Trend of preventable deaths up to the 6th day of life in the state of São Paulo – 2008 to 2017

Sala, Arnaldo; Luppi, Carla Gianna

doi:10.11606/s1518-8787.2020054002309

Acessibilidade / Reportar erro

Brasil

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Sumário

Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002309 copy

Trend of preventable deaths up to the 6th day of life in the state of São Paulo – 2008 to 2017

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To analyze the trend of early neonatal infant mortality in the state of São Paulo according to preventability and region of residence.

METHODS:

Ecological study with secondary data from 2008 to 2017, obtained from the Sistema de Informação sobre Nascidos Vivos (Sinasc – Live Birth Information System) and the Sistema de Informação sobre Mortalidade (SIM – Mortality Information System). The causes of death were classified according to preventability groups, and the annual percentage changes in the death rates of each preventability group were estimated using the Joinpoint software.

RESULTS:

The early neonatal component showed a reduction trend with an annual percentage change of −1.18 (95%CI −1.63 to −0.72), less pronounced than the other age components of infant mortality. In the analysis according to preventability, the causes reducible by attention to the woman during pregnancy and those reducible by attention to the fetus and the newborn presented annual percentage change of −1.03 (95%CI: −1.92 to −0.13) and −2.6 (95%CI: −4.07 to −1.11), respectively. In the causes reducible by attention to women during delivery, no reduction trend was observed. Regional discrepancies occurred in the variation of early neonatal infant mortality rates according to type of preventability.

CONCLUSIONS:

Mortality up to the 6th day of life presented greater difficulty of reduction when compared with the other age components. The absence of a reduction trend in preventable deaths due to the attention to women during delivery points to possible fragility in the attention to delivery.

DESCRIPTORS:
Early Neonatal Mortality; Midwifery; Integrated Management of Childhood Illness; Maternal-Child Health Services; Ecological Studies

Component/preventable causes of death		Year of death
Component/preventable causes of death		2008	2009	2010	2011	2012	2013	2014	2015	2016	2017
Early neonatal infant mortality		6.14	6.13	5.75	5.72	5.74	5.67	5.73	5.51	5.50	5.51
	1.1. Reducible by immunoprevention actions	0.00	0.00	–	–	–	–	–	–	–	–
	1.2.1. Reducible by adequate attention to the woman during pregnancy	2.40	2.32	2.21	2.31	2.22	2.38	2.30	2.22	2.07	2.15
	1.2.2. Reducible by adequate attention to the woman during delivery	0.84	0.86	0.86	0.72	0.81	0.75	0.74	0.73	0.80	0.84
	1.2.3. Reducible by adequate attention to the fetus and the newborn	1.31	1.34	1.25	1.28	1.26	1.04	1.12	1.03	1.14	1.09
	1.3. Reducible by actions of diagnosis and adequate treatment	0.02	0.02	0.01	0.01	0.01	0.00	0.01	0.02	0.00	0.01
	1.4. Reducible by health promotion actions linked to health care actions	0.03	0.03	0.02	0.03	0.03	0.04	0.02	0.02	0.03	0.02
	2. Ill-defined causes	0.20	0.17	0.17	0.10	0.12	0.16	0.15	0.15	0.14	0.16
	3. Other causes (not clearly preventable)	1.35	1.38	1.23	1.28	1.30	1.30	1.39	1.34	1.32	1.24
Late neonatal infant mortality		2.45	2.54	2.39	2.19	2.19	2.22	2.15	2.06	2.17	2.18
Late infant mortality		4.00	3.83	3.77	3.70	3.61	3.68	3.58	3.23	3.42	3.24
Infant mortality		12.60	12.50	11.90	11.61	11.54	11.57	11.46	10.80	11.08	10.92

Child mortality component	Preventable causes of death	Period	APC	Lower 95%CI	Higher 95%CI	P	AAPC	Lower 95%CI	Higher 95%CI
	1.1. Reducible by immunoprevention actions	2008–2017
	1.2.1. Reducible by adequate attention to the woman during pregnancy	2008–2017	−1.03	−1.92	−0.13	0.03
	1.2.2. Reducible by adequate attention to the woman during delivery ^a a Joinpoint in 2015.	2008–2015	−2.31	−4.94	0.41	0.08	−0.09	−3.84	3.82
	1.2.2. Reducible by adequate attention to the woman during delivery ^a a Joinpoint in 2015.	2015–2017	8.09	−11.94	32.67	0.37	−0.09	−3.84	3.82
	1.2.3. Reducible by adequate attention to the fetus and the newborn	2008–2017	−2.6	−4.07	−1.11	0.00
	1.3. Reducible by actions of diagnosis and adequate treatment	2008–2017	−10.95	−22.25	1.99	0.08
	1.4. Reducible by adequate health promotion actions	2008–2017	−2.74	−8.71	3.63	0.34
	2. Ill-defined causes ^b b Joinpoint in 2011.	2008–2011	−16.44	−30.00	−0.25	0.05	−2.72	−7.86	2.72
	2. Ill-defined causes ^b b Joinpoint in 2011.	2011–2017	4.97	−1.13	11.45	0.09	−2.72	−7.86	2.72
	3. Other causes (not clearly preventable)	2008–2017	−0.24	−1.33	0.85	0.62
Early neonatal infant mortality	Total	2008–2017	−1.18	−1.63	−0.72	0
Late neonatal infant mortality	Total	2008–2017	−1.76	−2.77	−0.74	0
Late infant mortality	Total	2008–2017	−2.12	−2.79	−1.45	0
Infant mortality	Total	2008–2017	−1.60	−2.06	−1.13	0

Subgroups of preventable causes of death	RDH	ENIM rate		Trend
Subgroups of preventable causes of death	RDH	2008	2017	Period	APC	Lower 95%CI	Higher 95%CI	AAPC	Lower 95%CI	Higher 95%CI
1.2.1. Reducible by adequate attention to the woman during pregnancy	Araçatuba	2.55	2.48	2008–2017	−0.76	−4.55	3.18
	Araraquara	4.10	2.13	2008–2017	−4.58	−9.36	0.46
	Baixada Santista	2.86	2.90	2008–2017	−1.90	−4.26	0.52
	Barretos	2.46	3.90	2008–2017	5.84	−0.96	13.1
	Bauru	2.58	2.19	2008–2017	−3.31	−7.63	1.22
	Campinas	2.00	1.69	2008–2017	−3.16	−6.99	0.83
	Franca	2.68	2.27	2008–2017	−3.57	−8.20	1.28
	Grande São Paulo (excludes MSP)	2.41	2.08	2008–2017	−1.17	−2.78	0.48
	Marília	2.75	2.75	2008–2017	−1.25	−7.09	4.97
	Piracicaba	1.81	2.42	2008–2017	0.37	−5.34	6.43
	Presidente Prudente	2.01	3.51	2008–2017	2.18	−6.09	11.18
	Registro	2.84	3.02	2008–2017	3.62	−3.49	11.24
	Ribeirão Preto	2.32	2.17	2008–2012	10.77	−6.19	30.8	−1.40	−8.54	6.30
	Ribeirão Preto	2.32	2.17	2012–2017	−10.17	−20.13	1.03	−1.40	−8.54	6.30
	São João da Boa Vista	2.76	2.84	2008–2017	−3.28	−8.63	2.37
	São José do Rio Preto	2.01	1.41	2008–2017	−4.82	−8.64	−0.84
	São Paulo (municipality)	2.09	1.91	2008–2015	2.82	0.61	5.07	−0.44	−3.42	2.64
	São Paulo (municipality)	2.09	1.91	2015–2017	−11.04	−24.38	4.67	−0.44	−3.42	2.64
	Sorocaba	2.67	2.52	2008–2017	2.24	−1.03	5.62
	Taubaté	3.57	2.41	2008–2017	−5.56	−9.60	−1.33
1.2.2. Reducible by adequate attention to the woman during delivery	Araçatuba	1.66	1.19	2008–2017	−1.47	−15.56	14.97
	Araraquara	0.60	0.49	2008–2015	10.1	2.53	18.23	−3.10	−12.29	7.06
	Araraquara	2015–2017	−38.02	−63.63	5.61			−3.10	−12.29	7.06
	Baixada Santista	1.51	0.66	2008–2017	−6.64	−10.53	−2.57
	Barretos	0.38	0.74	2008–2017	2.64	−9.50	16.40
	Bauru	1.20	1.03	2008–2017	−0.06	−5.77	5.99
	Campinas	0.62	0.85	2008–2017	−2.05	−7.52	3.75
	Franca	0.64	0.54	2008–2017	−2.69	−11.2	6.64
	Grande São Paulo (excludes MSP)	0.96	0.77	2008–2017	−1.48	−4.06	1.17
	Marília	1.56	0.87	2008–2017	−4.35	−11.94	3.89
	Piracicaba	0.80	0.47	2008–2017	−6.10	−13.35	1.76
	Presidente Prudente	1.23	1.60	2008–2017	6.65	−3.19	17.48
	Registro	0.95	2.26	2008–2017	0.92	−12.56	16.48
	Ribeirão Preto	0.85	0.72	2008–2017	0.48	−6.23	7.68
	São João da Boa Vista	0.92	0.91	2008–2017	−3.82	−11.66	4.71
	São José do Rio Preto	0.40	0.38	2008–2017	−1.33	−6.55	4.19
	São Paulo (municipality)	0.60	0.95	2008–2015	−1.55	−4.17	1.14	4.90	1.01	8.93
	São Paulo (municipality)	2015–2017	30.98	7.04	60.28			4.90	1.01	8.93
	Sorocaba	0.93	0.85	2008–2017	−3.66	−9.24	2.26
	Taubaté	0.86	0.83	2008–2017	−2.86	−8.64	3.28
1.2.3. Reducible by adequate attention to the fetus and the newborn	Araçatuba	1.55	1.40	2008–2017	−1.63	−13.27	11.57
	Araraquara	1.03	0.49	2008–2017	0.66	−7.62	9.68
	Baixada Santista	1.23	0.99	2008–2017	0.23	−5.70	6.53
	Barretos	1.33	1.30	2008–2017	3.45	−4.95	12.60
	Bauru	1.15	1.54	2008–2017	2.39	−0.79	5.67
	Campinas	1.12	1.09	2008–2017	−0.34	−1.87	1.22
	Franca	0.54	0.87	2008–2017	0.46	−8.67	10.50
	Grande São Paulo (excludes MSP)	1.32	1.05	2008–2017	−3.14	−5.69	−0.51
	Marília	1.78	1.52	2008–2017	0.30	−7.04	8.21
	Piracicaba	0.85	0.95	2008–2017	−0.98	−6.05	4.37
	Presidente Prudente	0.67	1.17	2008–2017	−5.18	−14.74	5.44
	Registro	0.95	0.75	2008–2014	18.64	−4.87	47.96	0.10	−18.08	22.32
	Registro	2014–2017	−28.73	−62.92	36.98			0.10	−18.08	22.32
	Ribeirão Preto	0.73	0.78	2008–2017	−1.43	−11.65	9.97
	São João da Boa Vista	1.33	1.01	2008–2017	−1.25	−6.73	4.56
	São José do Rio Preto	1.38	0.81	2008–2017	2.37	−6.50	12.09
	São Paulo (municipality)	1.46	1.07	2008–2017	−9.76	−15.46	−3.66	−4.12	−12.50	5.06
	São Paulo (municipality)	2008–2017	18.5	−27.32	93.22			−4.12	−12.50	5.06
	Sorocaba	1.93	1.32	2008–2017	−4.63	−7.67	−1.50
	Taubaté	1.23	1.28	2008–2017	0.48	−3.29	4.04

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[1] Correspondence: Arnaldo Sala, Av. Doutor Arnaldo, 351 5º andar 01246-000 São Paulo, SP, Brasil. E-mail: arnasala@usp.br