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Lee B, Lee YK, Kim SH, Oh H, Won S, Jang SY, Jeon YJ, Yoo BN, Bak JK. Impact of linkage level on inferences from big data analyses in health and medical research: an empirical study. BMC Med Inform Decis Mak 2024; 24:193. [PMID: 38982481 PMCID: PMC11234607 DOI: 10.1186/s12911-024-02586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Linkage errors that occur according to linkage levels can adversely affect the accuracy and reliability of analysis results. This study aimed to identify the differences in results according to personally identifiable information linkage level, sample size, and analysis methods through empirical analysis. METHODS The difference between the results of linkage in directly identifiable information (DII) and indirectly identifiable information (III) linkage levels was set as III linkage based on name, date of birth, and sex and DII linkage based on resident registration number. The datasets linked at each level were named as databaseIII (DBIII) and databaseDII (DBDII), respectively. Considering the analysis results of the DII-linked dataset as the gold standard, descriptive statistics, group comparison, incidence estimation, treatment effect, and moderation effect analysis results were assessed. RESULTS The linkage rates for DBDII and DBIII were 71.1% and 99.7%, respectively. Regarding descriptive statistics and group comparison analysis, the difference in effect in most cases was "none" to "very little." With respect to cervical cancer that had a relatively small sample size, analysis of DBIII resulted in an underestimation of the incidence in the control group and an overestimation of the incidence in the treatment group (hazard ratio [HR] = 2.62 [95% confidence interval (CI): 1.63-4.23] in DBIII vs. 1.80 [95% CI: 1.18-2.73] in DBDII). Regarding prostate cancer, there was a conflicting tendency with the treatment effect being over or underestimated according to the surveillance, epidemiology, and end results summary staging (HR = 2.27 [95% CI: 1.91-2.70] in DBIII vs. 1.92 [95% CI: 1.70-2.17] in DBDII for the localized stage; HR = 1.80 [95% CI: 1.37-2.36] in DBIII vs. 2.05 [95% CI: 1.67-2.52] in DBDII for the regional stage). CONCLUSIONS To prevent distortion of the analyses results in health and medical research, it is important to check that the patient population and sample size by each factor of interest (FOI) are sufficient when different data are linked using DBDII. In cases involving a rare disease or with a small sample size for FOI, there is a high likelihood that a DII linkage is unavoidable.
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Affiliation(s)
- Bora Lee
- Institute of Health & Environment, Seoul National University, Seoul, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sung Han Kim
- Department of Urology, Urologic Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang-si, Republic of Korea
| | - HyunJin Oh
- Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and Detection of National Cancer Center, Goyang-si, Republic of Korea
| | - Sungho Won
- Institute of Health & Environment, Seoul National University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program for Bioinformatics, College of Natural Science, Seoul National University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Ye Jin Jeon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Bit-Na Yoo
- National Evidence-based Healthcare Collaborating Agency (NECA), 3-5F 400, Neungdong-ro, Gwangin-gu, Seoul, 04933, Republic of Korea
| | - Jean-Kyung Bak
- National Evidence-based Healthcare Collaborating Agency (NECA), 3-5F 400, Neungdong-ro, Gwangin-gu, Seoul, 04933, Republic of Korea.
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Pinto PFPS, Macinko J, Silva AF, Lua I, Jesus G, Magno L, Santos CAST, Ichihara MY, Barreto ML, Moucheraud C, Souza LE, Dourado I, Rasella D. The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians. PLoS Med 2024; 21:e1004302. [PMID: 38991004 PMCID: PMC11272382 DOI: 10.1371/journal.pmed.1004302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 07/25/2024] [Accepted: 05/22/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. METHODS AND FINDINGS A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. CONCLUSIONS AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.
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Affiliation(s)
- Priscila F. P. S. Pinto
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, United States of America
| | - Andréa F. Silva
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Gabriela Jesus
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | | | - Maria Yury Ichihara
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Mauricio L. Barreto
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, United States of America
| | - Luis E. Souza
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- Instituto de Salud Global Barcelona (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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Santiago-Vieira C, Velasquez-Melendez G, de Cássia Ribeiro-Silva R, de Jesus Pinto E, Barreto ML, Li L. Recent changes in growth trajectories: a population-based cohort study of over 5 million Brazilian children born between 2001 and 2014. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100721. [PMID: 38629028 PMCID: PMC11019368 DOI: 10.1016/j.lana.2024.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
Background There is limited evidence on recent trends in childhood growth trajectories in Low-/middle-income countries. We investigated how age-trajectories for height and Body Mass Index (BMI) have changed among Brazilian children born in two different time periods after 2000. Methods We used a population-based cohort (part of the "Cohort of 100-Million Brazilians") created by the linkage of three Brazilian administrative databases: the Cadastro Único of the Federal Government, the National System of Live Births and the National Nutritional and Food Surveillance System. We included longitudinal data on 5,750,214 children who were 3 to <10 years of age and born between 2001 and 2014 (20,209,133 observations). We applied fractional polynomial models with random-effects to estimate mean height and BMI trajectories for children. Findings Compared to children born in 2001-2007, the cohort born in 2008-2014 were on average taller, by a z-score of 0.15 in boys and 0.12 in girls. Their height trajectories shifted upwards, by approximately 1 cm in both sexes. Levels of BMI increased little, by a z-score of 0.06 (boys) and 0.04 (girls). Mean BMI trajectories also changed little. However, the prevalence of overweight/obesity increased between cohorts, e.g., from 26.8% to 30% in boys and 23.9%-26.6% in girls aged between 5 and <10 years. Interpretation An increase of 1 cm in mean height of Brazilian children during a short period indicates the improvement in maternal and child health, especially those from low-income families due to the new health and welfare policies in Brazil. Although mean BMI changed little, the prevalence of child overweight/obesity slightly increased and remained high. Funding This work was supported by National Council for Scientific and Technological Development - CNPq; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES; National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre; Society for the Study of Human Biology; Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG; Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Complexo da Saúde do Ministério da Saúde - Decit/SECTICS/MS. The study also used resources from the Centre for Data and Knowledge Integration for Health (CIDACS), which receives funding from the Bill & Melinda Gates Foundation, the Wellcome Trust, the Health Surveillance Secretariat of the Ministry of Health and the Secretariat of Science and Technology of the State of Bahia (SECTI-BA).
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Affiliation(s)
- Carolina Santiago-Vieira
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
| | - Elizabete de Jesus Pinto
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
- Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
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Ortelan N, de Almeida MF, Pinto Júnior EP, Bispo N, Fiaccone RL, Falcão IR, Rocha ADS, Ramos D, Paixão ES, de Cássia Ribeiro-Silva R, Rodrigues LC, Barreto ML, Ichihara MYT. Evaluating the relationship between conditional cash transfer programme on preterm births: a retrospective longitudinal study using the 100 million Brazilian cohort. BMC Public Health 2024; 24:713. [PMID: 38443875 PMCID: PMC10916064 DOI: 10.1186/s12889-024-18152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. METHODS A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32-36), (iii) severe (28-31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. RESULTS 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63-0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59-0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43-0.74). CONCLUSIONS An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.
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Affiliation(s)
- Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation. Edifício Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia, 41745-715, Brazil.
| | | | - Elzo Pereira Pinto Júnior
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Nivea Bispo
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Ila Rocha Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Aline Dos Santos Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Maria Yury T Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
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Tedde JGG, Cerqueira-Silva T, Lagrosa Garcia SA, Amira BV, Rodrigues LC, Barreto ML, Rocha AS, de Cássia Ribeiro-Silva R, Falcão IR, Paixao ES. Association of interpregnancy interval with adverse pregnancy outcomes according to the outcomes of the preceding pregnancy: a longitudinal study with 4.7 million live births from Brazil. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100687. [PMID: 38332936 PMCID: PMC10850771 DOI: 10.1016/j.lana.2024.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
Background Earlier studies have proposed a link between the Interpregnancy Interval (IPI) and unfavorable birth outcomes. However, it remains unclear if the outcomes of previous births could affect this relationship. We aimed to investigate whether the occurrence of adverse outcomes-small for gestational age (SGA), preterm birth (PTB), and low birth weight (LBW)-at the immediately preceding pregnancy could alter the association between IPI and the same outcomes at the subsequent pregnancy. Methods We used a population-based linked cohort from Brazil (2001-2015). IPI was measured as the difference, in months, between the preceding birth and subsequent conception. Outcomes included SGA (<10th birthweight percentile for gestational age and sex), LBW (<2500 g), and PTB (gestational age <37 weeks). We calculated risk ratios (RRs), using the IPI of 18-22 months as the reference IPI category, we also stratified by the number of adverse birth outcomes at the preceding pregnancy. Findings Among 4,788,279 births from 3,804,152 mothers, absolute risks for subsequent SGA, PTB, and LBW were higher for women with more adverse outcomes in the preceding delivery. The RR of SGA and LBW for IPIs <6 months were greater for women without previous adverse outcomes (SGA: 1.44 [95% Confidence Interval (CI): 1.41-1.46]; LBW: 1.49 [1.45-1.52]) compared to those with three previous adverse outcomes (SGA: 1.20 [1.10-1.29]; LBW: 1.24 [1.15-1.33]). IPIs ≥120 months were associated with greater increases in risk for LBW and PTB among women without previous birth outcomes (LBW: 1.59; [1.53-1.65]; PTB: 2.45 [2.39-2.52]) compared to women with three adverse outcomes at the index birth (LBW: 0.92 [0.78-1.06]; PTB: 1.66 [1.44-1.88]). Interpretation Our study suggests that women with prior adverse outcomes may have higher risks for adverse birth outcomes in subsequent pregnancies. However, risk changes due to differences in IPI length seem to have a lesser impact compared to women without a prior event. Considering maternal obstetric history is essential in birth spacing counseling. Funding Wellcome Trust225925/Z/22/Z.
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Affiliation(s)
| | - Thiago Cerqueira-Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Brenda V. Amira
- Faculty of Medicine of São José do Rio Preto (FAMERP), Children's Hospital, São Paulo, Brazil
| | - Laura C. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Mauricio L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Aline S. Rocha
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | | | - Ila R. Falcão
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Enny S. Paixao
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Pescarini JM, Falcao IR, Reboucas P, Paixao ES, Sanchez-Clemente N, Goes EF, Abubakar I, Rodrigues LC, Brickley EB, Smeeth L, Barreto ML. Perinatal health outcomes of international migrant women in Brazil: A nationwide data linkage study of the CIDACS birth cohort (2011-2018). Travel Med Infect Dis 2024; 57:102672. [PMID: 38036158 DOI: 10.1016/j.tmaid.2023.102672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/26/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND We investigated perinatal outcomes among live births from international migrant and local-born mothers in a cohort of low-income individuals in Brazil. METHODS We linked nationwide birth registries to mortality records and socioeconomic data from the CIDACS Birth Cohort and studied singleton live births of women aged 10-49 years from 1st January 2011 to 31st December 2018. We used logistic regressions to investigate differences in antenatal care, adverse pregnancy outcomes, and neonatal (i.e., ≤28 days) mortality among international migrants compared to non-migrants in Brazil; and explored the interaction between migration, race/ethnicity and living in international border municipalities. RESULTS We studied 10,279,011 live births, of which 9469 (0.1 %) were born to international migrants. Migrant women were more likely than their Brazilian-born counterparts to have a previous foetal loss (ORadj: 1.16, 1.11-1.22), a delayed start of antenatal care (i.e., beyond 1st trimester) (1.22, 95%CI:1.16-1.28), a newborn who is large for gestational age (1.29, 1.22-1.36), or a newborn with congenital anomalies (1.37, 1.14-1.65). Conversely, migrant women were less likely to deliver prematurely (0.89, 0.82-0.95) or have a low birth weight infant (0.74, 0.68-0.81). There were no differences in neonatal mortality rates between migrants and non-migrants. Our analyses also showed that, when disparities in perinatal outcomes were present, disparities were mostly concentrated among indigenous mothers in international borders and among live births of Black mothers in non-borders. CONCLUSION Although live births of international migrants generally have lower rates of adverse birth outcomes, our results suggest that indigenous and Black migrant mothers may face disproportionate barriers to accessing antenatal care.
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Affiliation(s)
- Julia M Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
| | - Ila R Falcao
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Poliana Reboucas
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Enny S Paixao
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Nuria Sanchez-Clemente
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Neonatal and Paediatric Infection, St. George's University London, UK
| | - Emanuelle F Goes
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Ibrahim Abubakar
- Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Laura C Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Elizabeth B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Health Data Research (HDR), London, UK
| | - Mauricio L Barreto
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Jamaluddine Z, Seita A, Ballout G, Al-Fudoli H, Paolucci G, Albaik S, Ibrahim R, Sato M, Ghattas H, Campbell OMR. Establishment of a birth-to-education cohort of 1 million Palestinian refugees using electronic medical records and electronic education records. Int J Popul Data Sci 2023; 8:2156. [PMID: 38414543 PMCID: PMC10898319 DOI: 10.23889/ijpds.v8i1.2156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Introduction By linking datasets, electronic records can be used to build large birth-cohorts, enabling researchers to cost-effectively answer questions relevant to populations over the life-course. Currently, around 5.8 million Palestinian refugees live in five settings: Jordan, Lebanon, Syria, West Bank, and Gaza Strip. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides them with free primary health and elementary-school services. It maintains electronic records to do so.We aimed to establish a birth cohort of Palestinian refugees born between 1st January 2010 and 31st December 2020 living in five settings by linking mother obstetric records with child health and education records and to describe some of the cohort characteristics. In future, we plan to assess effects of size-at-birth on growth, health and educational attainment, among other questions. Methods We extracted all available data from 140 health centres and 702 schools across five settings, i.e. all UNRWA service users. Creating the cohort involved examining IDs and other data, preparing data, de-duplicating records, and identifying live-births, linking the mothers' and children's data using different deterministic linking algorithms, and understanding reasons for non-linkage. Results We established a birth cohort of Palestinian refugees using electronic records of 972,743 live births. We found high levels of linkage to health records overall (83%), which improved over time (from 73% to 86%), and variations in linkage rates by setting: these averaged 93% in Gaza, 89% in Lebanon, 75% in Jordan, 73% in West Bank and 68% in Syria. Of the 423,580 children age-eligible to go to school, 47% went to UNRWA schools and comprised of 197,479 children with both health and education records, and 2,447 children with only education records. In addition to year and setting, other factors associated with non-linkage included mortality and having a non-refugee mother. Misclassification errors were minimal. Conclusion This linked open birth-cohort is unique for refugees and the Arab region and forms the basis for many future studies, including to elucidate pathways for improved health and education in this vulnerable, understudied population. Our characterization of the cohort leads us to recommend using different sub-sets of the cohort depending on the research question and analytic purposes.
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Affiliation(s)
- Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Akihiro Seita
- United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA headquarters, Amman, Jordan
| | - Ghada Ballout
- United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA headquarters, Amman, Jordan
| | - Hussam Al-Fudoli
- United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA headquarters, Amman, Jordan
| | - Gloria Paolucci
- United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA headquarters, Amman, Jordan
| | - Shatha Albaik
- United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA headquarters, Amman, Jordan
| | - Rami Ibrahim
- United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA headquarters, Amman, Jordan
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hala Ghattas
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut Lebanon
| | - Oona M. R. Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Carrilho TRB, Silva NDJ, Paixão ES, Falcão IR, Fiaccone RL, Rodrigues LC, Katikireddi SV, Leyland AH, Dundas R, Pearce A, Velasquez-Melendez G, Kac G, Silva RDCR, Barreto ML. Maternal and child nutrition programme of investigation within the 100 Million Brazilian Cohort: study protocol. BMJ Open 2023; 13:e073479. [PMID: 37673446 PMCID: PMC10496662 DOI: 10.1136/bmjopen-2023-073479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION There is a limited understanding of the early nutrition and pregnancy determinants of short-term and long-term maternal and child health in ethnically diverse and socioeconomically vulnerable populations within low-income and middle-income countries. This investigation programme aims to: (1) describe maternal weight trajectories throughout the life course; (2) describe child weight, height and body mass index (BMI) trajectories; (3) create and validate models to predict childhood obesity at 5 years of age; (4) estimate the effects of prepregnancy BMI, gestational weight gain (GWG) and maternal weight trajectories on adverse maternal and neonatal outcomes and child growth trajectories; (5) estimate the effects of prepregnancy BMI, GWG, maternal weight and interpregnancy BMI changes on maternal and child outcomes in the subsequent pregnancy; and (6) estimate the effects of maternal food consumption and infant feeding practices on child nutritional status and growth trajectories. METHODS AND ANALYSIS Linked data from four different Brazilian databases will be used: the 100 Million Brazilian Cohort, the Live Births Information System, the Mortality Information System and the Food and Nutrition Surveillance System. To analyse trajectories, latent-growth, superimposition by translation and rotation and broken stick models will be used. To create prediction models for childhood obesity, machine learning techniques will be applied. For the association between the selected exposure and outcomes variables, generalised linear models will be considered. Directed acyclic graphs will be constructed to identify potential confounders for each analysis investigating potential causal relationships. ETHICS AND DISSEMINATION This protocol was approved by the Research Ethics Committees of the authors' institutions. The linkage will be carried out in a secure environment. After the linkage, the data will be de-identified, and pre-authorised researchers will access the data set via a virtual private network connection. Results will be reported in open-access journals and disseminated to policymakers and the broader public.
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Affiliation(s)
- Thais Rangel Bousquet Carrilho
- Nutritional Epidemiology Observatory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Natanael de Jesus Silva
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain
| | - Enny Santos Paixão
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Ila Rocha Falcão
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil
| | - Rosemeire Leovigildo Fiaccone
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador, BA, Brazil
| | - Laura Cunha Rodrigues
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, London, UK
| | | | - Alastair H Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK
| | - Ruth Dundas
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK
| | - Anna Pearce
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK
| | - Gustavo Velasquez-Melendez
- Department of Maternal and Child Nursing and Public Health, Nursing School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rita de Cássia Ribeiro Silva
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil
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9
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Fernandes QHRF, Paixão ES, Costa MDCN, Teixeira MG, Rios JDC, Santo KDSGD, Barreto ML, Acosta AX. Temporal trends in prevalence and infant mortality of birth defects in Brazil, from 2001 to 2018. CIENCIA & SAUDE COLETIVA 2023; 28:969-979. [PMID: 37042906 DOI: 10.1590/1413-81232023284.13912022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/19/2022] [Indexed: 04/13/2023] Open
Abstract
Congenital anomalies (CA) are a relevant problem for global public health, affecting about 3% to 6% of newborns worldwide. In Brazil, these are the second main cause of infant mortality. Thus, extensive studies are needed to demonstrate the impact of these anomalies on births and deaths. The present study describes the temporal trends of prevalence and infant mortality due to CA among live births in Brazil and regions, from 2001 to 2018, using the related data between the Live Birth Information System (SINASC, acronym in Portuguese) and the Mortality Information System (SIM, acronym in Portuguese). The prevalence and infant mortality due to CA has increased in Brazil and in most regions, especially in the Northeast and North. CAs in the musculoskeletal system were the most frequent at birth (29.8/10,000 live births), followed by those in the circulatory system (12.7/10,000 live births), which represented the primary cause of death in this group. The applied linkage technique made it possible to correct the national prevalence of CA by 17.9% during the analyzed period, after retrieving the anomalies reported in SIM, thereby proving to be a good tool to improve the quality of information on anomalies in Brazil.
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Affiliation(s)
- Qeren Hapuk R Ferreira Fernandes
- Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Centro de Integração de Dados e Conhecimentos para Saúde, Instituto Gonçalo Moniz - Fiocruz-BA. R. Waldemar Falcão 121, Candeal. 40.296-710 Salvador BA Brasil.
| | - Enny S Paixão
- London School of Hygiene and Tropical Medicine. London UK
| | - Maria da Conceição N Costa
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Instituto Gonçalo Moniz - Fiocruz-BA. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Maria Glória Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Instituto Gonçalo Moniz - Fiocruz-BA. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | | | | | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Instituto Gonçalo Moniz - Fiocruz-BA. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Angelina Xavier Acosta
- Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Centro de Integração de Dados e Conhecimentos para Saúde, Instituto Gonçalo Moniz - Fiocruz-BA. R. Waldemar Falcão 121, Candeal. 40.296-710 Salvador BA Brasil.
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia. Salvador BA Brasil
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Suárez-Idueta L, Pita R, Blencowe H, Barranco A, Gonzalez JF, Paixao ES, Barreto ML, Lawn JE, Ohuma EO. National data linkage assessment of live births and deaths in Mexico: Estimating under-five mortality rate ratios for vulnerable newborns and trends from 2008 to 2019. Paediatr Perinat Epidemiol 2023; 37:266-275. [PMID: 36938831 DOI: 10.1111/ppe.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Linked datasets that enable longitudinal assessments are scarce in low and middle-income countries. OBJECTIVES We aimed to assess the linkage of administrative databases of live births and under-five child deaths to explore mortality and trends for preterm, small (SGA) and large for gestational age (LGA) in Mexico. METHODS We linked individual-level datasets collected by National statistics from 2008 to 2019. Linkage was performed based on agreement on birthday, sex, residential address. We used the Centre for Data and Knowledge Integration for Health software to identify the best candidate pairs based on similarity. Accuracy was assessed by calculating the area under the receiver operating characteristic curve. We evaluated completeness by comparing the number of linked records with reported deaths. We described the percentage of linked records by baseline characteristics to identify potential bias. Using the linked dataset, we calculated mortality rate ratios (RR) in neonatal, infants, and children under-five according to gestational age, birthweight, and size. RESULTS For the period 2008-2019, a total of 24,955,172 live births and 321,165 under-five deaths were available for linkage. We excluded 1,539,046 records (6.2%) with missing or implausible values. We succesfully linked 231,765 deaths (72.2%: range 57.1% in 2009 and 84.3% in 2011). The rate of neonatal mortality was higher for preterm compared with term (RR 3.83, 95% confidence interval, CI 3.78, 3.88) and for SGA compared with appropriate for gestational age (AGA) (RR 1.22 95% CI, 1.19, 1.24). Births at <28 weeks had the highest mortality (RR 35.92, 95%CI, 34.97, 36.88). LGA had no additional risk vs AGA among children under five (RR 0.92, 95%CI, 0.90, 0.93). CONCLUSIONS We demonstrated the utility of linked data to understand neonatal vulnerability and child mortality. We created a linked dataset that would be a valuable resource for future population-based research.
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Affiliation(s)
| | - Robespierre Pita
- Centre of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil.,Computing Institute, Federal University of Bahia, Salvador, Brazil
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arturo Barranco
- Ministry of Health, Population and Health Information, Ministry of Health, Mexico City, Mexico
| | | | - Enny S Paixao
- Centre of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centre of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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11
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Costa MDCN, Cardim LL, Moore CA, de Jesus EDS, Carvalho-Sauer R, Barreto ML, Rodrigues LC, Smeeth L, Schuler-Faccini L, Brickley EB, Oliveira WK, Carmo EH, Pescarini JM, Andrade RFS, Rodrigues MMS, Veiga RV, Costa LC, França GVA, Teixeira MG, Paixão ES. Causes of death in children with congenital Zika syndrome in Brazil, 2015 to 2018: A nationwide record linkage study. PLoS Med 2023; 20:e1004181. [PMID: 36827251 PMCID: PMC9956022 DOI: 10.1371/journal.pmed.1004181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Children with congenital Zika syndrome (CZS) have severe damage to the peripheral and central nervous system (CNS), greatly increasing the risk of death. However, there is no information on the sequence of the underlying, intermediate, immediate, and contributing causes of deaths among these children. The aims of this study are describe the sequence of events leading to death of children with CZS up to 36 months of age and their probability of dying from a given cause, 2015 to 2018. METHODS AND FINDINGS In a population-based study, we linked administrative data on live births, deaths, and cases of children with CZS from the SINASC (Live Birth Information System), the SIM (Mortality Information System), and the RESP (Public Health Event Records), respectively. Confirmed and probable cases of CZS were those that met the criteria established by the Brazilian Ministry of Health. The information on causes of death was collected from death certificates (DCs) using the World Health Organization (WHO) DC template. We estimated proportional mortality (PM%) among children with CZS and among children with non-Zika CNS congenital anomalies (CA) by 36 months of age and proportional mortality ratio by cause (PMRc). A total of 403 children with confirmed and probable CZS who died up to 36 months of age were included in the study; 81.9% were younger than 12 months of age. Multiple congenital malformations not classified elsewhere, and septicemia unspecified, with 18 (PM = 4.5%) and 17 (PM = 4.2%) deaths, respectively, were the most attested underlying causes of death. Unspecified septicemia (29 deaths and PM = 11.2%) and newborn respiratory failure (40 deaths and PM = 12.1%) were, respectively, the predominant intermediate and immediate causes of death. Fetuses and newborns affected by the mother's infectious and parasitic diseases, unspecified cerebral palsy, and unspecified severe protein-caloric malnutrition were the underlying causes with the greatest probability of death in children with CZS (PMRc from 10.0 to 17.0) when compared to the group born with non-Zika CNS anomalies. Among the intermediate and immediate causes of death, pneumonitis due to food or vomiting and unspecified seizures (PMRc = 9.5, each) and unspecified bronchopneumonia (PMRc = 5.0) were notable. As contributing causes, fetus and newborn affected by the mother's infectious and parasitic diseases (PMRc = 7.3), unspecified cerebral palsy, and newborn seizures (PMRc = 4.5, each) were more likely to lead to death in children with CZS than in the comparison group. The main limitations of this study were the use of a secondary database without additional clinical information and potential misclassification of cases and controls. CONCLUSION The sequence of causes and circumstances involved in the deaths of the children with CZS highlights the greater vulnerability of these children to infectious and respiratory conditions compared to children with abnormalities of the CNS not related to Zika.
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Affiliation(s)
- Maria da Conceição N. Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luciana Lobato Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Cynthia A. Moore
- Goldbelt Professional Services, LLC, Chesapeake, Virginia, United States of America
| | - Eliene dos Santos de Jesus
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
- Municipal Health Department, Department of Health Information, Salvador, Bahia, Brazil
| | - Rita Carvalho-Sauer
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
- East Regional Health Center, State Health Secretariat of Bahia, Santo Antonio de Jesus, Bahia, Brazil
| | - Mauricio L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Laura C. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lavínia Schuler-Faccini
- Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Wanderson K. Oliveira
- Technical Directorate of Education and Research, Ministry of Defense Hospital das Armed Forces, Brasília, Distrito Federal, Brazil
| | - Eduardo Hage Carmo
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Secretariat of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Julia Moreira Pescarini
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto F. S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Physics Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Moreno M. S. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael V. Veiga
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Larissa C. Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Giovanny V. A. França
- Secretariat of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Maria Gloria Teixeira
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Enny S. Paixão
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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12
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Alves FJO, Ramos D, Paixão ES, Falcão IR, de Cássia Ribeiro-Silva R, Fiaccone R, Rasella D, Teixeira C, Machado DB, Rocha A, de Almeida MF, Goes EF, Rodrigues LC, Ichihara MY, Aquino EML, Barreto ML. Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort. JAMA Netw Open 2023; 6:e230070. [PMID: 36821115 PMCID: PMC9951038 DOI: 10.1001/jamanetworkopen.2023.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. OBJECTIVE To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. MAIN OUTCOME(S) AND MEASURES Maternal death. RESULTS A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. CONCLUSIONS AND RELEVANCE This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.
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Affiliation(s)
- Flávia Jôse O. Alves
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Dandara Ramos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Enny S. Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ila R. Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Rosemeire Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Camila Teixeira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Daiane Borges Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Aline Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | | | - Emanuelle F. Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Laura C. Rodrigues
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Maurício L. Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
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13
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Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol. PLoS One 2022; 17:e0268500. [PMID: 35604890 PMCID: PMC9126365 DOI: 10.1371/journal.pone.0268500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood. METHODS We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012. DISCUSSION Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.
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14
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Barreto ML, Ichihara MY, Pescarini JM, Ali MS, Borges GL, Fiaccone RL, Ribeiro-Silva RDC, Teles CA, Almeida D, Sena S, Carreiro RP, Cabral L, Almeida BA, Barbosa GCG, Pita R, Barreto ME, Mendes AAF, Ramos DO, Brickley EB, Bispo N, Machado DB, Paixao ES, Rodrigues LC, Smeeth L. Cohort Profile: The 100 Million Brazilian Cohort. Int J Epidemiol 2022; 51:e27-e38. [PMID: 34922344 PMCID: PMC9082797 DOI: 10.1093/ije/dyab213] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Julia M Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - M Sanni Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Center for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Gabriela L Borges
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Rosemeire L Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Carlos A Teles
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Daniela Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Samila Sena
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Roberto P Carreiro
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Liliana Cabral
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Bethania A Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - George C G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Robespierre Pita
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Marcos E Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Statistics, London School of Economics and Political Science, London, UK
| | - Andre A F Mendes
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Dandara O Ramos
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Elizabeth B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nivea Bispo
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Daiane B Machado
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Enny S Paixao
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura C Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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15
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Machado DB, Williamson E, Pescarini JM, Alves FJO, Castro-de-Araujo LFS, Ichihara MY, Rodrigues LC, Araya R, Patel V, Barreto ML. Relationship between the Bolsa Família national cash transfer programme and suicide incidence in Brazil: A quasi-experimental study. PLoS Med 2022; 19:e1004000. [PMID: 35584178 PMCID: PMC9162363 DOI: 10.1371/journal.pmed.1004000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 06/02/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socioeconomic factors have been consistently associated with suicide, and economic recessions are linked to rising suicide rates. However, evidence on the impact of socioeconomic interventions to reduce suicide rates is limited. This study investigates the association of the world's largest conditional cash transfer programme with suicide rates in a cohort of half of the Brazilian population. METHODS AND FINDINGS We used data from the 100 Million Brazilian Cohort, covering a 12-year period (2004 to 2015). It comprises socioeconomic and demographic information on 114,008,317 individuals, linked to the "Bolsa Família" programme (BFP) payroll database, and nationwide death registration data. BFP was implemented by the Brazilian government in 2004. We estimated the association of BFP using inverse probability of treatment weighting, estimating the weights for BFP beneficiaries (weight = 1) and nonbeneficiaries by the inverse probability of receiving treatment (weight = E(ps)/(1-E(ps))). We used an average treatment effect on the treated (ATT) estimator and fitted Poisson models to estimate the incidence rate ratios (IRRs) for suicide associated with BFP experience. At the cohort baseline, BFP beneficiaries were younger (median age 27.4 versus 35.4), had higher unemployment rates (56% versus 32%), a lower level of education, resided in rural areas, and experienced worse household conditions. There were 36,742 suicide cases among the 76,532,158 individuals aged 10 years, or older, followed for 489,500,000 person-years at risk. Suicide rates among beneficiaries and nonbeneficiaries were 5.4 (95% CI = 5.32, 5.47, p < 0.001) and 10.7 (95% CI = 10.51, 10.87, p < 0.001) per 100,000 individuals, respectively. BFP beneficiaries had a lower suicide rate than nonbeneficiaries (IRR = 0.44, 95% CI = 0.42, 0.45, p < 0.001). This association was stronger among women (IRR = 0.36, 95% CI = 0.33, 0.38, p < 0.001), and individuals aged between 25 and 59 (IRR = 0.41, 95% CI = 0.40, 0.43, p < 0.001). Study limitations include a lack of control for previous mental disorders and access to means of suicide, and the possible under-registration of suicide cases due to stigma. CONCLUSIONS We observed that BFP was associated with lower suicide rates, with similar results in all sensitivity analyses. These findings should help to inform policymakers and health authorities to better design suicide prevention strategies. Targeting social determinants using cash transfer programmes could be important in limiting suicide, which is predicted to rise with the economic recession, consequent to the Coronavirus Disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Daiane Borges Machado
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Elizabeth Williamson
- Department of Medical Statistics and Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Julia M. Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Medical Statistics and Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Flavia J. O. Alves
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Luís F. S. Castro-de-Araujo
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Psychiatry, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Laura C. Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Medical Statistics and Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, United Kingdom
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Chan School of Public Health, Harvard, United States of America
| | - Maurício L. Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
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16
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Rocha AS, de Cássia Ribeiro-Silva R, Fiaccone RL, Paixao ES, Falcão IR, Alves FJO, Silva NJ, Ortelan N, Rodrigues LC, Ichihara MY, de Almeida MF, Barreto ML. Differences in risk factors for incident and recurrent preterm birth: a population-based linkage of 3.5 million births from the CIDACS birth cohort. BMC Med 2022; 20:111. [PMID: 35392917 PMCID: PMC8991880 DOI: 10.1186/s12916-022-02313-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Preterm birth (PTB) is a syndrome resulting from a complex list of underlying causes and factors, and whether these risk factors differ in the context of prior PTB history is less understood. The aim of this study was to explore whether PTB risk factors in a second pregnancy were different in women with versus without previous PTB. METHODS We conducted a population-based cohort study using data from the birth cohort of the Center for Data and Knowledge Integration for Health (CIDACS) for the period 2001 to 2015. We used longitudinal transition models with multivariate logistic regression to investigate whether risk factors varied between incident and recurrent PTB. RESULTS A total of 3,528,050 live births from 1,764,025 multiparous women were analyzed. We identified different risk factors (Pdifference <0.05) between incident and recurrent PTB. The following were associated with an increased chance for PTB incidence, but not recurrent: household overcrowding (OR 1.09), maternal race/ethnicity [(Black/mixed-OR 1.04) and (indigenous-OR 1.34)], young maternal age (14 to 19 years-OR 1.16), and cesarean delivery (OR 1.09). The following were associated with both incident and recurrent PTB, respectively: single marital status (OR 0.85 vs 0.90), reduced number of prenatal visits [(no visit-OR 2.56 vs OR 2.16) and (1 to 3 visits-OR 2.44 vs OR 2.24)], short interbirth interval [(12 to 23 months-OR 1.04 vs OR 1.22) and (<12 months, OR 1.89, 95 vs OR 2.58)], and advanced maternal age (35-49 years-OR 1.42 vs OR 1.45). For most risk factors, the point estimates were higher for incident PTB than recurrent PTB. CONCLUSIONS The risk factors for PTB in the second pregnancy differed according to women's first pregnancy PTB status. The findings give the basis for the development of specific prevention strategies for PTB in a subsequent pregnancy.
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Affiliation(s)
- Aline S Rocha
- School of Nutrition, Federal University of Bahia, Salvador, Brazil. .,Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Enny S Paixao
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ila R Falcão
- School of Nutrition, Federal University of Bahia, Salvador, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Flavia Jôse O Alves
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Natanael J Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Barcelona Institute for Global Health, Hospital Clínic, Barcelona, Spain
| | - Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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17
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Shaw RJ, Harron KL, Pescarini JM, Pinto Junior EP, Allik M, Siroky AN, Campbell D, Dundas R, Ichihara MY, Leyland AH, Barreto ML, Katikireddi SV. Biases arising from linked administrative data for epidemiological research: a conceptual framework from registration to analyses. Eur J Epidemiol 2022; 37:1215-1224. [PMID: 36333542 PMCID: PMC9792414 DOI: 10.1007/s10654-022-00934-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Abstract
Linked administrative data offer a rich source of information that can be harnessed to describe patterns of disease, understand their causes and evaluate interventions. However, administrative data are primarily collected for operational reasons such as recording vital events for legal purposes, and planning, provision and monitoring of services. The processes involved in generating and linking administrative datasets may generate sources of bias that are often not adequately considered by researchers. We provide a framework describing these biases, drawing on our experiences of using the 100 Million Brazilian Cohort (100MCohort) which contains records of more than 131 million people whose families applied for social assistance between 2001 and 2018. Datasets for epidemiological research were derived by linking the 100MCohort to health-related databases such as the Mortality Information System and the Hospital Information System. Using the framework, we demonstrate how selection and misclassification biases may be introduced in three different stages: registering and recording of people's life events and use of services, linkage across administrative databases, and cleaning and coding of variables from derived datasets. Finally, we suggest eight recommendations which may reduce biases when analysing data from administrative sources.
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Affiliation(s)
- Richard J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK.
| | - Katie L Harron
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elzo Pereira Pinto Junior
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mirjam Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Andressa N Siroky
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Departamento de Estatística, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Desmond Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
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18
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Rocha AS, de Cássia Ribeiro-Silva R, Paixao ES, Falcão IR, Alves FJO, Ortelan N, de Almeida MF, Fiaccone RL, Rodrigues LC, Ichihara MY, Barreto ML. Recurrence of preterm births: A population-based linkage with 3.5 million live births from the CIDACS Birth Cohort. Int J Gynaecol Obstet 2021; 158:605-612. [PMID: 34854081 PMCID: PMC7613286 DOI: 10.1002/ijgo.14053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the recurrence of preterm birth (PTB) among the poorest half of the Brazilian population. METHODS A population-based retrospective study was conducted in Brazil with the live births of multiparous women extracted from the CIDACS Birth Cohort between 2001 and 2015. We used multivariate logistic regression to estimate the odds of recurrent PTB in second and third births. RESULTS A total of 3 528 050 live births from 1 764 025 multiparous women were analyzed. The adjusted odds for the occurrence of a PTB given a previous PTB was 2.58 (95% confidence interval [CI] 2.53-2.62). Lower gestational age increased the odds of a subsequent PTB (<28 weeks: adjusted OR [aOR] 3.61, 95% CI 3.41-3.83; 28-31 weeks: aOR 3.34, 95% CI 3.19-3.49; and 32-36 weeks: aOR 2.42, 95% CI 2.38-2.47). Women who had two previous PTBs were at high risk of having a third (aOR 4.98, 95% CI 4.70-5.27). Recurrence of PTB was more likely when the inter-birth interval was less than 12 months. CONCLUSION In Brazil, a middle-income country, women with a previous PTB had an increased risk of a subsequent one. This association was affected by gestational age, the number of PTBs, severity of previous PTBs, and a short interval between births.
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Affiliation(s)
- Aline S Rocha
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Enny S Paixao
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ila R Falcão
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Flavia Jôse O Alves
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Laura C Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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19
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Paixao ES, Bottomley C, Pescarini JM, Wong KLM, Cardim LL, Ribeiro Silva RDC, Brickley EB, Rodrigues LC, Oliveira Alves FJ, Leal MDC, Costa MDCN, Teixeira MG, Ichihara MY, Smeeth L, Barreto ML, Campbell OMR. Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil. PLoS Med 2021; 18:e1003791. [PMID: 34637451 PMCID: PMC8509988 DOI: 10.1371/journal.pmed.1003791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. METHODS AND FINDINGS We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. CONCLUSIONS In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.
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Affiliation(s)
- Enny S. Paixao
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- * E-mail:
| | - Christian Bottomley
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julia M. Pescarini
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Kerry L. M. Wong
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luciana L. Cardim
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro Silva
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Nutrition School, Federal University of Bahia, Salvador, Brazil
| | - Elizabeth B. Brickley
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laura C. Rodrigues
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Maria do Carmo Leal
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria da Conceicao N. Costa
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Gloria Teixeira
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Liam Smeeth
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Oona M. R. Campbell
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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20
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Paixao ES, Cardim LL, Falcao IR, Ortelan N, Silva NDJ, Rocha ADS, Sena S, Almeida D, Ramos DO, Alves FJO, Bispo N, Ali S, Fiaccone R, Rodrigues M, Smeeth L, Brickley EB, Cabral L, Teles C, Costa MCN, Ichihara MY, Barreto ML, Silva RDCR, Teixeira MG. Cohort Profile: Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS) Birth Cohort. Int J Epidemiol 2021; 50:37-38. [PMID: 33378472 PMCID: PMC7938509 DOI: 10.1093/ije/dyaa255] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Enny S Paixao
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Luciana L Cardim
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Ila Rocha Falcao
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Escola de Nutrição, Universidade Federal da Bahia, Salvador, Brazil
| | - Naiá Ortelan
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | | | - Aline dos Santos Rocha
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Escola de Nutrição, Universidade Federal da Bahia, Salvador, Brazil
| | - Samila Sena
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Daniela Almeida
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Dandara Oliveira Ramos
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Flávia Jôse Oliveira Alves
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Nívea Bispo
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Departamento de Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sanni Ali
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Rosemeire Fiaccone
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Departamento de Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Moreno Rodrigues
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Liam Smeeth
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth B Brickley
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liliana Cabral
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Carlos Teles
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Maria Conceição N Costa
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Rita de Cássia Ribeiro Silva
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Escola de Nutrição, Universidade Federal da Bahia, Salvador, Brazil
| | - Maria Gloria Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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21
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N. Costa MC, Cardim LL, Teixeira MG, Barreto ML, de Carvalho-Sauer RDCO, R. Barreto F, Itaparica Carvalho MS, Oliveira WK, França GVA, Carmo EH, Andrade RFS, Rodrigues MS, Veiga RV, Oliveira JF, Fernandes QHRF, Costa LC, Coelho GE, Paixao ES. Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †. Viruses 2020; 12:v12111228. [PMID: 33138282 PMCID: PMC7692842 DOI: 10.3390/v12111228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child's health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child-maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015-2017. METHODS Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. RESULTS The microcephaly/CZS case fatality rate was 10% (95% CI 9.2-10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63-2.83), and very low birth weight (OR = 3.77; 95% CI 2.20-6.46); late preterm births (OR = 1.65; 95% CI 1.21-2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46-8.02) and 5th minutes (OR = 4.13; 95% CI 2.78-6.13), among others. CONCLUSIONS A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.
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Affiliation(s)
- Maria Conceição N. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Luciana Lobato Cardim
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Maria Gloria Teixeira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Mauricio L. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Rita de Cassia Oliveira de Carvalho-Sauer
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
- East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus, Bahia ZC 44570-550, Brazil
| | - Florisneide R. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Martha Suely Itaparica Carvalho
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Municipal Health Secretariat of Salvador, Bahia ZC 40010-010, Brazil
| | - Wanderson K. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Technical Directorate of Education and Research, Ministry of Defense Hospital das Armed Forces, Brasília ZC 70675-731, Brazil
| | - Giovanny V. A. França
- Secretariat of Health Surveillance, Ministry of Health, Brasilia ZC 70070-040, Brazil;
| | - Eduardo Hage Carmo
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Roberto F. S. Andrade
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Physics Institute, Federal University of Bahia, Salvador, Bahia ZC 40210-340, Brazil
| | - Moreno S. Rodrigues
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Rafael V. Veiga
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Juliane F. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | | | - Larissa C. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Giovanini E. Coelho
- Department of Communicable Diseases and Environmental Determinants of Health, Neglected, Tropical and Vector-Borne Diseases, Pan-American Health Organization/World Health Organization, Washington, WA 20037, USA;
| | - Enny S. Paixao
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Correspondence:
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