Observational studyBMC pregnancy and childbirth2025
Disparities in stillbirth rates according to municipal deprivation levels: a nationwide study in Brazil.
Observational study in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Analysis of mode of delivery according to race and ethnicity in Brazil: Application of the Robson Classification.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
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8 authors.
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Abstract
backgroundInvestigating the relationship between stillbirth and deprivation is essential to guide healthcare improvements, as evidence is scarce in LMIC contexts. This study estimated the stillbirth rate (SBR) and the odds ratios (OR) of stillbirth in Brazil's municipal deprivation context.
methodsThis observational study included births in Brazil registered in the SINASC and SIM databases, employing two epidemiological designs. First, a cross-sectional analysis assessed the association between stillbirths and municipal deprivation, using data from January 1 to December 31, 2018. Logistic regression was used to estimate OR for stillbirths across deprivation levels, adjusting for sociodemographic, gestational, and fetal variables, with 95% confidence intervals. Deprivation was classified into quintiles based on Brazilian deprivation index (IBP) levels 1 to 5. Second, an ecological analysis examined time trends in SBR by deprivation level from January 1, 2000, to December 31, 2018. Time trends in SBR from 2000 to 2018 were analyzed using Prais-Winsten regression, both overall and stratified by IBP level.
resultsIn 2018, the OR of stillbirth, including both antepartum and intrapartum cases, increased with higher levels of deprivation. Compared to the least deprived areas, level 2 had a 9% greater OR of stillbirth (95%CI: 1.03-1.15), level 3 had a 30% higher OR (95% CI: 1.23-1.27), level 4 showed a 34% increase (95%CI: 1.27-1.41), and level 5 had the highest OR, with a 68% increase (95%CI: 1.60-1.77). From 2000 to 2018, SBR in Brazil declined by 1.1% per year (p < 0.001). Significant declines were observed across deprivation levels 1 (-1.6% per year; p < 0.001) to 4 (-1.5% per year; p < 0.001), while level 5 showed persistently high stillbirth rates with no significant improvement (p ≥ 0.05).
conclusionThese results highlight the stark inequalities in stillbirth chances across Brazil. Targeted action is needed to close the gap in the most deprived municipalities and reduce stillbirth rates and perinatal health disparities.
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