Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.
Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Int J Epidemiol. 2019 Apr 1;48(Suppl 1):i16-i25. doi: 10.1093/ije/dyy169.
Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span.
Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated.
From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time-more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time.
In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location.
巴西在过去几十年中在母婴健康方面取得了重要进展。我们旨在描述 33 年来生殖史指标(生育间隔、先前不良围产期结局、产次和多胎)的时间趋势以及社会经济和种族不平等。
四项基于人群的出生队列研究纳入了 1982 年、1993 年、2004 年和 2015 年在巴西南里奥格兰德州佩洛塔斯所有医院分娩的产妇。通过访谈收集生殖史信息。指标按家庭收入五分位数和肤色分层。计算了不平等的绝对和相对措施。
从 1982 年到 2015 年,初产妇的比例从 39.2%增加到 49.6%,中位生育间隔增加了 23.2 个月。贫穷的妇女更有可能报告间隔时间短和产次高,尽管所有收入和种族群体都有所减少。先前低出生体重的历史与收入呈负相关,并且随着时间的推移增加了 7.7 个百分点(pp)-在最富有的(12.1 pp)比最贫穷的五分位数(0.4 pp)增加更快。多胎从 1.7%增加到 2.7%,其中最富有的五分位数和白人妇女的增幅最大(分别增加 220%和 70%)。短生育间隔的绝对和相对收入和种族相关不平等增加,而先前低出生体重的不平等随着时间的推移而减少。
在这 33 年期间,生育间隔、多胎和先前低出生体重婴儿的报告有所增加。这些趋势分别可以用计划生育覆盖率增加、辅助生殖和早产率上升来解释。我们的研究结果表明,同一地点的健康的社会经济和种族不平等是动态的,随时间而变化。