Health inequalities in Brazil: proposed prioritization to achieve the Sustainable Development Goals

Miranda, Wanessa Debôrtoli de; Silva, Gabriela Drummond Marques da; Fernandes, Luísa da Matta Machado; Silveira, Fabrício; Sousa, Rômulo Paes de

doi:10.1590/0102-311XPT119022

person Wanessa Debôrtoli de Miranda

developed the study project · data analysis · interpretation · article writing · approved the final version to be published · is responsible for all aspects of the study, also ensuring its accuracy and integrity

school Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.

0000-0002-0838-9861

person Gabriela Drummond Marques da Silva

data analysis · interpretation · article writing · approved the final version to be published · is responsible for all aspects of the study, also ensuring its accuracy and integrity

school Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

0000-0002-1145-3940

person Luísa da Matta Machado Fernandes

data analysis · interpretation · article writing · approved the final version to be published · is responsible for all aspects of the study, also ensuring its accuracy and integrity

school Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

0000-0002-5440-7928

person Fabrício Silveira

data analysis · interpretation · article writing · approved the final version to be published · is responsible for all aspects of the study, also ensuring its accuracy and integrity

school Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

0000-0003-1240-3942

person Rômulo Paes de Sousa

data analysis · interpretation · article writing · approved the final version to be published · is responsible for all aspects of the study, also ensuring its accuracy and integrity

school Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

0000-0002-3384-6657

personCorrespondence W. D. Miranda Departamento de Gestão em Saúde, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brasil.
wanessa.debortoli@hotmail.com

groupsContributors

W. D. Miranda developed the study project, performed data analysis and interpretation and article writing, approved the final version to be published, and is responsible for all aspects of the study, also ensuring its accuracy and integrity. G. D. M. Silva performed data analysis and interpretation and article writing, approved the final version to be published, and is responsible for all aspects of the study, also ensuring its accuracy and integrity. L. M. M. Fernandes performed data analysis and interpretation and article writing, approved the final version to be published, and is responsible for all aspects of the study, ensuring its accuracy and integrity. F. Silveira performed data analysis and interpretation and article writing, approved the final version to be published, and is responsible for all aspects of the study, ensuring its accuracy and integrity. R. P. Sousa performed data analysis and interpretation and article revision, approved the final version to be published, and is responsible for all aspects of the study, ensuring its accuracy and integrity.

Additional information

ORCID: Wanessa Debôrtoli de Miranda (0000-0002-0838-9861); Gabriela Drummond Marques da Silva (0000-0002-1145-3940); Luísa da Matta Machado Fernandes (0000-0002-5440-7928); Fabrício Silveira (0000-0003-1240-3942); Rômulo Paes de Sousa (0000-0002-3384-6657).

Theme/Indicator	Numerator	Denominator	Source	Weighted average (2015-2019)		Annual median
Theme/Indicator	Numerator	Denominator	Source	Minimum	Maximum	2015	2020
(1) Reproductive and maternal health
Maternal mortality ratio/100,000 live births	Maternal deaths by municipality and year of death	Live births by the mother's place of residence	DATASUS ⁵⁰	0.0	135.9	55.7	65.4
Births in health facilities (%)	Live births in the place of occurrence: hospital or other health facility	Live births by the mother’s place of residence	DATASUS ⁵¹	74.2	100.0	99.7	99.5
Teen birth rate/1,000 women	Live births of women aged 10 to 19 years	Number of women aged 10 to 19 years	DATASUS ⁵¹	16.2	82.8	33.5	26.8
(2) Newborn and child health
Prevalence of stunting (%)	Number of children under 5 years of age with low and very low height and weight for their age, as indicated in SISVAN	Total number of children under 5 years of age monitored by SISVAN	Secretary of Primary Health Care, Brazilian Ministry of Health ⁵²	5.2	31.6	11.0	11.3
Prevalence of malnutrition (%)	Number of thin and significantly thin children under 5 years of age, as indicated in SISVAN	Total number of children under 5 years of age monitored at SISVAN	Secretary of Primary Health Care, Brazilian Ministry of Health ⁵²	1.5	9.5	4.8	4.9
Mortality under 5 years of age/1,000 live births	Deaths of children under 5 years of age	Live births by the mother’s place of residence	DATASUS ⁵³	8.1	32.1	14.3	13.0
Neonatal mortality/1,000 live births	Deaths of infants from 0 to 27 days old	Live births by the mother’s place of residence	DATASUS ⁵⁴	4.1	16.6	8.8	8.1
Vaccination coverage (%)	Total number of children under 5 years of age who had access to age-related vaccines	Total number of children under 5 years of age	DATASUS ⁵⁵	0.0	90.6	92.7	75.1
(3) Infectious diseases
New HIV infections/100,000 inhabitants	AIDS cases by year of diagnosis and municipality of residence	Population of the municipality	Department of Diseases, Chronic Conditions and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health ⁵⁶	0.0	55.2	12.1	9.0
Incidence of tuberculosis/100,000 inhabitants	Confirmed cases by municipality of residence and year of diagnosis	Population of the municipality	DATASUS ⁵⁷	5.6	143.0	22.4	21.1
Hepatitis B/100,000 inhabitants	Confirmed cases of hepatitis B	Population of the municipality	DATASUS ⁵⁸	0.0	67.9	2.9	1.1
(4) Noncommunicacle diseases
Premature mortality from chronic diseases/100,000 inhabitants	Number of deaths (people aged from 30 to 69 years) due to CNCDs recorded as ICD-10 codes: I00-I99; C00-C97; J30-J98; E10-E14 - in a certain place/year	Population (aged 30 to 69 years) living in a certain place/year	DATASUS ⁵³	107.8	474.5	290.0	287.6
Suicide mortality/100,000 inhabitants	Number of deaths recorded as ICD-10 codes: X60-X84 and Y87.0	Population of the municipality	DATASUS ⁵³	0.0	18.9	5.8	7.4
(5) Injuries and violence
People directly affected by disasters/100,000 inhabitants	Number of deaths, missing people, and people directly affected by disasters	Population of the municipality	Brazilian Ministry of Integration and Regional Development ⁵⁹	0.0	1598.9	0.0	45.3
Mortality from traffic accidents/100,000 inhabitants	Number of deaths from traffic accidents (ICD-10 codes: V01-V89) of residents in the municipality	Population of the municipality	DATASUS ⁶⁰	2.1	40.6	22.1	18.0
Women suffering intimate partner violence/1,000 women	Number of women aged 15 years or older who were victims of physical, sexual or psychological violence from current or former partner in the reporting year	Number of women aged 15 and older	DATASUS ⁶¹	0.0	90.8	4.9	6.1
Women suffering non-intimate partner violence/1,000 women	Number of women aged 15 years or older who were victims of physical, sexual or psychological violence from someone other than current or former partner in the reporting year	Number of women aged 15 and older	DATASUS ⁶¹	0.0	50.9	6.5	7.8
Mortality due to occupational accidents/100,000 inhabitants	Number of deaths due to occupational accidents in the municipality	Number of people living in the municipality	DATASUS ⁶⁰	0.0	10.5	1.7	1.6
Victims of sexual violence/10,000 inhabitants	Number of people aged 19 or under who were victims of sexual violence in the reporting year	People aged 19 years and younger	DATASUS ⁶²	0.0	75.4	2.1	3.1
(6) Environmental hazards
Mortality due to poor sanitation/100,000 inhabitants	Number of deaths from diarrhea (ICD-10 codes: A00, A01, A03, A04, A06-09), intestinal nematode infections (ICD-10 codes: B76-B77, B79), and protein-calorie malnutrition (ICD-10 codes: E40-E46)	Total population of the municipality	DATASUS ⁵³	0.0	27.8	5.3	3.9
Mortality due to accidental poisoning/100,000 inhabitants	Deaths from causes recorded as ICD-10 codes: X40, X43, X44, X46- X49	Total population of the municipality	DATASUS ⁵³	0.0	1.0	0.0	0.0
Schools with access to water for human consumption (%)	Number of basic and high schools with access to water for human consumption	Number of basic and high schools	Anísio Teixeira Brazilian National Institute of Educational Studies and Research ⁶³	29.7 *	100.0 *	-	98.1
(7) Universal health coverage and health systems
Primary care coverage (%)	Estimated number of people served by primary care	Total number of people in the municipality	Secretary of Primary Health Care, Brazilian Ministry of Health ⁶⁴	0.0	100.0	93.4	89.7
Coverage of live birth records (%)	Estimated number of live births notified at SINASC	Estimated number of live births in the municipality	IBGE ⁶⁵	89.6	100.0	98.2	-
(8) Other health-related inducators
Population covered by Brazilian Income Transfer Program(%)	Number of families covered by Brazilian Income Transfer Program	Estimated number of poor families - Demographic Census (IBGE/2010)	Secretariat for Evaluation, Information Management and Single Registry, Brazilian Ministry of Development and Social Assistance, Family and Fight against Hunger ⁶⁶	52.8	100.0	100.0	96.7

Region/States	Health Regions	Priorization interval		Minimum	Median	Mean	SD	Maximum
Region/States	Health Regions	Medium	Adequate
North	45	14	31	0.59	0.73	0.71	0.06	0.78
Rondônia	7	0	7	0.73	0.77	0.76	0.02	0.78
Acre	3	2	1	0.59	0.68	0.67	0.07	0.73
Amazonas	9	5	4	0.59	0.67	0.66	0.06	0.74
Roraima	2	2	0	0.66	0.66	0.66	0.00	0.66
Pará	13	5	8	0.59	0.72	0.71	0.05	0.76
Amapá	3	0	3	0.71	0.74	0.74	0.02	0.76
Tocantins	8	0	8	0.72	0.76	0.76	0.02	0.78
Northeast	133	1	132	0.67	0.79	0.79	0.03	0.88
Maranhão	19	1	18	0.67	0.75	0.75	0.03	0.78
Piauí	11	0	11	0.74	0.76	0.76	0.02	0.78
Ceará	22	0	22	0.76	0.80	0.80	0.02	0.83
Rio Grande do Norte	8	0	8	0.78	0.80	0.80	0.01	0.82
Paraíba	16	0	16	0.79	0.82	0.82	0.02	0.88
Pernambuco	12	0	12	0.75	0.78	0.78	0.02	0.83
Alagoas	10	0	10	0.78	0.79	0.79	0.01	0.81
Sergipe	7	0	7	0.76	0.79	0.79	0.02	0.81
Bahia	28	0	28	0.73	0.79	0.79	0.03	0.83
Southeast	165	1	164	0.70	0.80	0.80	0.03	0.86
Minas Gerais	89	0	89	0.72	0.80	0.80	0.03	0.86
Espírito Santo	4	0	4	0.77	0.79	0.78	0.01	0.79
Rio de Janeiro	9	1	8	0.70	0.77	0.76	0.03	0.79
São Paulo	63	0	63	0.72	0.81	0.81	0.02	0.86
South	68	0	68	0.71	0.77	0.77	0.03	0.83
Paraná	22	0	22	0.72	0.79	0.79	0.03	0.83
Santa Catarina	16	0	16	0.73	0.79	0.78	0.02	0.83
Rio Grande do Sul	30	0	30	0.71	0.76	0.76	0.02	0.81
Central-West	39	3	36	0.64	0.78	0.76	0.04	0.82
Mato Grosso do Sul	4	1	3	0.67	0.75	0.74	0.05	0.78
Mato Grosso	16	2	14	0.64	0.75	0.74	0.04	0.80
Goiás	18	0	18	0.75	0.79	0.79	0.02	0.82
Federal District	1	0	1	0.82	0.82	0.82	-	0.82

Theme/Indicator	Centra-West	Northeast	North	Southeast	South	Brazil	Ranking *
(1) Reproductive and maternal health
Maternal mortality ratio	0.61	0.58	0.55	0.66	0.77	0.63	3
Teen birth rate/1,000 women	0.69	0.72	0.56	0.87	0.85	0.79	10
Births in health facilities (%)	0.98	0.98	0.93	0.99	0.99	0.99	24
(2) Newborn and child health
Prevalence of malnutrition (%)	0.62	0.56	0.59	0.70	0.82	0.65	4
Neonatal mortality rate	0.66	0.60	0.58	0.73	0.79	0.69	6
Vaccination coverage	0.74	0.59	0.54	0.76	0.84	0.70	7
Mortality under 5 years of age	0.72	0.67	0.62	0.8	0.86	0.75	8
Prevalence of stunting (%)	0.75	0.70	0.55	0.84	0.85	0.77	9
(3) Infectious diseases
New HIV infections/1,000 inhabitants	0.78	0.85	0.79	0.82	0.71	0.81	11
Incidence of tuberculosis/100,000 inhabitants	0.91	0.86	0.83	0.90	0.88	0.88	16
Hepatitis B/100,000 inhabitants	0.90	0.98	0.91	0.96	0.87	0.96	21
(4) Noncommunicable diseases
Premature mortality from chronic diseases	0.55	0.56	0.69	0.45	0.37	0.50	1
Suicide mortality rate	0.63	0.72	0.68	0.66	0.45	0.66	5
(5) Injuries and violence
Mortality from traffic accidents	0.31	0.49	0.55	0.63	0.50	0.54	2
Mortality due to occupational accidents/100,000 inhabitants	0.71	0.92	0.76	0.84	0.68	0.84	13
Women suffering non-intimate partner violence	0.90	0.93	0.89	0.73	0.80	0.84	14
Women suffering intimate partner violence	0.96	0.98	0.95	0.88	0.92	0.94	20
Victims of sexual violence	0.97	0.98	0.94	0.96	0.94	0.97	22
People directly affected by disasters/100,000 inhabitants	1.00	0.99	0.97	1.00	0.99	1.00	25
(6) Environmental hazards
Mortality due to poor sanitation	0.87	0.81	0.90	0.86	0.90	0.86	15
Mortality due to accidental poisoning	0.90	0.92	0.89	0.91	0.92	0.91	19
Schools with access to water for human consumption (%)	0.96	0.95	0.78	1.00	0.93	0.97	23
(7) Universal coverage of health and health systems
Coverage of live birth records	0.88	0.84	0.77	0.93	0.98	0.90	17
Primary care coverage (%)	0.85	0.96	0.79	0.86	0.85	0.90	18
(8) Other health-related indicators
Population covered by Brazilian Income Transfer Program (%)	0.75	0.97	0.95	0.76	0.49	0.82	12

[TFN6] CNCDs: chronic noncommunicable diseases; DATASUS: Brazilian Health Informatics Department; IBGE: Brazilian Institute of Geography and Statistics; ICD-10: 10th revision of the International Classification of Diseases; SINASC: Brazilian Information System on Live Births; SISVAN: Brazilian Information System on Food and Nutrition Surveillance.

[TFN7] Source: developed by the authors.

[TFN8] * Includes 2019 data only.

Health inequalities in Brazil: proposed prioritization to achieve the Sustainable Development Goals

Abstracts