Intensive care inequity in Rio de Janeiro: the effect of spatial distribution of health services on severe acute respiratory infection

ABSTRACT Objective: To analyze the distribution of adult intensive care units according to geographic region and health sector in Rio de Janeiro and to investigate severe acute respiratory infection mortality in the public sector and its association with critical care capacity in the public sector. Methods: We evaluated the variation in intensive care availability and severe acute respiratory infection mortality in the public sector across different areas of the city in 2014. We utilized databases from the National Registry of Health Establishments, the Brazilian Institute of Geography and Statistics, the National Mortality Information System and the Hospital Admission Information System. Results: There is a wide range of intensive care unit beds per capita (from 4.0 intensive care unit beds per 100,000 people in public hospitals in the West Zone to 133.6 intensive care unit beds per 100,000 people in private hospitals in the Center Zone) in the city of Rio de Janeiro. The private sector accounts for almost 75% of the intensive care unit bed supply. The more developed areas of the city concentrate most of the intensive care unit services. Map-based spatial analysis shows a lack of intensive care unit beds in vast territorial extensions in the less developed regions of the city. There is an inverse correlation (r = -0.829; 95%CI -0.946 to -0.675) between public intensive care unit beds per capita in different health planning areas of the city and severe acute respiratory infection mortality in public hospitals. Conclusion: Our results show a disproportionate intensive care unit bed provision across the city of Rio de Janeiro and the need for a rational distribution of intensive care.

摘要
目的：分析里约热内卢市成人重症监护病房（intensive care unit，ICU）按地理区域与卫生部门的分布情况，并探讨公立医疗部门的重症急性呼吸道感染死亡率及其与公立部门重症监护能力的关联。
方法：本研究评估了2014年该市不同区域公立医疗部门的重症监护资源可及性与重症急性呼吸道感染死亡率的差异。研究采用了国家卫生机构注册库、巴西地理与统计研究所、国家死亡信息系统以及医院入院信息系统的数据库。
结果：里约热内卢市的人均重症监护床位存在显著差异：西区公立医院为每10万人4.0张重症监护床位，中心区私立医院则达每10万人133.6张。私立医疗部门的重症监护床位供应占全市总量的近75%。该市较为发达的区域集中了绝大多数重症监护服务。基于地图的空间分析显示，该市欠发达区域的大片辖区内存在重症监护床位短缺问题。该市不同卫生规划区域的公立人均重症监护床位与公立医院的重症急性呼吸道感染死亡率呈负相关（r=-0.829；95%CI：-0.946~-0.675）。
结论：本研究结果显示，里约热内卢市的重症监护床位配置存在不均衡现象，亟需对重症监护资源进行合理布局。