École de Santé Publique de l'Université de Montréal, student affiliated to the Centre de Recherche en Santé Publique (CReSP), 7101, Park Avenue, 3rd floor, Montreal (Québec) H3N, 1X9, Canada.
CAPES Foundation scholar (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Ministry of Education of Brazil, Science without Borders Program, proc. 12940/13-5), Brasilia, DF, 700040-020, Brazil.
BMC Public Health. 2021 Apr 30;21(1):831. doi: 10.1186/s12889-021-10903-9.
Despite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies. The objective of this article is to propose a methodological approach aiming at identifying the determinants of infant mortality in Brazil after the implementation of those policies.
A series of multilevel panel data with fixed effect nested within-clusters were conducted supported by the concept of health capabilities based on data from 26 Brazilian states between 2004 and 2015. The dependent variables were the neonatal, the infant and the under-five mortality rates. The independent variables were the employment rate, per capita income, Bolsa Família Program coverage, the fertility rate, educational attainment, the number of live births by prenatal visits, the number of health professionals per thousand inhabitants, and the access to water supply and sewage services. We also used different time lags of employment rate to identify the impact of employment on the infant mortality rates over time, and household income stratified by minimum wages to analyze their effects on these rates.
The results showed that in addition to variables associated with infant mortality in previous studies, such as Bolsa Família Program, per capita income and fertility rate, other factors affect child mortality. Educational attainment, quality of prenatal care and access to health professionals are also elements impacting infant deaths. The results also identified an association between employment rate and different infant mortality rates, with employment impacting neonatal mortality up to 3 years and that a family income below 2 minimum wages increases the odds of infant deaths.
The results proved that the methodology proposed allowed the use of variables based on aggregated data that could hardly be used by other methodologies.
尽管实施了一系列社会和卫生政策，巴西的婴儿死亡率下降速度仍然放缓，存在地区差异且死亡率仍然居高不下，这引发了对这些政策实施后婴儿死亡率决定因素的质疑。本文的目的是提出一种方法学方法，旨在确定巴西在实施这些政策后婴儿死亡率的决定因素。
本研究使用了一系列基于巴西 26 个州 2004 年至 2015 年数据的多水平面板数据，这些数据具有固定效应嵌套在聚类内，并基于健康能力的概念。因变量是新生儿、婴儿和五岁以下儿童死亡率。自变量是就业率、人均收入、Bolsa Família 计划覆盖率、生育率、教育程度、产前检查的活产数、每千居民的卫生专业人员数以及供水和污水处理服务的获得情况。我们还使用了不同的就业率时滞来确定就业率随时间变化对婴儿死亡率的影响，并按最低工资划分家庭收入来分析其对这些比率的影响。
结果表明，除了与先前研究中与婴儿死亡率相关的变量（如 Bolsa Família 计划、人均收入和生育率）外，其他因素也会影响儿童死亡率。教育程度、产前保健质量和获得卫生专业人员的机会也是影响婴儿死亡的因素。结果还表明就业率与不同婴儿死亡率之间存在关联，就业率对新生儿死亡率的影响可达 3 年，家庭收入低于 2 个最低工资标准会增加婴儿死亡的几率。
结果证明，所提出的方法学允许使用基于聚合数据的变量，而其他方法很难使用这些变量。
