Arruda Camila Lehmkuhl de, Ferreira D'Agostini Marin Daniela, Depieri Michels Bruna, Martins Rosa Vanessa, Iser Betine Pinto Moehlecke
Psychologist and Medical Doctor, University of Southern Santa Catarina, Tubarão, Brazil.
Obstetrics and Gynaecology Specialist, Master in Health Sciences, Teacher at Medicine School, University of Southern Santa Catarina, Tubarão, Brazil.
J Obstet Gynaecol. 2022 Oct;42(7):2715-2721. doi: 10.1080/01443615.2022.2099737. Epub 2022 Jul 28.
This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age ( < .001) and inversely related to schooling ( < .001) and predominated in non-white women ( < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation.Impact Statement The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births. This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years. Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.
本研究对巴西南部的孕产妇死亡率进行了特征描述，并验证了其在2000年至2018年期间的趋势。这是一项生态时间序列研究，分析了统一卫生系统信息部的二手数据。使用广义线性回归计算孕产妇死亡率（MMR）的趋势，并根据女性特征计算比率，置信区间（CI）为95%。巴西南部地区的MMR从2000年的每10万例活产53.4例死亡降至2018年的36.8例死亡，每年下降趋势为1.2个百分点。死亡率与年龄增长直接相关（<0.001），与受教育程度呈负相关（<0.001），在非白人女性中占主导地位（<0.001）。主要死亡原因是直接原因，包括高血压疾病。尽管巴西南部的孕产妇死亡率呈下降趋势，但观察到的MMR一直高于世界卫生组织的建议值。影响声明孕产妇死亡率（MMR）是一个指标，可用于分析女性健康状况与其所在地区的社会经济和护理特征之间的关系。2000年至2015年期间，巴西的MMR一直很高，每10万例活产约有50例死亡，而世界卫生组织认为每10万例活产少于20例死亡的MMR才较为合理。本研究更新了巴西南部地区MMR的数据，该地区是巴西MMR最低的地区，但各州之间的数值存在差异。2000年至2018年期间，巴西南部的MMR有所下降，但30岁以上以及处于社会弱势群体（如低收入和非白人女性）中的女性死亡率较高。圣卡塔琳娜州在此期间数值稳定，且多年来一直低于其他州的MMR平均水平。在区域背景下比较以前和当前的孕产妇死亡率对于调整针对受影响最严重人群的公共卫生政策很重要。孕产妇死亡对于单身和低收入女性来说仍然是现实，她们在获得医疗保健方面困难更大。统一卫生系统需要采取策略来解决这个问题。
