巴西医院分娩的地理可达性（2010 - 2011年和2018 - 2019年）：一项横断面研究。
Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study.
作者信息
Albuquerque Priscila Costa, Felipe Lucas Lopes, Lopes Juliana Freitas, Tassinari Wagner de Souza, Zicker Fabio, Fonseca Bruna de Paula
机构信息
Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Av. Brasil 4036, Rio de Janeiro, 21040-361, RJ, Brazil.
Post Graduation Program in Informatics (PPGI), Department of Computer Science, Federal University of Rio de Janeiro (UFRJ), Av. Athos da Silveira Ramos 274, Cidade Universitária, Rio de Janeiro, 21941-916, RJ, Brazil.
出版信息
Lancet Reg Health Am. 2024 Dec 27;42:100976. doi: 10.1016/j.lana.2024.100976. eCollection 2025 Feb.
BACKGROUND
Delays in obstetric care are associated with adverse maternal outcomes, while long-distance travel for delivery is associated with high neonatal mortality and increased maternal morbidity. Distance and travel time are key components of geographic accessibility to health services and important risk indicators for maternal and neonatal care. This study evaluated whether the Brazilian Unified Health System (SUS) has been geographically accessible in providing hospital childbirth services, over time.
METHODS
Geographic accessibility to hospital deliveries in Brazil was mapped over two biennia (2010-2011 and 2018-2019), spanning a 10-year period, using national aggregated data from SUS Hospital Admissions Authorizations. Travel flows, distances, and times between women's municipalities of residence and hospitals were estimated.
FINDINGS
A total of 6,930,944 hospital deliveries were analyzed. Overall, 25.4% (n = 1,759,306) of pregnant women traveled outside their municipalities to give birth in SUS hospitals, increasing from 23.6% (n = 843,501) in 2010-2011 to 27.3% (n = 915,805) in 2018-2019. Distance and travel time rose by 31.1% (54.0 km-70.8 km) and 33.6% (63.1-84.3 min), respectively. Women experiencing maternal and/or neonatal death traveled longer distances and times. Regional disparities were evident: the Northeast had the highest proportion of women traveling (35.6%; n = 817,499), and the North had the lowest (16.0%; n = 138,295). Women in the North faced the longest travel distances (97.5-133.4 km) and times (1,012-1,850 min), while those in the Southeast and South experienced the shortest distances (37.2-55.9 km and 41.2-54.8 km, respectively) and times (38-52 min and 41-52 min).
INTERPRETATION
The results highlight regional disparities in maternal health service access within the SUS, which may affect maternal and neonatal outcomes. Targeted public health measures are needed to improve the availability of service, particularly in the North and Northeast regions, where access issues are most severe.
FUNDING
Fundação Oswaldo Cruz; CNPq; FAPERJ.
背景
产科护理延误与不良孕产妇结局相关，而长途跋涉去分娩则与高新生儿死亡率及孕产妇发病率增加相关。距离和旅行时间是卫生服务地理可及性的关键组成部分，也是孕产妇和新生儿护理的重要风险指标。本研究评估了随着时间推移，巴西统一卫生系统（SUS）在提供医院分娩服务方面在地理上是否可及。
方法
利用SUS医院入院授权的全国汇总数据，绘制了巴西两个两年期（2010 - 2011年和2018 - 2019年）共10年期间医院分娩的地理可及性情况。估算了女性居住市镇与医院之间的人流、距离和时间。
结果
共分析了6930944例医院分娩。总体而言，25.4%（n = 1759306）的孕妇前往市镇以外的SUS医院分娩，这一比例从2010 - 2011年的23.6%（n = 843501）增至2018 - 2019年的27.3%（n = 915805）。距离和旅行时间分别增加了31.1%（从54.0公里增至70.8公里）和33.6%（从63.1分钟增至84.3分钟）。经历孕产妇和/或新生儿死亡的女性旅行距离更长、时间更久。地区差异明显：东北部外出分娩的女性比例最高（35.6%；n = 817499），北部最低（16.0%；n = 138295）。北部的女性面临最长的旅行距离（97.5 - 133.4公里）和时间（1012 - 1850分钟），而东南部和南部的女性经历的距离最短（分别为37.2 - 55.9公里和41.2 - 54.8公里）和时间最短（分别为38 - 52分钟和41 - 52分钟）。
解读
结果凸显了SUS内部孕产妇卫生服务可及性的地区差异，这可能影响孕产妇和新生儿结局。需要采取有针对性的公共卫生措施来改善服务可及性，尤其是在可及性问题最为严重的北部和东北部地区。
资金来源
奥斯瓦尔多·克鲁兹基金会；国家科学技术发展委员会；里约热内卢州研究资助基金会。
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