Intra-urban differentials of fetal mortality in clusters of social vulnerability in Sao Paulo Municipality, Brazil

Abstract

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in Sao Paulo Municipality, 2007-2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, >= 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR >= 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR >= 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.