Race inequalities in maternal mortality in the city of Rio de Janeiro, Brazil: 2010-2019

Alves, Lúcio Gomes Rodrigues; Guimarães, Raphael Mendonça

doi:10.1590/1806-9282.67.01.20200633

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Original Article • Rev. Assoc. Med. Bras. 67 (1) • Jan 2021 • https://doi.org/10.1590/1806-9282.67.01.20200633 copy

Race inequalities in maternal mortality in the city of Rio de Janeiro, Brazil: 2010-2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

To analyze the behavior of maternal mortality according to the race/color variable in the city of Rio de Janeiro, Brazil, between 2010 and 2019.

METHODS:

This is a cross-sectional study that used microdata collected in the Sistema de Informações sobre Mortalidade and Sistema de Informações sobre Nascidos Vivos. Data were disaggregated by race/color and age groups of childbearing age. Pearson's χ²2. Anachebe NF. Racial and ethnic disparities in infant and maternal mortality. Ethn Dis. 2006;16(2suppl3):S3-71-6. PMID: 16774028 test was used to compare the ratio in each category of covariates. In order to explore the differences in the maternal mortality ratio of the respective variables, the data were adjusted using Poisson's model. Polynomial regression models were tested to describe the trend.

RESULTS:

There were 732 maternal deaths in the city of Rio de Janeiro between 2010 and 2019. The time trend analysis of general maternal mortality showed a significant decline between 2010 and 2018 followed by a new upward trend in 2019. There was a greater maternal mortality ratio for older age groups, especially for women over 40 (prevalence ratio of 18.80, 95%CI 13.54–26.78; p<0.0001) and black ones (prevalence ratio of 2.31, 95%CI 1.90–2.80; p<0.0001).

CONCLUSION:

There is evidence that maternal mortality is associated with issues of race, which suggests the racial disparity in obstetric care in the city of Rio de Janeiro.

KEYWORDS:
Maternal mortality; Primary healthcare; Healthcare disparities; Racism

		Gross model			Adjusted model
		PR	95%CI	p-value	PR	95%CI	p-value
Age group (years)
	15 to 19	1	[-]	[-]	1	[-]	[-]
	20 to 39	2.62	1.92-3.66	<0.001	2.78	2.04-3.90	<0.001
	40 and more	18.8	13.54-26.78	<0.001	20.62	14.83-29.43	<0.001
Race
	White	1	[-]	[-]	1	[-]	[-]
	Brown	1.11	0.95-1.29	0.078	1.28	1.10-1.51	0.001
	Black	2.31	1.90-2.80	<0.001	2.64	2.18-3.20	<0.001

		Equation	R²2. Anachebe NF. Racial and ethnic disparities in infant and maternal mortality. Ethn Dis. 2006;16(2suppl3):S3-71-6. PMID: 16774028	p-value	Trend	Significance
Race
	White	y=-0.21x2+3.10x+53.29	0.03	0.888	Increase with subsequent decline	NS
	Brown	y=0.67x2-7.97x+155.99	0.09	0.742	Decline with subsequent growth	NS
	Black	y=0.44 x2-4.93x+88.18	0.12	0.667	Decline with subsequent growth	NS
Age group (years)
	15 to 19	y=1.23x2-13.02x+97.08	0.15	0.616	Decline with subsequent growth	NS
	20 to 39	y=-0.12x2+2.2x+64.93	0.08	0.759	Increase with subsequent decline	NS
	40 and more	y=5.86x2-88.74x+469.45	0.48	0.129	Decline with subsequent growth	NS
	Total	y=0.30x2-3.42x+84.38	0.09	0.764	Decline with subsequent growth	NS

Year	Race
	White				Black				Brown				Total
	MMR	RR	95%CI		MMR	RR	95%CI		MMR	RR	95%CI		MMR	RR	95%CI
	MMR	RR	LL	UL	MMR	RR	LL	UL	MMR	RR	LL	UL	MMR	RR	LL	UL
2010	63.86	1.00	[-]	[-]	172.92	1.00	[-]	[-]	85.76	1.00	[-]	[-]	89.31	1.00	[-]	[-]
2011	40.28	0.63	0.56	0.71	123.51	0.71	0.66	0.77	84.32	0.98	0.92	1.05	69.58	0.78	0.74	0.81
2012	60.47	0.95	0.83	1.06	137.11	0.79	0.74	0.85	65.92	0.77	0.72	0.82	70.46	0.79	0.75	0.82
2013	79.60	1.25	1.10	1.40	106.95	0.62	0.57	0.66	68.96	0.80	0.75	0.86	77.23	0.86	0.83	0.90
2014	61.17	0.96	0.84	1.07	130.02	0.75	0.70	0.81	87.40	1.02	0.95	1.08	80.98	0.91	0.87	0.95
2015	70.00	1.10	0.96	1.23	146.28	0.85	0.79	0.91	71.61	0.84	0.78	0.89	75.55	0.85	0.81	0.88
2016	49.61	0.78	0.68	0.87	146.86	0.85	0.79	0.91	85.24	0.99	0.93	1.06	77.56	0.87	0.83	0.91
2017	81.51	1.28	1.12	1.43	145.42	0.84	0.78	0.90	74.35	0.87	0.81	0.92	82.25	0.92	0.88	0.96
2018	39.17	0.61	0.54	0.69	146.00	0.84	0.78	0.90	64.94	0.76	0.71	0.81	63.31	0.71	0.68	0.74
2019	75.98	1.19	1.05	1.33	124.98	0.72	0.67	0.77	90.24	1.05	0.99	1.12	87.02	0.97	0.93	1.02
2010	100.68	1.00			71.20	1.00			434.31	1.00			89.31	1.00
2011	55.08	0.55	0.46	0.63	66.52	0.93	0.87	1.00	204.01	0.47	0.38	0.56	69.58	0.78	0.74	0.81
2012	46.27	0.46	0.39	0.53	63.24	0.89	0.83	0.95	379.51	0.87	0.70	1.04	70.46	0.79	0.75	0.82
2013	80.09	0.80	0.67	0.92	74.12	1.04	0.97	1.12	127.59	0.29	0.24	0.35	77.23	0.86	0.83	0.90
2014	81.84	0.81	0.69	0.94	78.67	1.10	1.03	1.18	90.44	0.21	0.17	0.25	80.98	0.91	0.87	0.95
2015	96.81	0.96	0.81	1.11	62.28	0.87	0.81	0.94	311.35	0.72	0.58	0.86	75.55	0.85	0.81	0.88
2016	30.98	0.31	0.26	0.36	85.68	1.20	1.12	1.29	87.29	0.20	0.16	0.24	77.56	0.87	0.83	0.91
2017	55.09	0.55	0.46	0.63	84.80	1.19	1.11	1.28	134.08	0.31	0.25	0.37	82.25	0.92	0.88	0.96
2018	78.80	0.78	0.66	0.90	56.93	0.80	0.74	0.86	127.78	0.29	0.24	0.35	63.31	0.71	0.68	0.74
2019	100.07	0.99	0.84	1.15	80.93	1.14	1.06	1.22	173.87	0.40	0.32	0.48	87.02	0.97	0.93	1.02

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[1] Corresponding author: raphael.guimaraes@fiocruz.br