Universidade Estadual do Piauí, Curso de Enfermagem, Parnaíba, PI, Brazil.
Secretaria da Saúde do Estado do Ceará, Fortaleza, CE, Brazil.
Epidemiol Serv Saude. 2023 Oct 30;32(3):e2022973. doi: 10.1590/S2237-96222023000300009.EN. eCollection 2023.
To analyze the spatio-temporal pattern of maternal mortality and associated factors in Northeast Brazil, from 2009 to 2019.
This was an ecological study using the joinpoint method for temporal analysis and spatial autocorrelation and scan tests to identify clusters; regression models using the ordinary least squares and geographically weighted regression methods were used to identify factors associated with mortality, considering p-value < 0.05.
Maternal mortality decreased by 1.5% (95%CI; -2.5;-0.5) per year (p-value = 0.009); clusters, of deaths were found, mainly in Piauí and Maranhão, the variables associated with the maternal mortality ratio were Gini Index (β = 105.72; p-value < 0.001), municipal human development index (β = 190.91; p-value = 0.001), per capita income (β = -0.08; p-value = 0.001), Firjan Municipal Development Index-Health (β = -51.28; p-value < 0.001), life expectancy at birth (β = -3.50; p-value < 0.001).
There was a reduction in mortality in the period studied, with a concentration of deaths, primarily in Piauí and Maranhão; socioeconomic indicators were associated with higher mortality in the region.
There was a decrease in maternal mortality in Northeast Brazil, from 2009 to 2019. Deaths were mainly concentrated in the states of Piauí and Maranhão. Five socioeconomic indicators were associated with higher mortality in the region.
In order to maintain the trend of falling maternal mortality in Northeast Brazil, the need exists to reduce social inequalities and expand access to health services, especially within the scope of Primary Care.
Public policies are needed to expand health services in general as well as comprehensive women's health care in the Brazilian National Health System, especially for women living in contexts of greater social vulnerability.
分析 2009 年至 2019 年巴西东北部产妇死亡率的时空模式及相关因素。
本研究为生态研究，采用时间分析的 Joinpoint 方法和空间自相关和扫描检验来识别聚类；采用普通最小二乘法和地理加权回归模型来识别与死亡率相关的因素，考虑到 p 值 < 0.05。
产妇死亡率每年下降 1.5%（95%CI；-2.5；-0.5）（p 值 = 0.009）；发现了死亡聚类，主要集中在皮奥伊州和马拉尼昂州，与产妇死亡率比相关的变量包括基尼指数（β = 105.72；p 值 < 0.001）、市级人类发展指数（β = 190.91；p 值 = 0.001）、人均收入（β = -0.08；p 值 = 0.001）、Firjan 市级发展指数-卫生（β = -51.28；p 值 < 0.001）、出生时预期寿命（β = -3.50；p 值 < 0.001）。
在所研究的时期内，死亡率有所下降，死亡主要集中在皮奥伊州和马拉尼昂州；社会经济指标与该地区较高的死亡率相关。
2009 年至 2019 年期间，巴西东北部的产妇死亡率有所下降。死亡主要集中在皮奥伊州和马拉尼昂州。有 5 个社会经济指标与该地区较高的死亡率相关。
为了保持巴西东北部产妇死亡率下降的趋势，需要减少社会不平等，并扩大卫生服务的获取，特别是在初级保健范围内。
需要制定公共政策，以扩大卫生服务和巴西国家卫生系统中妇女全面健康护理，特别是为生活在社会弱势环境中的妇女提供服务。
