Early neonatal mortality according to hospital provider in metropolitan region of São Paulo, Brazil, 2009
METHODS: retrospective cohort study of 304,616 live births (LB). Databases of LB and death certificates and hospital data were linked through the deterministic linkage technique. The hospitals were classified in public or private system. We analyzed the maternal characteristics and calculated early neonatal mortality rate and the relative risk (RR) according the type of hospital of birth.
RESULTS: there was 191,820 (63%) LB in public hospitals and 112,796 (37%) in private. Public hospitals have higher proportions of mothers with low schooling, adolescents, high parity and inadequate prenatal care. Private hospitals have higher proportions of older and white mothers and cesarean deliveries. The overall early neonatal mortality rate was 5.56%o LB and it was 63% higher (6.49%o LB; RR=1.63, 1.47-1.82) in public than in the private system (3.97%o LB). The mortality rate decreases as birth weight increases, although the highest risk remains among the newborns of public hospitals. The mortality differential is lower among the infants in the <1500g LB group (RR=1.32; 1.17-1.50). This differential is even smaller and not statistically significant in 1500-2499g group (RR=1.19;0.93-1.51). The mortality rate of infants ≥2.500g was twice higher (RR=2.03;1.57-2.63) in public hospitals.
CONCLUSIONS: The public health system is responsible for an expressive part of delivery and neonatal care in metropolitan region of São Paulo, attends mothers with worse socioeconomics conditions and presented better results when attending high risk LB (<1500 g). Socioeconomic differences of mothers profile may become more evident in the lower risk of death group (≥2500g) as well as may exist also problems in the quality of care in public system. These results showed the necessity of improvement in delivery and neonatal care.