Objective: To analyze the intraurban spatial distribution of perinatal mortality, its avoidability, and relationship with socioeconomic indicators in Recife, Pernambuco, Brazil, in the period from 2013 to 2015. Method: An ecological study with data from the Information Systems on Mortality and Live Births and the Brazilian Institute of Geography and Statistics, using neighborhoods as the analysis unit. We elaborated an indicator of social deprivation formed by variables from the demographic census. We estimated the Kernel density of the deaths and calculated the Moran index of the perinatal mortality coefficients in the spatial analysis. We elaborated thematic maps of avoidable perinatal mortality and social deprivation. Results: The global statistical analysis of the mortality distribution indicated evidence of spatial aggregation. Moran's index was 0.18. We found clusters of perinatal mortality in neighborhoods of the Central, North, Northwest, and South Regions. In the North, Northwest, Southwest, and South Regions we identified neighborhoods with greater social deprivation and avoidable mortality coefficients. The primary cause of death was of fetuses and newborns affected by hypertensive maternal disorders. Conclusion: We demonstrated intraurban differentials in perinatal mortality among neighborhoods. The stratification of the urban space according to the social deprivation indicator presented a relation with the perinatal mortality and its avoidability.
Objective: To develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. Methods: ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. Results: The social deprivation index selected two factors that, together, explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deprivation), 8.1 per thousand (medium deprivation), 8.8 per thousand (high deprivation), and 10.7 per thousand (very high social deprivation). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: The spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.
Suicide is a worldwide public health problem. Spatial analysis techniques are useful to describe suicide patterns in different regions, identifying priority areas. The present study sought to describe the spatiotemporal pattern of suicides in the state of Pernambuco (Brazil) from 1999 to 2018. This is an ecological study with suicide data recorded in the Brazilian Mortality Information System (SIM-Sistema de Informações sobre Mortalidade). Thematic maps of the gross mean coefficients and local empirical Bayes method were developed to investigate the suicide spatial pattern in two decades. Spatial autocorrelation and critical clusters were verified using the Global Moran's Index and local indicators of spatial association. There were 6610 suicides. The mortality rate was 5.2 and 5.3 per 100,000 inhabitants in the first and second decades, respectively.
To describe the occurrence and spatial distribution of infant deaths investigated by surveillance in Recife, state of Pernambuco, Brazil, in 2014. This is an exploratory ecological study investigating 183 infant deaths. Data from the confidential records of surveillance investigation of the infant death and the Mortality Information System were used. In order to detect spatial distribution patterns, the kernel estimation of infant, neonatal and post-neonatal mortality was used. Deaths were mainly of the neonatal type (n = 144; 78.69%), with gestational age below 37 weeks (n = 147; 80.3%) and birth weight lower than 2500 g (n = 143; 78.1%). The main causes of infant deaths were the disorders originating in the perinatal period, with emphasis on maternal hypertensive disorders (n = 31; 16.9%). The kernel map showed a higher density in 12 neighborhoods of the North (4), Northwest (2), West (3) and South (3) regions of the municipality. It was found a heterogeneous pattern in the occurrence and distribution of deaths in the territory; spatial clusters were observed in several areas of Recife with similar geographic spaces between types of death.
A mortalidade fetal é um indicador da assistência obstétrica e de condições de vida capaz de refletir o estado de saúde da mulher e a qualidade e a acessibilidade dos cuidados no pré-natal e na assistência intraparto. Com o objetivo de analisar os padrões espaciais da mortalidade fetal, a evitabilidade dos óbitos e a carência social no estado de Pernambuco, foi realizado um estudo ecológico considerando municípios, regiões de saúde e mesorregiões como unidades de análise. Incluíram-se os óbitos fetais registrados no Sistema de Informação sobre Mortalidade no período de 2010 a 2017. Classificou-se a evitabilidade dos óbitos pela Lista Brasileira de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde. Aplicou-se a estatística descritiva e o teste qui-quadrado para comparação de proporções das causas de morte. Na elaboração do índice de carência social, utilizou-se a técnica de análise fatorial por componentes principais com o teste de esfericidade de Bartlett para identificar a matriz de correlação. Com o índice calculado, os municípios foram agrupados em estratos de carência social pela técnica de k-means. Foram aplicadas a análise bayesiana e a estatística espacial de Moran para identificação de áreas prioritárias de mortalidade fetal e do índice de carência social. Registraram-se 12.337 óbitos fetais, sendo 8.927 (72,3%) por causas evitáveis. As variáveis idade da mãe, número de filhos mortos, tipo de gravidez, tipo de parto e peso ao nascer estiveram relacionadas à evitabilidade do óbito. Na construção do índice de carência social, o teste de esfericidade de Bartlett (χ² de 144,463; p < 0,01) e o coeficiente KMO (0,8) mostraram que as correlações entre os itens eram adequadas para a análise fatorial, assim como as correlações entre os indicadores. O índice de carência social indicou dois fatores que, juntos, explicaram 77,63% da variância total. A taxa de mortalidade fetal evitável apresentou aumento entre estratos de carência social, com taxas de 7,99 por mil nascimentos (baixa carência), 8,06 por mil (média carência), 8,83 por mil (alta carência) e 10,7 por mil (muito alta carência). O índice global de Moran verificou autocorrelação espacial significativa para a taxa de mortalidade fetal bayesiana (I = 0,10; p = 0,05), para a taxa de mortalidade fetal evitável bayesiana (I = 0,13; p = 0,03) e para o índice de carência social (I = 0,53; p = 0,01). Alguns municípios das mesorregiões do São Francisco e do Sertão Pernambucano tiveram simultaneamente elevada mortalidade fetal e mortalidade fetal evitável, além de índice de carência social muito alto. A análise espacial identificou áreas com maior risco para a mortalidade fetal. O índice de carência social relacionou alguns determinantes das mortes fetais em áreas com piores condições de vida. Detectaram-se áreas prioritárias para a intervenção de políticas públicas de redução da mortalidade fetal e seus determinantes.
Objectives To analyze the spatial-temporal patterns of fetal mortality according to its relationship with social vulnerability, identifying priority areas for intervention. Methods Ecological study conducted in the state of Pernambuco, Northeast region of Brazil, from 2011 to 2018. The mean fetal mortality rate per city was calculated for the studied period. A cluster analysis was performed to select cities with homogeneous characteristics regarding fetal mortality and social vulnerability, then the Attribute Weighting Algorithm and Pearson correlation techniques were employed. In the spatial analysis it was used the local empirical Bayesian modeling and global and local Moran statistics. Results Twelve thousand nine hundred and twelve thousand fetal deaths were registered. The fetal mortality rate for the period was 11.44 fetal deaths per 1,000 births. The number of groups formed was 7, in which correlation was identified between fetal mortality and dimensions, highlighting the correlations between fetal mortality rate and the Index of Social Vulnerability urban infrastructure for the municipalities in group 1 and 5, the values of the correlations found were 0.478 and 0.674 respectively. The spatial analysis identified areas of higher risk for fetal mortality distributed in regions of medium, high and very high social vulnerability. Conclusions The study allowed observing the existing correlations between fetal mortality and social vulnerability and identifying priority areas for intervention, with a view to reducing fetal mortality in the state.
Este estudo teve o objetivo de identificar a influência da pandemia de covid-19 nas séries temporais da mortalidade materna no Recife, Pernambuco, no período de 2018-2021. Trata-se de um estudo ecológico com dados do Sistema de Informações sobre Mortalidade e do Sistema de Informações sobre Nascidos Vivos, para o cálculo das razões de mortalidade materna. Calculou-se a razão da mortalidade materna dividindo o número de óbitos maternos pelos nascidos vivos por mês e utilizou-se da técnica de regressão Zero Adjusted Inverse Gaussian, para análise do dado. Foram registrados 61 óbitos maternos, 21 nos dois anos antes da pandemia e 40 óbitos nos dois primeiros anos pandêmicos. As mulheres negras foram a maior parte, com idade média de 33 anos e desvio padrão de 8,4 anos. No período anterior à pandemia, as hemorragias apresentavam destaque. Nos dois primeiros anos pandêmicos a infecção por coronavírus representou a principal causa básica de óbito materno. Os resultados do modelo de regressão demonstraram que houve aumento, estatisticamente significante, na razão da mortalidade materna no período pandêmico, sendo o aumento do primeiro semestre de 2020, cuja razão foi de 182,83 por 100.000 nascidos vivos. A pandemia de covid-19 influenciou no aumento da razão da mortalidade materna e contribuiu para mudanças epidemiológicas nas causas de óbito materno no Recife. PALAVRAS-CHAVE: Mortalidade materna. Covid-19. Nascidos vivos.
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