Scholarlink

Background <p>Investigating the relationship between stillbirth and deprivation is essential to guide healthcare improvements, as evidence is scarce in LMIC contexts. This study estimated the stillbirth rate (SBR) and the odds ratios (OR) of stillbirth in Brazil’s municipal deprivation context.</p> Methods <p>This observational study included births in Brazil registered in the SINASC and SIM databases, employing two epidemiological designs. First, a cross-sectional analysis assessed the association between stillbirths and municipal deprivation, using data from January 1 to December 31, 2018. Logistic regression was used to estimate OR for stillbirths across deprivation levels, adjusting for sociodemographic, gestational, and fetal variables, with 95% confidence intervals. Deprivation was classified into quintiles based on Brazilian deprivation index (IBP) levels 1 to 5. Second, an ecological analysis examined time trends in SBR by deprivation level from January 1, 2000, to December 31, 2018. Time trends in SBR from 2000 to 2018 were analyzed using Prais-Winsten regression, both overall and stratified by IBP level.</p> Results <p>In 2018, the OR of stillbirth, including both antepartum and intrapartum cases, increased with higher levels of deprivation. Compared to the least deprived areas, level 2 had a 9% greater OR of stillbirth (95%CI: 1.03–1.15), level 3 had a 30% higher OR (95% CI: 1.23–1.27), level 4 showed a 34% increase (95%CI: 1.27–1.41), and level 5 had the highest OR, with a 68% increase (95%CI: 1.60–1.77). From 2000 to 2018, SBR in Brazil declined by 1.1% per year (<i>p</i> &lt; 0.001). Significant declines were observed across deprivation levels 1 (-1.6% per year; <i>p</i> &lt; 0.001) to 4 (-1.5% per year; <i>p</i> &lt; 0.001), while level 5 showed persistently high stillbirth rates with no significant improvement (<i>p</i> ≥ 0.05).</p> Conclusion <p>These results highlight the stark inequalities in stillbirth chances across Brazil. Targeted action is needed to close the gap in the most deprived municipalities and reduce stillbirth rates and perinatal health disparities.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Disparities in stillbirth rates according to municipal deprivation levels: a nationwide study in Brazil

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年10月27日

查看全文
  • Ismina Papadhima,
  • Lays Janaina Prazeres Marques,
  • Elzo Pereira Pinto Jr,
  • Hannah Blencowe,
  • Marcia Furquim de Almeida,
  • Maria Yury Ichihara,
  • Mauricio L. Barreto,
  • Enny S. Paixao

摘要

Background

Investigating the relationship between stillbirth and deprivation is essential to guide healthcare improvements, as evidence is scarce in LMIC contexts. This study estimated the stillbirth rate (SBR) and the odds ratios (OR) of stillbirth in Brazil’s municipal deprivation context.

Methods

This observational study included births in Brazil registered in the SINASC and SIM databases, employing two epidemiological designs. First, a cross-sectional analysis assessed the association between stillbirths and municipal deprivation, using data from January 1 to December 31, 2018. Logistic regression was used to estimate OR for stillbirths across deprivation levels, adjusting for sociodemographic, gestational, and fetal variables, with 95% confidence intervals. Deprivation was classified into quintiles based on Brazilian deprivation index (IBP) levels 1 to 5. Second, an ecological analysis examined time trends in SBR by deprivation level from January 1, 2000, to December 31, 2018. Time trends in SBR from 2000 to 2018 were analyzed using Prais-Winsten regression, both overall and stratified by IBP level.

Results

In 2018, the OR of stillbirth, including both antepartum and intrapartum cases, increased with higher levels of deprivation. Compared to the least deprived areas, level 2 had a 9% greater OR of stillbirth (95%CI: 1.03–1.15), level 3 had a 30% higher OR (95% CI: 1.23–1.27), level 4 showed a 34% increase (95%CI: 1.27–1.41), and level 5 had the highest OR, with a 68% increase (95%CI: 1.60–1.77). From 2000 to 2018, SBR in Brazil declined by 1.1% per year (p < 0.001). Significant declines were observed across deprivation levels 1 (-1.6% per year; p < 0.001) to 4 (-1.5% per year; p < 0.001), while level 5 showed persistently high stillbirth rates with no significant improvement (p ≥ 0.05).

Conclusion

These results highlight the stark inequalities in stillbirth chances across Brazil. Targeted action is needed to close the gap in the most deprived municipalities and reduce stillbirth rates and perinatal health disparities.