Estudo das fraturas do úmero por trauma de baixo impacto em adultos acima de 50 anos de idade: análise retrospectiva do banco de dados de internação hospitalar no Brasil, de 2004 a 2013
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Data
2024-03-13
Autores
Tavano, Fabio Tadeu [UNIFESP]
Orientadores
Szejnfeld, Vera Lucia [UNIFESP]
Tipo
Dissertação de mestrado
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Introdução: As fraturas de úmero por fragilidade são frequentes, com um aumento crescente da incidência em idosos, o que representa um importante impacto na qualidade de vida e função do ombro afetado. Essas fraturas apresentam maior prevalência em mulheres acima de 65 anos, tornando-se a terceira mais comum por osteoporose, ficando atrás das de quadril e antebraço distal. Estudos epidemiológicos sobre as fraturas de úmero no Brasil são escassos e não incluem análises estatísticas das taxas de internação e tratamento. Objetivos: Calcular as taxas de fratura de úmero por fragilidade no Brasil de 2004 a 2013, em pacientes internados maiores de 50 anos, conforme o sexo, faixa etária e região geográfica, além de comparar as taxas de fraturas de úmero com as de antebraço distal. Métodos: Estudo retrospectivo observacional ecológico, com análise de tendência temporal, em pacientes acima de 50 anos, admitidos em rede hospitalar do Sistema Único de Saúde no Brasil, de 2004 a 2013. Os dados utilizados foram obtidos do Sistema de Informação Hospitalar, selecionados a partir dos Códigos Internacionais de Doenças para fraturas de úmero e antebraço distal, seguidos de seleção de códigos de traumas de baixo impacto. Realizou-se o cálculo das taxas de fraturas, por sexo, faixa etária e região geográfica, além de análise de regressão linear. Foi feita a comparação das taxas de fratura de úmero e antebraço, agrupadas em triênios, mediante análise de variância em blocos e nível de significância de 5%. Resultados: A taxa média de fraturas de úmero foi de 12,56 por 100.000 habitantes, sendo 14,11 no sexo feminino e 10,85 no sexo masculino. No período, houve um aumento de 16,3% da taxa absoluta dessas fraturas na população total, porém este aumento foi significativo apenas no sexo feminino (p 0,024). Em relação à faixa etária e sexo, verificamos que as faixas de 70 a 79 anos e acima de 80 anos, do sexo feminino, apresentaram aumento acentuado de 97% e 127% respectivamente, em comparação com mulheres mais jovens. O sexo masculino não apresentou aumento pronunciado com a idade. Ao longo de 10 anos, na análise de regressão linear, observou-se tendência de redução das taxas de fratura de úmero no período de 2004 a 2008, seguida de ascensão contínua a partir de 2009, principalmente, no sexo feminino da Região Sudeste (p 0,031). Na análise de variância em blocos, as taxas de fratura de antebraço foram significativamente maiores que as taxas de úmero em todas as faixas etárias do sexo feminino e nas faixas de 50 e 60 anos no sexo masculino. Conclusões: De 2004 a 2013, as taxas de fratura de úmero de baixo impacto em pacientes acima de 50 anos internados em rede hospitalar pública aumentaram, sobretudo, em mulheres com mais de 70 anos, da Região Sudeste do país. As taxas de fraturas do antebraço superaram as taxas de úmero em mulheres de todas as idades e nos homens abaixo de 70 anos.
Introduction: Humeral fragility fractures are frequent, with an increasing incidence in older people, which impacts the affected shoulder’s quality of life and function. These fractures are more prevalent in women over 65, making them the third most common due to osteoporosis, behind those of the hip and distal forearm. Epidemiological studies on humerus fractures in Brazil are scarce and do not include statistical hospitalization and treatment rates analysis. Objectives: To calculate the rates of fragility fractures of the humerus in Brazil from 2004 to 2013, in inpatients older than 50 years, according to sex, age group, and geographic region, and to compare the rates of humerus fractures with those of distal forearm fractures. Methods: It is a retrospective observational ecological study, with time trend analysis, of patients over 50 admitted to Brazil’s Unified Health System hospital network from 2004 to 2013. The data were obtained from the Hospital Information System, selected from the International Codes of Diseases for humerus and distal forearm fractures, followed by codes for low-impact trauma. Fracture rates were calculated by sex, age group, and geographic region, and linear regression analysis was performed. Also, a comparison of humerus and forearm fracture rates, grouped into triennials, was performed using block analysis of variance and 5% significance level. Results: The mean rate of humerus fractures was 12.56 per 100,000 inhabitants, 14.11 in females and 10.85 in males. In the period, there was a 16.3% increase in the total rate of these fractures in the population, but this increase was significant only in females (p 0.024). Regarding age group and sex, we found that the female age groups 70 to 79 years and over 80 years showed a marked increase of 97% and 127%, respectively, compared to younger women. Males did not show a pronounced increase with age. Over ten years, linear regression analysis showed a tendency toward reduction of humerus fracture rates from 2004 to 2008, followed by a continuous increase from 2009, mainly in females in the Southeast Region (p 0.031). In the block analysis of variance, forearm fracture rates were significantly higher than humerus rates in all age groups in females and the 50 and 60 age groups in males. Conclusions: From 2004 to 2013, rates of low-impact humerus fracture in patients over 50 admitted to the public hospital network increased, especially in women over 70 from the country’s Southeast Region. Forearm fracture rates exceeded humerus rates in women of all ages and men under 70 years.
Introduction: Humeral fragility fractures are frequent, with an increasing incidence in older people, which impacts the affected shoulder’s quality of life and function. These fractures are more prevalent in women over 65, making them the third most common due to osteoporosis, behind those of the hip and distal forearm. Epidemiological studies on humerus fractures in Brazil are scarce and do not include statistical hospitalization and treatment rates analysis. Objectives: To calculate the rates of fragility fractures of the humerus in Brazil from 2004 to 2013, in inpatients older than 50 years, according to sex, age group, and geographic region, and to compare the rates of humerus fractures with those of distal forearm fractures. Methods: It is a retrospective observational ecological study, with time trend analysis, of patients over 50 admitted to Brazil’s Unified Health System hospital network from 2004 to 2013. The data were obtained from the Hospital Information System, selected from the International Codes of Diseases for humerus and distal forearm fractures, followed by codes for low-impact trauma. Fracture rates were calculated by sex, age group, and geographic region, and linear regression analysis was performed. Also, a comparison of humerus and forearm fracture rates, grouped into triennials, was performed using block analysis of variance and 5% significance level. Results: The mean rate of humerus fractures was 12.56 per 100,000 inhabitants, 14.11 in females and 10.85 in males. In the period, there was a 16.3% increase in the total rate of these fractures in the population, but this increase was significant only in females (p 0.024). Regarding age group and sex, we found that the female age groups 70 to 79 years and over 80 years showed a marked increase of 97% and 127%, respectively, compared to younger women. Males did not show a pronounced increase with age. Over ten years, linear regression analysis showed a tendency toward reduction of humerus fracture rates from 2004 to 2008, followed by a continuous increase from 2009, mainly in females in the Southeast Region (p 0.031). In the block analysis of variance, forearm fracture rates were significantly higher than humerus rates in all age groups in females and the 50 and 60 age groups in males. Conclusions: From 2004 to 2013, rates of low-impact humerus fracture in patients over 50 admitted to the public hospital network increased, especially in women over 70 from the country’s Southeast Region. Forearm fracture rates exceeded humerus rates in women of all ages and men under 70 years.
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Citação
TAVANO, Fabio Tadeu. Estudo das fraturas do úmero por trauma de baixo impacto em adultos acima de 50 anos de idade: análise retrospectiva do banco de dados de internação hospitalar no Brasil, de 2004 a 2013. 2024. 110 f. Dissertação (Mestrado em Reumatologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.