Social inequalities in perinatal mortality in Belo Horizonte, Brazil: the role of hospital care.

Abstract:

OBJECTIVES:We examined the contribution of hospital type and quality of care to perinatal mortality rates in the city of Belo Horizonte, Brazil. METHODS:We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in1999. After adjusting for maternal education and birthweight, we compared mortality rates according to hospital category--defined by a hospital's relation to the national Universal Public Health System (SUS)--and quality of care. We used the Wigglesworth Classification to examine perinatal deaths. RESULTS:After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS-contracted hospitals (relative to private, non-SUS-contracted hospitals). Hospital quality was also directly associated with perinatal death rates. Mortality rates were especially high for normal-birthweight babies born in private SUS-contracted hospitals. Intrapartum asphyxia was the leading cause of preventable death. CONCLUSIONS:In a class-segregated health care system, such as Brazil's, disparities in quality of care between SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality.

journal_name

Am J Public Health

authors

Lansky S,França E,Kawachi I

doi

10.2105/AJPH.2005.075986

subject

Has Abstract

pub_date

2007-05-01 00:00:00

pages

867-73

issue

5

eissn

0090-0036

issn

1541-0048

pii

AJPH.2005.075986

journal_volume

97

pub_type

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