Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters

Nascimento, Thiago Luis Cardoso; Teixeira, Camila Silveira Silva; Anjos, Marília Santos dos; Menezes, Greice Maria de Souza; Costa, Maria da Conceição Nascimento; Natividade, Marcio Santos da

doi:10.1590/S1679-49742021000100003

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Original article • Epidemiol. Serv. Saúde 30 (1) • 2021 • https://doi.org/10.1590/S1679-49742021000100003 linkcopy

Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To identify socioeconomic and health care determinants of spatial variation in adolescent pregnancy in Brazil in 2014.

Methods This was a spatial ecological study having municipalities as units of analysis. Spatial linear regression was used to verify association between the fertility rate in 15-19 year-old women and socioeconomic and health variables.

Results The adolescent fertility rate was negatively associated with higher Family Health Strategy coverage (β = -0.011 – 95%CI -0.017;-0.005), an adequate number of prenatal consultations (β = -0.122 – 95%CI -0.132;-0.224) and low average family income per capita (β = -0.104 – 95%CI -0.105;-0.103). Association was positive in relation to the Gini index (β = 7.031 – 95%CI 4.793;9.269), low income (β = 0.127 – 95%CI 0.108;0.145), higher household density (β = 6.292 – 95%CI 5.062;7.522) and less schooling (β = 0.260 – 95%CI 0.224;0.295).

Conclusion Reduced access to primary care and lower income are associated with higher adolescent fertility rates. Poorer socioeconomic and health care indicators are associated with higher adolescent fertility rates.

Pregnancy in Adolescence; Spatial Analysis; Socioeconomic Factors; Primary Health Care

Indicators	North (n=442)	Northeast (n=1,768)	Southeast (n=1,512)	South (n=1,019)	Midwest (n=416)	Brazil (n=5,157)
Adolescent fertility rate^a	93.5 (74.2;113.6)	69.3 (56.1;84.1)	53.3 (43.5;64.8)	54.2 (39.9;68.2)	73.1 (59.1;87.7)	65.6 (48.56;49.1)
Gini index	0.6 (0.5;0.6)	0.5 (0.5;0.6)	0.4 (04;0.5)	0.4 (0.4;0.5)	0.5 (0.4;0.5)	0.5 (0.42;0.53)
Average family income per capita (in minimum wages)	314.5 (229.0;406.0)	253.1 (218.0;295.0)	572.5 (443.0;701.0)	658.3 (305.0;799.0)	559.3 (472.0;645.0)	440.5 (268.0;631.0)
Proportion (%) of low-income population^b	30,2 (17,0;44,0)	32.6 (24.0;40.0)	3.7 (1.1;9.5)	1.3 (0.1;5.3)	3.6 (0.5;9.6)	11.5 (2.1;31.0)
Dweller density per household	3.6 (3.2;4.4)	3.3 (3.2;3.5)	3.0 (2.9;3.1)	2.9 (2.8;3.0)	2.9 (2.8;3.0)	3.1 (2.9;3.3)
Family Health Strategy coverage (%)	80.0 (55.1;93.4)	93.4 (85.2;100.0)	92.8 (65.8;100.0)	95.6 (73.4;100.0)	89.0 (74.2;100.0)	93.3 (74.8;100.0)
Proportion (%) of adequate number of prenatal care sessions^c	47.8 (36.0;60.6)	59.1 (47.0;70.4)	76.8 (69.4;83.0)	78.9 (69.5;85.4)	68.5 (59.1;76.3)	69.6 (56.4;79.5)
Schooling rate^d (%)	3.4 (2.0;5.3)	2.9 (2.0;3.8)	1.4 (0.8;2.0)	1.6 (1.0;2.2)	1.8 (1.1;2.7)	2.0 (1.2;4.4)

Indicators	Moran’s index	p-value
Gini indexi	0.278	<0.001
Average family income per capita (in minimum wages)	0.477	<0.001
Proportion (%) of low-income population^b	0.807	<0.001
Dweller density per household	0.342	<0.001
Family Health Strategy coverage (%)	0.145	<0.001
Proportion (%) of adequate number of prenatal care sessionsc^c	0.662	<0.001
Puerperal women (%) aged 15-19 with less than eight years of schooling	0.517	<0.001

Indicators	Bivariate spatial linear regression β (95%CI)^c	Multivariate spatial linear regression β (95%CI)^c
Índice de Gini	5.433 (3.196;7.671)	7.031 (4.793;9.269)
Average family income per capita (in minimum wages)	-0.099 (-0.100;-0.098)	-0.104 (-0.105;-0.103)
Proportion (%) of low-income population^d	0.095 (0.076;0.113)	0.127 (0.108;0.145)
Dweller density per household	1.760 (1.637;1.88)	6.292 (5.062;7.522)
Family Health Strategy coverage (%)	-0.003 (-0.004;-0.003)	-0.011 (-0.017;-0.005)
Proportion (%) of adequate number of prenatal care sessions^e	-0.054 (-0.064;-0.044)	-0.122 (-0.224;-0.132)
Proportion (%) of 15-19 year-old puerperal women with less than eight years of schooling	0.295 (0.331;0.260)	0.260 (0.224;0.295)

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Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 (61) 3315-3464 - Brasília - DF - Brazil
E-mail: revista.saude@saude.gov.br

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[TFN1001] a) Fertility rate among women 15-19 years old (per 1,000 women) smoothed using the empirical Bayesian method – proxy for pregnancy in adolescence.

[TFN2001] b) Up to half a minimum wage.

[TFN3001] c) Had seven or more prenatal care sessions.

[TFN4001] d) Schooling rate as a proxy for socioeconomic status.

Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters*

Abstract

Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters^*