Social inequalities in perinatal mortality in Belo Horizonte, Brazil: the role of hospital care.
OBJECTIVE
We examined the contribution of hospital type and quality of care to perinatal mortality rates in the city of Belo Horizonte, Brazil.


METHODS
We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in1999. After adjusting for maternal education and birthweight, we compared mortality rates according to hospital category--defined by a hospital's relation to the national Universal Public Health System (SUS)--and quality of care. We used the Wigglesworth Classification to examine perinatal deaths.


RESULTS
After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS-contracted hospitals (relative to private, non-SUS-contracted hospitals). Hospital quality was also directly associated with perinatal death rates. Mortality rates were especially high for normal-birthweight babies born in private SUS-contracted hospitals. Intrapartum asphyxia was the leading cause of preventable death.


CONCLUSIONS
In a class-segregated health care system, such as Brazil's, disparities in quality of care between SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality.
Lansky
Sônia
S
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass, USA. slansky@uol.com.br
França
Elisabeth
E
Kawachi
Ichiro
I
D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D016304:Hospitals, Private / Q000592:standards / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D011787:Quality of Health Care; D013222:State Medicine / Q000592:standards* / Q000706:statistics & numerical data