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. 2022 Jun 20;22(1):1226.
doi: 10.1186/s12889-022-13629-4.

Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns

Ana Sílvia Scavacini Marinonio  1 , Daniela Testoni Costa-Nobre  2 , Milton Harumi Miyoshi  2 , Rita de Cassia Xavier Balda  2 , Kelsy Catherina Nema Areco  2 , Tulio Konstantyner  2 , Mandira Daripa Kawakami  2 , Adriana Sanudo  2 , Paulo Bandiera-Paiva  2 , Rosa Maria Vieira de Freitas  3 , Lilian Cristina Correia Morais  3 , Mônica La Porte Teixeira  3 , Bernadette Cunha Waldvogel  3 , Maria Fernanda Branco de Almeida  2 , Ruth Guinsburg  2 , Carlos Roberto Veiga Kiffer  2
Affiliations

Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns

Ana Sílvia Scavacini Marinonio et al. BMC Public Health. .

Abstract

Background: Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015. METHODS: Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥ 400 g, without congenital anomalies from mothers living in São Paulo State, Brazil, during 2004-2015. RDS-associated neonatal mortality was defined as deaths < 28 days with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality and preterm live births rates per municipality were submitted to first- and second-order spatial analysis before and after smoothing using local Bayes estimates. Spearman test was applied to identify the correlation pattern between both rates.

Results: Six hundred forty-five thousand two hundred seventy-six preterm live births and 11,078 RDS-associated neonatal deaths in São Paulo State, Brazil, during the study period were analyzed. After smoothing, a non-random spatial distribution of preterm live births rate (I = 0.78; p = 0.001) and RDS-associated neonatal mortality rate (I = 0.73; p = 0.001) was identified. LISA maps confirmed clusters for both, with a negative correlation (r = -0.24; p = 0.0000). Clusters of high RDS-associated neonatal mortality rates overlapping with clusters of low preterm live births rates were detected.

Conclusions: Asymmetric cluster distribution of preterm live births and RDS-associated neonatal deaths may be helpful to indicate areas for perinatal healthcare improvement.

Keywords: Epidemiological Studies; Infant; Neonatal Mortality; Newborn; Population; Premature; Respiratory Distress Syndrome; Spatial Distribution.

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Conflict of interest statement

The authors declare that they have no competing interests. Database use was possible due to FAPESP (Project # 2017/03748–7) and due to agreements #23089.004297/2008–11 and #23089.000057/2014–95 between Fundação SEADE and Universidade Federal de São Paulo.

Figures

Fig. 1
Fig. 1
Location of São Paulo State and its municipalities in Brazil, and America. A American Continent; B Brazil; C São Paulo State and its municipalities
Fig. 2
Fig. 2
Flowchart of the studied population. BW Birthweight, GA Gestational age, RDS Respiratory distress syndrome
Fig. 3
Fig. 3
Distribution of preterm live birth and RDS-associated neonatal mortality rates. Data from 645 municipalities after smoothing using local Bayes estimate. A Lisa Cluster Map of preterm live births rates; B Lisa Cluster Map of RDS-associated neonatal mortality rates
Fig. 4
Fig. 4
Spearman rank correlation of preterm live birth rates versus RDS-associated neonatal mortality rates
Fig. 5
Fig. 5
Map with asymmetries of clusters between preterm live birth rates and RDS-associated neonatal mortality rates
See this image and copyright information in PMC

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