RESUMO Objetivo: Identificar fatores associados à definição do método estimador da idade gestacional (IG) registrado na declaração de nascido vivo (DNV) e comparar os resultados obtidos segundo método no município de São Paulo, entre 2012 e 2019. Métodos: Estudo transversal de base populacional utilizando o Sistema de Informações sobre Nascidos Vivos. Realizou-se análise descritiva e comparativa segundo método de estimativa da IG, seguida de modelo de regressão logística uni e multivariada para identificar as variáveis preditoras do método utilizado. Resultados: A estimativa da IG pela data da última menstruação (DUM) (39,9%) foi inferior à obtida por outros métodos (OM) (60,1%) — exame físico e ultrassonografia, entre 2012-2019. O registro da DUM na DNV aumentou com a idade da mãe, foi maior entre as brancas, mais escolarizadas e com companheiro, nas cesarianas e nos partos realizados com financiamento privado. Na regressão logística, o financiamento público apresentou chance 2,33 vezes maior que o privado para uso de OM. A proporção de prematuros (<37 semanas) com IG pela DUM foi 26,5% maior do que a obtida por OM. A mediana de peso ao nascer foi maior entre prematuros com IG estimada pela DUM. Conclusão: A prematuridade foi mais elevada com a IG estimada pela DUM no MSP, o que pode indicar superestimação por este método. A fonte de financiamento foi a variável mais explicativa para definição do método estimador da IG na DNV. Os resultados apontam a necessidade de cautela ao comparar a IG obtida por métodos diferentes.
RESUMO Este artigo analisa a série histórica de um conjunto de indicadores, de 2002 a 2014, relacionados ao Sistema Único de Saúde do Brasil, embasado na metodologia da Proposta de Avaliação de Desempenho do Sistema de Saúde. Os resultados mostram que houve uma sensível melhoria nos indicadores de dimensão socioeconômica e nos da dimensão condições de saúde. A melhoria dos indicadores de condições de saúde pode estar relacionada ao incremento de suporte financeiro; ao incremento de recursos humanos; ao aumento do acesso às consultas médicas e aos serviços de alta complexidade; e a uma maior disponibilização de horas de profissionais de saúde para a população residente. PALAVRAS-CHAVE
Objective: To identify factors associated with the definition of the gestational age (GA) estimation method recorded in the live birth certificate (LBC), and to compare the results obtained according to the method in the city of São Paulo (CSP), between 2012 and 2019. Methods: Cross-sectional population-based study using the Live Birth Information System. Descriptive and comparative analysis was performed according to the GA estimation method, followed by a univariate and multivariate logistic regression model to identify the predictor variables of the method used. Results: The estimation of GA by the date of the last menstrual period (LMP) (39.9%) was lower than that obtained by other methods (OM) (60.1%) — physical examination and ultrasound, between 2012–2019. LMP registration in the LBC increased with the mother's age, it was higher among women who were white, more educated and with partners, in cesarean sections and with private funding. In the logistic regression, public funding was 2.33 times more likely than private funding to use OM. The proportion of preterm infants (<37 weeks) with GA by LMP was 26.5% higher than that obtained by OM. Median birth weight was higher among preterm infants with GA estimated by LMP. Conclusion: Prematurity was higher with the GA estimated by LMP in the CSP, which may indicate overestimation by this method. The source of funding was the most explanatory variable for defining the GA estimator method at the LBC. The results point to the need for caution when comparing the GA obtained by different methods.
Birth at term comprises a period with heterogeneous neonatal outcomes that tend to be worse for infants born earlier. However, few studies have analyzed this period, in which each day can make a difference. Therefore, we aim to assess neonatal mortality (NM) according to gestational age (GA) at birth measured in days in term liveborn infants born in 2012–2017 in São Paulo, the largest city in Latin America. This population-based cohort study assessed term liveborn infants followed until the end of the neonatal period. We analyzed 7 models for NM according to GA in days: crude NM adjusted for maternal and prenatal variables, NM additionally adjusted for type of birth and type of hospital, and adjusted NM stratified by type of birth (cesarean and vaginal) and by type of hospital (public and private). We included 440,119 live infants born at 259–293 days of gestation. The median GA at birth was 274 days. In all models, NM was higher for infants born early term, decreasing in infants born full term and rising again in infants born late term. In the unadjusted model, hazard ratios of NM changed daily, decreasing from 3.34 to 1.00 on day 278 and increasing again thereafter. In the stratified analysis according to type of hospital, being born in a public hospital was associated with a reduced risk of NM for infants born at 278–283 days of pregnancy. There was a decrease in GA related to obstetric interventions, especially cesarean sections, which increased NM. The loss of days of pregnancy was larger in private hospitals. Increasing the granularity of GA to days is feasible and has the potential to drive public policies. To the best of our knowledge, this is the first Brazilian study on GA in days using a national live births database.
The population’s health care may generate a large volume of data concerning services provided, making more knowledge available and making it possible to guide managers with respect to actions regarding health care. Among the databases processed by the Unified Health System [ Sistema Único de Saúde – SUS], are the System of Information on Live Births [Sistema de Informações sobre Nascidos Vivos (SINASC)], the System of Hospital Data [Sistema de Informações Hospitalares (SIH)] of the Ministry of Health, the System of Information on Mortality [Sistema de Informações de Mortalidade (SIM)], and, in the Municipality of Sao Paulo, the Integrated System of Health Care Management of the Municipal Department of Health [Sistema Integrado de Gestão da Assistência à Saúde da Secretaria Municipal de Saúde (SIGA)]. The objective of this study is to describe a method of linkage between the databases SIGA, SINASC, SIH and SIM making it possible to identify pregnant women/parturients and their fetuses and newborns in all these records. Consequently, analysis of the procedures and interventions undertaken on a woman during pregnancy and birth, those undertaken on her baby during and soon after birth, as well as hospitalizations, including those which occurred after discharge from hospital are attained. This study is part of a research project entitled, “How can interventions during labor and its outcomes become more visible to the data systems?”. The linkage of data from the SIGA, SINASC, SIH and SIM databases underwent 5 phases: treatment of the SIGA base, linkage, validations, descriptions, and metrics calculation.
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