Spatial distribution of fetal mortality and correlation with indicators on women’s health and vulnerability in São Paulo city, Brazil

Abstract

Objectives:  to analyze the spatial distribution for stillbirth and spatial association with women’s health and social vulnerability indicators in the city of São Paulo, Brazil.

Methods:  ecological study of administrative districts of the city of Sao Paulo, from 2014 to 2021. The outcome is the stillbirth rate, and covariates are mother’s age, inadequate prenatal care, the Paulistan Social Vulnerability Index (PSVI), women in childbearing age, mortality rate and birth rate. Exploratory spatial analyses included crude and Bayesian stillbirth rates. Spatial autocorrelation was tested using t Moran’s index and Geary’s coefficients. Local Indicator of Spatial Association and Moran scatterplot were used to identify the risk areas. The Lee coefficient was used to correlate the indicators with stillbirth.

Results:  a total of 39 low-risk clusters were identified in the central region, while 40 high-risk clusters were identified, primarily in the eastern region (p<0.05). Higher social vulnerability, higher proportions of adolescent mothers, and higher mortality rates among women of childbearing age were significantly correlated with higher stillbirth rates (p<0.05).

Conclusions:  the analysis identified the areas where higher social vulnerability, higher proportions of adolescent mothers and higher mortality rates of women of reproductive age are correlated with higher stillbirth rates.

Key words:
Spatial analysis; Fetal mortality; Social vulnerability; Correlation of data