Cesarean section rates in São Paulo State: regional inequalities in SUS obstetric care

Lucena, Fabiana Santos; Garcia, Mariana Tarricone; Duarte, Lígia Schiavon

doi:10.1590/1806-93042020000400012

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Saúde Materno Infantil

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 20 (4) • Oct-Dec 2020 • https://doi.org/10.1590/1806-93042020000400012 copy

Cesarean section rates in São Paulo State: regional inequalities in SUS obstetric care

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to analyze the relation between cesarean section rates in SUS childbirth care establishments in São Paulo State and urbanization conditions, according to Robson group classification system.

Methods:

Sistema de Informação sobre Nascidos Vivos (Live Births Information System) and Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Establishments) 2016 databases were analyzed. The studied outcome was cesarean section rates in the establishments, grouped by administration type (public or nonprofit entities) and urbanization condition.

Results:

the cesarean section rate in SUS childbirth care establishments was 50.5%, ranging from 41.1% in metropolitan regions up to 75.2% in the low urbanized regions. Cesarean section rates in public administration establishments (38.2%) were significantly lower than the nonprofit administration maternity hospitals (62.3%). Robson groups 5 and 2 contributed mostly to the cesarean section global rate (36.6% and 21.5%, respectively).

Conclusions:

The less urbanized regions showed significantly higher cesarean section rates than the metropolitan and highly urbanized regions. Cesarean section rates of public administration establishments were significantly lower than the nonprofit administration establishments. However, when separated by urbanization condition its difference was only observed in the metropolitan regions.

Key words
Cesarean section; Childbirth; Regionalization; Urbanization; Public health system

	Total	Metropolitan	High urbanization	Medium urbanization	Low urbanization
Population 2016^* * SEADE Foundation;
N (%)	43.359.005 (100.0)	25.381.216 (58.5)	10.256.412 (23.7)	5.078.538 (11.7)	2.642.839 (6.1)

GDP^* * SEADE Foundation;
% of state GDP	100,0	66,2	21,9	7,6	4.3
Per capita (R$)	46,991.4	53,177.0	43,505.6	30,348.5	33,096.6

Live births
N (%)
Total	428,817 (100.0)	247,722 (57.8)	99,505 (23.2)	56,000 (13.0)	25,590 (6.0)
Public administration	210,012 (100.0)	172,139 (82.0)	24,303 (11.6)	11,553 (5.5)	2,017 (1.0)
Nonprofit entities	218,805 (100.0)	75,583 (34.5)	75,202 (34.4)	44,447 (20.3)	23,573 (10.8)

N Establishments
N (%)
Total	339 (100.0)	103 (30.4)	100 (29.5)	76 (22.4)	60 (17.7)
Public administration	112 (100.0)	71 (63.4)	20 (17.9)	14 (12.5)	7 (6.3)
Nonprofit entities	227 (100.0)	32 (14.4)	80 (35.5)	62 (27.3)	53 (23.3)

N Health regions with establishment
Total	63	8	19	16	20
Public administration	37	8	12	11	6
Nonprofit entities	59	6	18	16	19

Physicians/1,000 inhabitants^ National Registry of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde - CNES).	2.4	2.7	2.2	2.0	1.6

Obstetric nurses^ National Registry of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde - CNES).
N/Establishment	1.1	2.8	0.4	0.2	0.3
N Establishments with
Obstetric nurses	44	26	9	4	5

Urbanization condition categories	Total		Public Administration		Nonprofit entities
Urbanization condition categories	N Establishments	Cesarean section rate	N Establishments	Cesarean section rate	N Establishments	Cesarean section rate
Total
Total number of live births	339	50.5	112	38.2	227	62.3^* ***** p<0.001.
Group 1	326	39.0	107	22.5	219	55.1^* ***** p<0.001.
Group 2	324	56.8	108	43.0	216	68.2^* ***** p<0.001.
Group 3	327	13.5	107	7.9	220	22.2^* ***** p<0.001.
Group 4	326	31.6	108	24.6	218	39.6^* ***** p<0.001.
Group 5	335	79.6	111	70.6	224	86.5^* ***** p<0.001.

Metropolitan
Total number of live births	103	41.1	71	35.5	32	54.0^* ***** p<0.001.
Group 1	102	29.5	70	20.1	32	50.7^* ***** p<0.001.
Group 2	102	44.5	70	39.5	32	54.0^* ***** p<0.001.
Group 3	101	10.7	70	7.4	31	22.6^* ***** p<0.001.
Group 4	102	24.9	70	22.6	32	30.1^ p<0.01;
Group 5	102	72.6	70	68.4	32	80.8^* ***** p<0.001.

High urbanization
Total number of live births	100	59.6	20	46.6	80	63.9
Group 1	94	44.5	17	25.2	77	50.9^ p<0.01;
Group 2	94	70.1	18	56.9	76	73.7
Group 3	95	14.7	17	7.5	78	18.2
Group 4	95	42.5	18	36.0	77	44.9
Group 5	99	84.5	20	76.5	79	86.8

Medium urbanization
Total number of live births	76	64.3	14	56.2	62	66.4
Group 1	73	57.6	13	52.1	60	58.9
Group 2	72	72.9	13	57.5	59	76.3
Group 3	74	20.5	14	18.4	60	21.1
Group 4	73	41.3	13	32.0	60	43.8
Group 5	75	88.2	14	80.3	61	90.0

Low urbanization
Total number of live births	60	75.2	7	64.1	53	76.2
Group 1	57	70.4	7	44.2	50	72.5
Group 2	56	83.3	7	79.7	49	83.7
Group 3	57	33.9	6	14.6	51	35.9
Group 4	56	56.9	7	44.7	49	58.0
Group 5	59	93.2	7	88.2	52	93.6

Urbanization condition categories	Cesarean section (N)			Live births (N)		Relative contribution (%) in the overall cesarean section rate
Urbanization condition categories	Total	Public Adm.	Nonprofit entities	Total	Public Adm.	Nonprofit entities	Total	Public Adm.	Nonprofit entities
Total
Group 1	23288	6635	16653	59734	29523	30211	10.8	8.3	12.2^* * p<0.05;
Group 2	46598	15863	30735	81971	36909	45062	21.5	19.8	22.6^ p<0.01.
Group 3	8913	3173	5740	66166	40285	25881	4.1	4.0	4.2
Group 4	18235	7466	10769	57623	30398	27225	8.4	9.3	7.9
Group 5	79242	30293	48949	99509	33517	56584	36.6	37.8	35.9

Metropolitan
Group 1	10466	4954	5512	35489	24619	10870	10.3	8.1	13.5
Group 2	20535	11926	8609	46140	30187	15953	20.1	19.5	21.1^ p<0.01.
Group 3	4705	2560	2145	44005	34501	9504	4.6	4.2	5.3
Group 4	9171	5779	3392	36875	25603	11272	9.0	9.5	8.3
Group 5	36971	22916	14055	50914	33517	17397	36.3	37.5	34.5

High urbanization
Group 1	5668	793	4875	12737	3153	9584	9.6	7.0	10.1
Group 2	13999	2421	11578	19968	4257	15711	23.6	21.4	24.1
Group 3	1816	302	1514	12381	4041	8340	3.1	2.7	3.2
Group 4	5014	1153	3861	11810	3202	8608	8.4	10.2	8.0
Group 5	21956	4529	17427	25997	5923	20074	37.0	40.0	36.3

Medium urbanization
Group 1	4262	754	3508	7400	1448	5952	11.8	11.6	11.9
Group 2	8083	1163	6920	11086	2022	9064	22.5	17.9	23.5
Group 3	1418	271	1147	6904	1469	5435	3.9	4.2	3.9
Group 4	2738	449	2289	6632	1403	5229	7.6	6.9	7.8
Group 5	13061	2287	10774	14814	2849	11965	36.3	35.2	36.5

Low urbanization
Group 1	2892	134	2758	4108	303	3805	15.0	10.4	15.4
Group 2	3981	353	3628	4777	443	4334	20.7	27.3	20;2
Group 3	974	40	934	2876	274	2602	5.1	3.1	5.2
Group 4	1312	85	1227	2306	190	2116	6.8	6.6	6.8
Group 5	7254	561	6693	7784	636	7148	37.7	43.4	37.3

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] E-mail: marianatarricone@gmail.com