Divergent Trends in Hospitalizations and Mortality from Diabetes and Hypertension: A Population-Based Time-Series Study with Implications for Public Health Nursing in Southern Brazil.

Objective

To analyze temporal trends in hospitalization and mortality rates due to diabetes mellitus and hypertension in the state of Paraná, Brazil.

Design

Population-based ecological time-series study. SAMPLE Residents of the state of Paraná, Southern Brazil, from 2014 to 2024.

Measurements

Annual hospitalization and mortality rates per 100,000 inhabitants due to diabetes mellitus and hypertension were calculated using national health information systems and stratified by sex and age group. ANALYTIC STRATEGY Joinpoint regression models were applied to estimate annual and average annual percent changes and identify temporal inflection points.

Results

Hospitalization rates declined for both conditions across most population groups, particularly among older adults. In contrast, mortality rates increased over much of the study period, especially among younger and middle-aged adults, with stabilization only in recent years. Divergent trends between hospitalizations and mortality were consistent across sex and age strata.

Conclusions

Declining hospitalization rates do not necessarily indicate improved population health outcomes. The coexistence of reduced hospitalizations and increased mortality highlights gaps in early diagnosis, continuity of care, and longitudinal management of chronic conditions. These findings underscore the need for public health nursing strategies that integrate surveillance data, strengthen primary care follow-up, and address upstream determinants of chronic disease outcomes.