Narrowing inequalities in infant mortality in Southern Brazil

Goldani, Marcelo Zubarán; Benatti, Rosange Maria; Silva, Antônio Augusto Moura da; Bettiol, Heloísa; Corrêa, Joel Cristiano Westphal; Tietzmann, Marcos Roberto; Barbieri, Marco Antônio

doi:10.1590/s0034-89102002000400014

Cited by 18 publications

(17 citation statements)

References 10 publications

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“…A study evaluating child mortality trends in Porto Alegre reported smaller reductions in poorer areas; however, it did not include a multilevel analysis. 8 A cohort study of 223,289 live births and 1,266 child deaths in the state of New York, US, included multilevel logistic regression analysis to identify individual and contextual (counties) determinants of child mortality. The poverty had no signifi cant effect.…”

Section: Resultsmentioning

confidence: 99%

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

et al. 2011

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OBJECTIVE:To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models. METHODS:Cohort study including 138,407 live births with birth certifi cates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis. RESULTS:The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1-and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain signifi cant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions. CONCLUSIONS:The use of multilevel models showed a small effect of contextual determinants on the neonatal mortality rate. There was found a positive association with the poverty rate in the general model, and the proportion of households with water supply among preterm newborns.

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Section: Resultsmentioning

confidence: 99%

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

et al. 2011

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“…Há que se destacar, no entanto, que apenas o cluster considerado como de melhores condições de vida (cluster 5) apresentou uma taxa cujos valores do IC95% não se sobrepunham aos intervalos de confiança das demais. Nos últimos anos, no Brasil, tem sido registrada maior redução da mortalidade infantil, especialmente do componente pós-neonatal, em áreas com condições sociais mais desfavoráveis, queda essa atribuída, sobretudo, aos valores iniciais mais elevados do que os apresentados por áreas mais ricas, além dos efeitos da expansão de serviços de saúde e da transferência de tecnologias, propiciando acesso mais amplo a esses recursos, inclusive a parcelas da população menos privilegiadas socialmente 2,3,4,5,19 .…”

Section: Discussionunclassified

“…Nas últimas décadas, entretanto, mesmo em países de economia dependente ou onde persistem enormes desigualdades sociais ou, ainda, quando ocorrem períodos de crise econô-mica, tem-se observado decréscimo no valor dessa taxa, o que tem sido atribuído, principalmente, à redução da fecundidade e à expansão de serviços de saúde e de outros benefícios sociais, além de maior acesso a novas tecnologias em saúde 2,3,4,5,6 .…”

Section: Introductionunclassified

Condições de vida e mortalidade infantil no Estado do Paraná, Brasil, 1997/2001

et al. 2006

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Com o objetivo de verificar se as condições de vida e de infra-estrutura dos municípios do Estado do Paraná, Brasil, se relacionam com a taxa de mortalidade infantil e seus componentes, foi realizado estudo de agregados, com os 399 municípios do Estado agrupados em cinco clusters de condições de vida. As taxas de mortalidade infantil, neonatal e pós-neonatal foram calculadas para o qüinqüênio 1997/2001. Observaram-se taxas médias de mortalidade infantil, neonatal e pós-neonatal no Estado de 19,3, 12,0 e 7,3 por mil nascidos vivos, respectivamente. A taxa de mortalidade infantil pós-neonatal variou de 8,7 (cluster de piores condições) a 6,3 por mil nascidos vivos (cluster de melhores condições de vida). Com relação ao componente neonatal, os clusters de melhor e pior situação apresentaram as menores taxas, com valores semelhantes: 11,8 e 11,4 por mil nascidos vivos, respectivamente. Conclui-se que o componente pós-neonatal ainda discrimina adequadamente as condições de vida no Estado do Paraná, porém há necessidade de estudos complementares visando esclarecer as causas das taxas semelhantes de mortalidade neonatal dos clusters classificados como de melhores e de piores condições de vida.

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“…In Sweden and in the United Kingdom, for example, social inequality regarding LBW is stable (6)(7)(8)(9), whereas in the Czech Republic it is increasing due to a more accelerated increase in LBW rate among infants born to mothers with lower schooling (6,10). In Porto Ale-gre, Brazil, social inequality regarding infant mortality has recently decreased due to a more accelerated reduction in the infant mortality rate among children born to mothers with lower schooling (11).…”

Section: Introductionmentioning

confidence: 99%

Social inequality and perinatal health: comparison of three Brazilian cohorts

Filho

Junior

Silva

et al. 2007

Braz J Med Biol Res

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The objective of the present study was to estimate and compare social inequality in terms of three indicators, i.e., low birth weight (LBW), preterm birth (PTB) and small for gestational age (SGA) birth, in three birth cohorts. Two cohorts were from the city of Ribeirão Preto, where data were collected for all 6748 live born singletons in 1978/79 and for one third of live born singletons (2846) in 1994. The third cohort consisted of 2443 singletons born in São Luís over a period of one year (1997/98). In Ribeirão Preto, LBW and PTB rates increased in all social strata from 1978/79 to 1994. Social inequalities regarding LBW and PTB disappeared since the increase in these rates was more accelerated in the groups with higher educational level. The percentage of SGA infants increased over the study period. Social inequality regarding SGA birth increased due to a more intense increase in SGA births in the strata with lower schooling. In São Luís, in 1997/98 there was no social inequality in LBW or PTB rates, whereas SGA birth rate was higher in mothers with less schooling. We speculate that the more accelerated increase in medical intervention, especially due to the increase in cesarean sections in the more privileged groups, could be the main factor explaining the unexpected increase in LBW and PTB rates in Ribeirão Preto and the decrease or disappearance of social inequality regarding these perinatal indicators in the two cities. Correspondence

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Narrowing inequalities in infant mortality in Southern Brazil

Cited by 18 publications

References 10 publications

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

Condições de vida e mortalidade infantil no Estado do Paraná, Brasil, 1997/2001

Social inequality and perinatal health: comparison of three Brazilian cohorts

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