[Hierarchical modeling of determinants associated with hospitalizations for ambulatory care sensitive conditions in Espírito Santo State, Brazil].

The aim of this study was to investigate the relationship between health services organization and hospitalization rates for ambulatory care sensitive conditions after adjusting for socioeconomic and demographic variables in municipalities (counties) in Espírito Santo State, Brazil. In an ecological study, data were collected from the Brazilian Unified National Health System (SUS) on the following variables: hospitalization for ambulatory care sensitive conditions, city size, demographic and socioeconomic characteristics, and health services organization. Rates were analyzed by Poisson regression with robust variance. Models were adjusted for the total population and age group. The explanatory variables were ordered hierarchically. Hospitalization rates for ambulatory care sensitive conditions were associated with illiteracy rate (RR: 1.08-1.17), proportion of beds in the SUS (RR: 1.09-1.12), urbanization (RR: 1.02-1.03), proportion of blacks (RR: 0.97-0.98), and health insurance coverage (RR: 0.97-0.98). Some determinants of hospitalization for ambulatory care sensitive conditions involve patterns of health services use and lie outside the scope of primary care.