Fetal and infant mortality trends according to the avoidability of causes of death and maternal education

Kale, Pauline Lorena; Fonseca, Sandra Costa; Oliveira, Pedro Willian Marques de; Brito, Alexandre dos Santos

doi:10.1590/1980-549720210008.supl.1

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Revista Brasileira de Epidemiologia

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Sumário

Original Article • Rev. bras. Epidemiol. 24 (suppl 1) • 2021 • https://doi.org/10.1590/1980-549720210008.supl.1 copy

Fetal and infant mortality trends according to the avoidability of causes of death and maternal education

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To estimate trends of fetal (FMR) and neonatal (NMR) mortality rates due to avoidable causes and maternal education in the city of Rio de Janeiro (2000–2018).

Methods:

Ecological time series study. Mortality and Live Birth Information System Data. The List of Avoidable Causes of Death Due to Interventions of the Brazilian Health System was used for neonatal deaths and an adaptation for fetal deaths, according to maternal education indicators (low <4 and high ≥12, years of study). Joinpoint regression models were used to estimate trends in FMR, based on one thousand births, and NMR, based on one thousand live births.

Results:

FMR decreased from 11.0 to 9.3% and NMR from 11.3 to 7.8% (2000/2018). In 2006, FMR (10.5%) exceeded NMR (9.0%), remaining higher. From 2000 to 2018, the annual decrease of FMR was 0.8% (2000 to 2018) and of NMR, 3.8% until 2007, decreasing to 1.1% by 2011; from then on, it remained stable. Avoidable causes, especially those reducible by adequate prenatal care, showed higher rates. Both FMR and NMR for low-education women were higher than those for the high-education level, the difference being much more pronounced for FMR, and at the end of the period: low- and high-education FMR were respectively 16.4 and 4.5% (2000) and 48.5 and 3.9% (2018), and for NMR, 18.2 and 6.7% (2000) and 28.4 and 5.0% (2018).

Conclusion:

The favorable trend of decreasing mortality was not observed for children of mothers with low education, revealing inequalities. The causes were mostly avoidable, being related to prenatal care and childbirth.

Keywords
Fetal mortality; Infant mortality; Time series studies; Underlying cause of death; Educational status; Health inequality monitoring

Mortality rates	Periods of trends	MR^ fetal mortality per thousand births and neonatal mortality per thousand live births.		Estimates
Mortality rates	Periods of trends	Initial	Final	APV	95%CI		AC
Total fetal	2000–2018^* * p < 0.05;	11.1	9.3	−0.8	−1.2	−0.4	–
Avoidable fetal	2000–2002^* * p < 0.05;	9.1	4	−34.3	−45.5	−20.8	−0.5
	2002–2011^* * p < 0.05;	4	6	4.6	3	6.3
	2011–2018	6	6.2	0	−1.8	1.9
Ill-defined fetal	2000–2002^* * p < 0.05;	1.4	5.6	95.8	26.2	203.8	−0.1
	2002–2007	5.6	4.5	−3.8	−11.3	4.3
	2007–2011	4.5	2.6	−12.4	−25.6	3.1
	2011–2018	2.6	2.4	−2.2	−6.9	2.8
Other fetal	2000–2018^* * p < 0.05;	0.4	0.7	3.7	2.5	4.9	–
Fetal — low education	2000–2005	16.4	15.1	2.4	−5.8	11.2	−0.4
	2005–2015^* * p < 0.05;	15.1	67.1	13.9	10.1	17.8
	2015–2018	67.1	48.7	−9.4	−30.2	17.6
Fetal — high education	2000–2018	4.5	3.9	0.4	−0.4	1.3	−0.5
Total neonatal	2000–2007^* * p < 0.05;	11.3	8.2	−3.8	−5.2	−2.3	–
	2007–2018^* * p < 0.05;	8.2	7.8	−1.1	−2	−0.3
Avoidable neonatal	2000–2007^* * p < 0.05;	9.0	6.1	−4.1	−5.6	−2.6	−0.3
	2007–2018^* * p < 0.05;	6.1	6.0	−1	−1.8	−0.1
Ill-defined neonatal	2000–2013^* * p < 0.05;	0.3	0.1	−9.9	−12	−7.7	−0.5
	2013–2016	0.1	0.1	21.2	−53.8	217.6
	2016–2018	0.1	0	−48.7	−88.4	126.7
Other neonatal	2000–2004^* * p < 0.05;	2.0	3.0	7.6	2.9	12.4	−0.3
	2004–2007	3.0	1.9	−10.6	−26.2	8.4
	2007–2018	1.9	1.8	−0.5	−1.5	0.5
Neonatal— low education	2000–2009	18.2	18.2	0.5	−1.2	2.2	−0.4
	2009–2015^* * p < 0.05;	18.2	34.6	10.9	5.1	17.0
	2015–2018	34.6	28.4	−6.3	−21.3	11.7
Neonatal — high education	2000–2009^* * p < 0.05;	6.7	3.9	−4.4	−7.4	−1.3	−0.2
	2009–2018	3.9	5.0	2.0	−1.3	5.3

	Fetal^* * Brazilian List of Causes of Avoidable Deaths adapted for fetal deaths;				Neonatal^ List of Avoidable Causes of Death Due to Interventions of the Brazilian Health System (0–4 years); 1.1 Reducible by immunoprevention; 1.2.1 Reducible by adequate prenatal care; 1.2.2 Reducible by adequate intrapartum care; 1.2.3) Reducible by adequate care of the fetus and newborn; 1.3 Reducible by adequate diagnosis and treatment; 1.4 Reducible by health promotion measures linked to adequate healthcare measures.
Year	1.1	1.2.1	1.2.2	total	1.1	1.2.1	1.2.2	1.2.3	1.3	1.4	total
	%	%	%	n	%	%	%	%	%	%	N
2000	0.1	44.2	55.7	910	0.0	46.9	17.1	33.9	1.7	0.5	885
2001	0.0	39.4	60.6	568	0.0	43.1	16.7	38.8	0.9	0.4	737
2002	0.0	54.3	45.7	348	0.0	51.5	14.8	31.5	1.5	0.7	718
2003	0.0	55.7	44.3	357	0.0	43.2	16.5	38.1	1.8	0.4	683
2004	0.0	69.4	30.6	445	0.0	51.4	14.0	33.8	0.7	0.2	615
2005	0.0	70.0	30.0	343	0.0	50.9	12.8	34.2	1.2	0.8	593
2006	0.0	75.6	24.4	381	0.0	51.7	14.4	31.8	1.0	1.0	578
2007	0.0	66.3	33.7	406	0.0	52.5	20.1	26.0	1.0	0.4	507
2008	0.0	69.3	30.7	440	0.0	53.0	17.8	27.7	0.6	0.9	534
2009	0.0	68.8	31.2	443	0.0	57.2	16.6	25.3	0.0	0.8	589
2010	0.0	78.1	21.9	484	0.2	59.4	16.1	23.0	0.6	0.8	527
2011	0.2	73.4	26.4	522	0.0	62.2	16.2	20.1	1.4	0.0	487
2012	0.0	80.9	19.1	560	0.5	63.3	14.1	19.0	1.5	1.6	547
2013	0.0	81.6	18.4	522	0.0	62.2	13.1	23.3	1.2	0.2	571
2014	0.0	74.8	25.2	532	0.0	59.8	14.5	24.9	0.6	0.2	502
2015	0.0	74.9	25.1	529	0.0	56.9	15.9	26.5	0.7	0.0	554
2016	0.0	75.2	24.8	491	0.0	58.7	12.7	26.1	0.8	1.7	521
2017	0.0	75.8	24.2	517	0.0	57.2	16.8	23.1	1.3	1.7	477
2018	0.0	76.2	23.8	513	0.0	59.7	18.2	21.1	0.4	0.6	494

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[1] Corresponding author: Pauline Lorena Kale. Avenida Horácio Macedo, s/n., Ilha do Fundão, Cidade Universitária, CEP: 21941-598, Rio de Janeiro, RJ, Brasil. E-mail: pkale@iesc.ufrj.br