Marques Lays Janaina Prazeres, Silva Zilda Pereira da, Alencar Gizelton Pereira, Almeida Marcia Furquim de
Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.
Cad Saude Publica. 2021 Mar 12;37(2):e00079120. doi: 10.1590/0102-311X00079120. eCollection 2021.
This study aimed to analyze the time trend in stillbirth rate (SBR) and the contribution by investigation to improving the definition of underlying cause of stillbirth in the city of São Paulo, Brazil, according to the place where the death certificate was issued. An ecological approach was used to analyze the trend in SBR by weight stratum (< 2,500g and ≥ 2,500g) and total deaths in the city in 2007-2017. Prais-Winsten generalized linear regression was used. The study of cases analyzed the underlying causes of stillbirth from 2012 to 2014, before and after the investigation, time of conclusion of the investigation, and redefinition of the underlying cause of stillbirths by type of issuer. In deaths with < 2,500g, there was an upward trend in SBR of 1.5% per year and a reduction (-1.3% per year) in stillbirths ≥ 2,500g. Total deaths presented a stable trend. In 2012-2014, 90% of deaths with ≥ 2,500g were investigated. After investigation, the underlying cause of death was redefined in 15% of the deaths, and not otherwise specified stillbirth (P95) represented 25% of the causes of death. The highest proportion of changes in the underlying cause of death occurred in deaths for which the death certificate was issued by the death certification review service (17%), while in health services the proportion was 10.6%. In conclusion, the SBR in deaths with ≥ 2,500g showed a downward trend. There was a significant redefinition of underlying causes, especially in those attested by the death certification review service. However, the redefinition was insufficient to expand the proportion of causes of death that would allow a better understanding of the mortality conditions.
本研究旨在根据死亡证明签发地，分析巴西圣保罗市死胎率（SBR）的时间趋势以及调查对改善死胎根本原因定义的贡献。采用生态方法按体重分层（<2500克和≥2500克）和2007 - 2017年该市的总死亡人数分析SBR趋势。使用了Prais-Winsten广义线性回归。病例研究分析了2012年至2014年调查前后死胎的根本原因、调查结束时间以及按签发人类型对死胎根本原因的重新定义。在体重<2500克的死亡中，SBR每年上升1.5%，而体重≥2500克的死胎则有所下降（每年-1.3%）。总死亡人数呈现稳定趋势。在2012 - 2014年，90%体重≥2500克的死亡进行了调查。调查后，15%的死亡重新定义了根本死因，未另作说明的死胎（P95）占死因的25%。死亡根本原因变化比例最高的是由死亡证明审查服务机构签发死亡证明的死亡（17%），而在卫生服务机构签发的死亡中这一比例为10.6%。总之，体重≥2500克的死亡中的SBR呈下降趋势。根本原因有显著重新定义，尤其是在由死亡证明审查服务机构证明的那些情况中。然而，这种重新定义不足以扩大能够更好理解死亡状况的死因比例。
