Intra-urban differentials of fetal mortality in clusters of social vulnerability in São Paulo Municipality, Brazil

Abstract

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007–2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

Prevalence and risk of stillbirth according to biologic vulnerability phenotypes in the municipality of São Paulo, Brazil: A population‐based cohort study

“…We used administrative records and there is no available information about the precise moment of stillbirths. In the case of antepartum stillbirths, which represent the majority of deaths in the municipality of São Paulo, 42 gestational age and birth weight are based on the time of delivery and not on the time of death 43 . The fetus may lose weight in the uterus if death occurs several days or weeks before delivery 44 .…”

Assessing the risks for stillbirth in São Paulo, Brazil: protocol for a multidisciplinary case–control study – FetRisks

“…Even so, 25% of stillbirths continue to be classified as unspecified, indicating the need to improve the understanding of mortality conditions and causes. 17 Although half of São Paulo's population is covered by private healthcare, public hospitals of the Unified Health System (SUS) account for approximately 60% of childbirth care and over 75% of stillbirths. [18][19][20] The multiplicity and complexity of the different risk factors related to stillbirth and the way these factors relate to each other make it difficult to consider them together in epidemiological studies and to effectively prevent it.…”

“…São Paulo has a high per capita income and low illiteracy rates, 21 but an important social inequality, especially in the city's outskirts, which may partially explain the higher stillbirth rates observed in these areas. 17 Moreover, the MRSP has some recognised risk factors that are investigated in this study, such as unequal distribution of health services, 22 high levels of air pollution, especially across lower-income neighbourhoods, 23 as well as a growing incidence of maternal and congenital syphilis. 24 25 Inclusion and exclusion criteria Women with stillbirths are invited to join the study in the participating hospitals.…”