巴西新冠肺炎疫情下孕产妇死亡的空间聚集、健康的社会决定因素及风险：一项基于全国人口的生态学研究
Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study.
作者信息
Siqueira Thayane Santos, Silva José Rodrigo Santos, Souza Mariana do Rosário, Leite Débora Cristina Fontes, Edwards Thomas, Martins-Filho Paulo Ricardo, Gurgel Ricardo Queiroz, Santos Victor Santana
机构信息
Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil.
Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil.
出版信息
Lancet Reg Health Am. 2021 Nov;3:100076. doi: 10.1016/j.lana.2021.100076. Epub 2021 Sep 10.
BACKGROUND
Detailed information on how socio-economic characteristics are related to COVID-19 incident cases and maternal deaths is needed. We investigated the spatial distribution of COVID-19 cases and maternal deaths in Brazil and their association with social determinants of health.
METHODS
This was a population-based ecological study with a spatial analysis of all cases and deaths of COVID-19 in the obstetric population. Data on COVID-19 cases and deaths in the obstetric population, social vulnerability, health inequities, and health system capacity at the municipal level were obtained from several publicly sources in Brazil. A Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial statistic tests were used to identity the spatial clusters and measure the municipalities' risk of COVID-19 in the obstetric population. Beta regression was used to characterise the association between socio-economic indicators and the burden of COVID-19.
FINDINGS
A total of 13,858 cases and 1,396 deaths due to COVID-19 were recorded in Brazil from March 2020 to June 2021. There was a variation in the number of cases per municipality, with 105 municipalities with rates from 2,210 to 3,884 cases and 45 municipalities with rates from 3,884 to 7,418 cases per 100,000 live births. The maternal mortality ratio also varied widely across municipalities. There was a spatial dependence on smoothed maternal mortality rates (I Moran 0•10; P = 0•010), and 15 municipalities had higher risk of maternal deaths. Municipalities characterized by lower health resources and higher socioeconomic inequalities presented the highest rates of incidence and maternal mortality by COVID-19.
INTERPRETATION
In Brazil, COVID-19 cases and deaths in the obstetric population had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside. Municipalities with a high degree of socioeconomic dissimilarities showed higher maternal mortality rates than areas with better social and infrastructure indicators.
FUNDING
None.
背景
需要详细了解社会经济特征与新冠病毒感染病例及孕产妇死亡之间的关系。我们调查了巴西新冠病毒感染病例和孕产妇死亡的空间分布及其与健康社会决定因素的关联。
方法
这是一项基于人群的生态学研究，对产科人群中所有新冠病毒感染病例和死亡进行空间分析。产科人群中新冠病毒感染病例和死亡、社会脆弱性、健康不平等以及市级卫生系统能力的数据来自巴西的多个公开来源。使用贝叶斯经验局部模型来识别指标的波动。空间统计检验用于识别空间聚集并衡量产科人群中各市的新冠病毒感染风险。使用β回归来描述社会经济指标与新冠病毒感染负担之间的关联。
结果
2020年3月至2021年6月期间，巴西共记录了13858例新冠病毒感染病例和1396例死亡。各市的病例数存在差异，每10万例活产中有105个市的发病率在2210至3884例之间，45个市的发病率在3884至7418例之间。孕产妇死亡率在各市之间也有很大差异。平滑后的孕产妇死亡率存在空间依赖性（I莫兰指数0.10；P = 0.010），有15个市的孕产妇死亡风险较高。卫生资源较少且社会经济不平等程度较高的市，新冠病毒感染的发病率和孕产妇死亡率最高。
解读
在巴西，产科人群中的新冠病毒感染病例和死亡呈现出异质性的地理分布，明确的空间聚集大多位于农村地区。社会经济差异程度高的市的孕产妇死亡率高于社会和基础设施指标较好的地区。
资金来源
无。
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