Social determinants of gastrointestinal malformation mortality in Brazil: a national study

Abstract

Introduction: In Brazil, approximately 5% are born with a congenital disorder, potentially fatal without surgery. This study aims to evaluate the relationship between gastrointestinal congenital malformation (GICM) mortality, health indicators, and socioeconomic factors in Brazil.

Methods: GICM admissions (Q39-Q45) between 2012 and 2019 were collected using national databases. Patient demographics, socioeconomic factors, clinical management, outcomes, and the healthcare workforce density were also accounted for. Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed 'NeoSurg'. Socioeconomic variables were combined to create a socioeconomic index termed 'SocEcon'. Simple linear regression was used to investigate if the temporal changes of both indexes were significant. The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient.

Results: Over 8 years, Brazil recorded 12804 GICM admissions. The Southeast led with 6147 cases, followed by the Northeast (2660), South (1727), North (1427), and Midwest (843). The North and Northeast reported the highest mortality, lowest NeoSurg, and SocEcon Index rates. Nevertheless, mortality rates declined across regions from 7.7% (2012) to 3.9% (2019), a 51.7% drop. The North and Midwest experienced the most substantial reductions, at 63% and 75%, respectively. Mortality significantly correlated with the indexes in nearly all regions (p<0.05).

Conclusion: Our study highlights the correlation between social determinants of health and GICM mortality in Brazil, using two novel indexes in the pediatric population. These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally.

Keywords: Neonatal Screening; Neonatology; Patient Outcome Assessment; Pediatrics; Schools, Public Health.

Figure 1

Number of gastrointestinal congenital anomaly diagnosis per 1000 live births, by region, from 2012 to 2019.

Figure 2

Temporal variation and indicators of mortality due to GICM from 2012 to 2019. This figure illustrates the annual variation in mortality rates associated with GICM across Brazil and its regions, alongside the developed NeoSurg and SocEcon indicators. The left y-axis pertains to the mortality rates, while the right y-axis reflects the values for the NeoSurg and SocEcon Indexes. Each panel represents a different geographical area, arranged as follows: Brazil (A), NorthEast (B), South (C), North (D), South East (E) and MidWest (F). GICM, gastrointestinal congenital malformation; NeoSurg, Neonatal Surgical Care Index; SocEcon, Childhood Related Socio-Economic Index.