IMPACT OF DIABETES MELLITUS ON HOSPITALIZATION AND MORTALITY AMONG ELDERLY IN BRAZIL: A STUDY FROM 2019 TO 2023

Abstract

Population aging has increased hospital admissions due to diabetes mellitus among the elderly, with type 2 diabetes (T2DM) prevalent due to its association with obesity and insulin resistance. Elderly individuals with diabetes have a higher risk of mortality due to complications and additional health challenges such as polypharmacy, functional, and cognitive issues. This study aimed to analyze hospital admissions and deaths due to diabetes mellitus in the elderly population across different regions of Brazil, using data from the Hospital Information System of the Unified Health System (SIH/SUS) from 2019 to 2023. Variables considered included admissions, year, geographic region, type of care, deaths, mortality rate, average length of stay, sex, average cost, and total cost. The analysis revealed that between 2019 and 2023, hospital admissions varied significantly by region, with the Northeast and Southeast recording the highest numbers, 118,600 and 118,239 cases respectively. There was a slight upward trend in the North and declines in the South and Midwest regions over this period. Elective admissions increased while emergency admissions decreased, especially in 2020, possibly influenced by the COVID-19 pandemic. The Southeast led in the number of deaths, with 7,929 cases, followed by the Northeast, highlighting variations in mortality rates between regions. Average hospitalization costs were highest in the Southeast and lowest in the Northeast, reflecting regional disparities. The pandemic impacted all regions, significantly influencing admission trends, except in the Midwest, where statistically less evident changes were observed. Additional studies have corroborated the high prevalence of diabetes in the elderly, indicating that more than half of diabetes-related hospitalizations occur in people over 60 years old. Pharmacological management includes metformin due to its efficacy and safety, while DPP-IV inhibitors require adjustments based on renal function, and sulfonylureas are initiated with conservative doses. Complications such as retinopathy, nephropathy, and peripheral neuropathy, especially in the context of diabetic foot, significantly contribute to hospitalizations and morbidity among the elderly. The COVID-19 pandemic exacerbated these challenges, limiting access to care and increasing the risk of serious complications such as lung infections and elevated mortality among diabetic elderly individuals. Thus, there is a need for health policy formulation addressing diabetes control in the Brazilian elderly population, especially during health crises such as the COVID-19 pandemic. Integrated public health strategies are essential to mitigate serious complications, promote early diagnosis, and effective management of the condition.