in China, Europe stood out by the number of cases, and was considered the epicenter of the pandemic, followed by the United States, Brazil, and other countries in Latin America. Until September 19th, Brazil had 4,582,240 confirmed cases of COVID-19 and a total of 136,532 deaths (2.9%)(5). The rapid growth curve of the contagion of the virus associated with the characteristic conditions of a developing country, of medium to low income such as Brazil, may result in a higher incidence of hospitalizations and deaths when compared with the characteristics of developed countries, a consequence of the difficulty in access to specialized health services, little mass testing of the population and problems in the infrastructure of the public health system(6). The severity with which COVID-19 affects some people makes them more susceptible to hospital admissions. Some studies of hospitalized patients from the general population have been reported, with little information related to the outcomes of hospitalizations of women infected with the new coronavirus(7). When analyzing the published literature on COVID-19 and women, information gaps were identified, namely, being a woman means greater susceptibility to infection, the severity of the clinical condition, having adverse events? The dilemma on the effect of clinical symptoms and/or length of stay in women is rising, since there were few serious and fatal cases in this specific group reported in studies from Italy, New York, China, and 14 states in the United States to date(4,8-11). In Brazil, women’s health has been addressed in public policies, and knowing the profile and length of stay of hospitalizations in the Unified Health System can be helpful in the context of assistance to women, especially in this pandemic scenario. Given that the hospital stay may vary in different health services and the existence of individual peculiarities, it is justified to estimate the impact of these characteristics on the age group and the hospital stay of the first women infected by COVID-19, to, promptly, direct management strategies to the assistance of this population. In this sense, we sought to answer the following research question: What is the length of hospital stay of the first hospitalizations due to COVID-19 of women in Brazil? What is the outcome of these admissions according to the states of Brazil, level of underlying diseases, and deaths? Thus, the established objective was to analyze the length of hospital stay and outcomes of the first hospitalizations due to COVID-19 of women at the beginning of the pandemic.