Palabras clave
Mortalidad infantil
peso al nacer
disparidades en el Estado de Salud
estadísticas vitales
análisis espacio-temporal
Colombia
peso al nacer
disparidades en el Estado de Salud
estadísticas vitales
análisis espacio-temporal
Colombia
Cómo citar
Rojas-Gualdrón, D. F., Velásquez-Ospina, J., Tejada-Tobón, M., & Pineda-Sánchez, J. (2020). Distribución geográfica del cambio en mortalidad neonatal según bajo peso al nacer, Colombia 2008-2017. Salud UIS, 52(2), 119–128. https://doi.org/10.18273/revsal.v52n2-2020006
Resumen
Introducción. Reducir las desigualdades sociales y geográficas en mortalidad neonatal es propósito de la agenda del desarrollo sostenible. Objetivo: Analizar la tendencia geográfica a nivel departamental del cambio en la mortalidad neonatal según bajo peso en Colombia entre 2008 y 2017. Metodología: Estudio ecológico basado en registros de estadísticas vitales del DANE. Mediante el modelo lineal mixto generalizado se analizaron de forma conjunta mortalidad neonatal y diferencias absoluta y relativa según bajo peso al nacer siguiendo la tipología de Blakely. La variación geográfica entre departamentos se analizó mediante Medianas de Razón de Mortalidad (MRM) y mapas. Resultados: A nivel nacional entre 2008-2010 y 2015-2017 la mortalidad neonatal ajustada disminuyó en 0,67 (IC95% 0,52-0,81) muertes y el exceso de muertes entre nacidos de bajo peso en 4,92 (IC95% 3,53-6,33) muertes por cada mil nacidos vivos; la razón de mortalidad no varió entre periodos (RRM 1,03; IC95% 0,97-1,09). Este patrón de cambio es deseable según tipología de Blakely. Sin embargo, en diez departamentos la mortalidad y diferencias según bajo peso no disminuyeron. Durante el periodo 2015-2017 la variación departamental en mortalidad neonatal fue de MRM = 2,13 (IC95% 1,63-2,64) sin cambio entre periodos; la mortalidad neonatal fue mayor en departamentos periféricos. Conclusión: Pese a los avances a nivel nacional en reducción de la mortalidad neonatal, un tercio de los departamentos donde se registró una cuarta parte de los nacimientos no mostró cambios deseables. La alta variabilidad territorial observada plantea la necesidad de implementar estrategias de vigilancia e intervención con foco tanto en factores perinatales como en locación geográfica para lograr disminuir brechas en supervivencia del recién nacido.
Referencias
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11. Bhutta ZA. Mapping the geography of child mortality: a key step in addressing disparities. Lancet Glob Health. 2016;4(12): e877-e878. doi: https://doi.org/10.1016/S2214-109X(16)30264-9.
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14. Blume JD, Greevy RA, Welty VF, Smith JR, Dupont WD. An Introduction to Second-Generation p -Values. Am Stat. 2019;73(sup1):157-67. https:// doi.org/10.1080/00031305.2018.1537893.
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18. Siahanidou T, Dessypris N, Analitis A, Mihas C, Evangelou E, Chrousos G, et al. Disparities of infant and neonatal mortality trends in Greece during the years of economic crisis by ethnicity, place of residence and human development index: a nationwide population study. BMJ Open. 2019; 9(8): e025287. doi: http://dx.doi.org/10.1136/ bmjopen-2018-025287.
19. Adewuyi EO, Zhao Y. Determinants of neonatal mortality in rural and urban Nigeria: Evidence from a population-based national survey. Pediatr Int Off J Jpn Pediatr Soc. 2017; 59(2): 190-200. doi: http:// dx.doi.org/10.1111/ped.13086.
20. Dettrick Z, Jimenez-Soto E, Hodge A. Socioeconomic and geographical disparities in under-five and neonatal mortality in Uttar Pradesh, India. Matern Child Health J. 2014;18(4): 960-969. doi: http://dx.doi.org/10.1007/s10995-013-1324-8.
21. Kayode GA, Ansah E, Agyepong IA, Amoakoh- Coleman M, Grobbee DE, Klipstein-Grobusch K. Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis. BMC Pregnancy Childbirth. 2014; 14(1): 1-22. doi: http:// dx.doi.org/10.1186/1471-2393-14-165.
22. Almeida MCS, Gomes CMS, Nascimento LFC. Spatial analysis of neonatal mortality in the state of São Paulo, 2006-2010. Rev Paul Pediatr. 2014; 32(4): 374-380. doi: http://dx.doi.org/10.1590/ S0103-05822014000400014.
23. Dai D. Black residential segregation, disparities in spatial access to health care facilities, and late-stage breast cancer diagnosis in metropolitan Detroit. Health Place. 2010; 16(5):1038-1052. doi: http:// dx.doi.org/10.1016/j.healthplace.2010.06.012.
24. Luo J, Tian L, Luo L, Yi H, Wang F. Two-step optimization for spatial accessibility improvement: a case study of health care planning in rural China. Biomed Res Int. 2017; 2094654. doi: http://dx.doi. org/10.1155/2017/2094654.
25. Panciera R, Khan A, Rizvi SJR, Ahmed S, Ahmed T, Islam R, et al. The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study. BMC Pregnancy Childbirth. 2016; 16: 240. doi: http:// dx.doi.org/10.1186/s12884-016-1032-7.
26. Maredza M, Chola L, Hofman K. Economic evaluations of interventions to reduce neonatal morbidity and mortality: a review of the evidence in LMICs and its implications for South Africa. Cost Eff Resour Alloc. 2016; 14(1): 2. doi: http://dx.doi. org/10.1186/s12962-015-0049-5.
27. Marmot Michael. An inverse care law for our time BMJ 2018; 362: k3216. https://doi.org/10.1136/ bmj.k3216.
28. Cendales R, Pardo C. Quality of death certification in Colombia. Colomb Médica. 2018;121-7. https:// doi.org/10.25100/cm.v49i1.3155.
29. Ribotta B, Salazar L, Bertone C. Evaluaciones subnacionales de la cobertura de las estadísticas vitales. Estudios recientes en América Latina. Rev Gerenc Polit Salud. 2018;18(36). doi: https://doi. org/10.11144/Javeriana.rgps18-36.esce.
30. Rodríguez Morales MM. La invisibilidad estadística étnico-racial negra, afrocolombiana, raizal y palenquera en Colombia. Trab Soc. 2010;12: 89-99.
31. Mikkelsen L, Phillips DE, AbouZahr C, Setel PW, de Savigny D, Lozano R, et al. A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet. 2015; 386(10001): 1395-1406. doi: https://doi.org/10.1016/S0140-6736(15)60171-4.
32. Phillips DE, Adair T, Lopez AD. How useful are registered birth statistics for health and social policy? A global systematic assessment of the availability and quality of birth registration data. Popul Health Metrics. 2018; 16(1):21. doi: https:// doi.org/10.1186/s12963-018-0180-6.
33. Peralta A, Benach J, Espinel-Flores V, Gotsens M, Borrell C, Marí-Dell’Olmo M. Studying Geographic Inequalities in Mortality in Contexts with Deficient Data Sources: Lessons from Ecuador. Epidemiology. 2020; 31(2): 290-300. doi: https://doi.org/10.1097/ EDE.0000000000001146.
34. Marmot M, Bell R. Social inequalities in health: a proper concern of epidemiology. Ann Epidemiol. 2016; 26(4): 238-240. doi: https://doi.org/10.1016/j. annepidem.2016.02.003.
2. Hug L, Alexander M, You D, Alkema L. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health. 2019; 7(6): e710-720. doi: https://doi.org/10.1016/S2214-109X(19)30163-9.
3. Save the Children Fund (Great Britain). Surviving the first day: state of the world’s mothers 2013. London: Save the Children; 2013. https://www. savethechildren.org/content/dam/usa/reports/ advocacy/sowm/sowm-2013.pdf.
4. Blencowe H, Krasevec J, de Onis M, Black RE, An X, Stevens GA, et al. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2019; 7(7): e849-860. doi: https://doi. org/10.1016/S2214-109X(18)30565-5.
5. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet. 2014; 384(9940): 347-370. doi: https://doi.org/10.1016/ S0140-6736(14)60792-3.
6. Wang H, Bhutta ZA, Coates MM, Coggeshall M, Dandona L, Diallo K, et al. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016; 388(10053): 1725-1774. doi: https://doi. org/10.1016/S0140-6736(16)31575-6.
7. Naciones Unidas. Informe de los objetivos del desarrollo sostenible, 2017. Santiago: ONU; 2017.https://unstats.un.org/sdgs/files/report/2017/ TheSustainableDevelopmentGoalsReport2017_ Spanish.pdf.
8. Straney LD, Lim SS, Murray CJL. Disentangling the effects of risk factors and clinical care on subnational variation in early neonatal mortality in the United States. PloS One. 2012; 7(11): e49399. doi: https://doi.org/10.1371/journal.pone.0049399.
9. Padilla CM, Kihal-Talantikit W, Vieira VM, Deguen S. City-specific spatiotemporal infant and neonatal mortality clusters: links with socioeconomic and air pollution spatial patterns in France. Int J Environ Res Public Health. 2016; 13(6). pii: E624. doi: https://doi.org/ 10.3390/ijerph13060624.
10. Rojas-Gualdrón DF, Caicedo B. Geographical accessibility to obstetric and neonatal care and its effect on early neonatal mortality in Colombia, 2012-2014. MedUnab. 2017; 20(1): 7-18.
11. Bhutta ZA. Mapping the geography of child mortality: a key step in addressing disparities. Lancet Glob Health. 2016;4(12): e877-e878. doi: https://doi.org/10.1016/S2214-109X(16)30264-9.
12. Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLOS Med. 2015; 12(10): e1001885. doi: https://doi. org/10.1371/journal.pone.0125620.
13. Blakely T, Disney G, Atkinson J, Teng A, Mackenbach JP. A typology for charting socioeconomic mortality gradients: «Go south-west». Epidemiology. 2017; 28(4):594-603. https:// doi.org/10.1097/EDE.0000000000000671.
14. Blume JD, Greevy RA, Welty VF, Smith JR, Dupont WD. An Introduction to Second-Generation p -Values. Am Stat. 2019;73(sup1):157-67. https:// doi.org/10.1080/00031305.2018.1537893.
15. Lian M. Statistical significance of geographic heterogeneity measures in spatial epidemiologic studies. Open J Stat. 2015; 5: 46-50. https://doi.org/ 10.4236/ojs.2015.51006.
16. Austin PC, Stryhn H, Leckie G, Merlo J. Measures of clustering and heterogeneity in multilevel Poisson regression analyses of rates/count data. Stat Med. 2018;37(4):572-89. https://doi.org/10.1002/ sim.7532.
17. Rodrigues NCP, Monteiro DLM, Almeida AS de, Barros MB de L, Pereira Neto A, O’Dwyer G, et al. Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997-2012. J Pediatr (Rio J). 2016; 92(6): 567-573. doi: http:// dx.doi.org/10.1016/j.jped.2016.03.004.
18. Siahanidou T, Dessypris N, Analitis A, Mihas C, Evangelou E, Chrousos G, et al. Disparities of infant and neonatal mortality trends in Greece during the years of economic crisis by ethnicity, place of residence and human development index: a nationwide population study. BMJ Open. 2019; 9(8): e025287. doi: http://dx.doi.org/10.1136/ bmjopen-2018-025287.
19. Adewuyi EO, Zhao Y. Determinants of neonatal mortality in rural and urban Nigeria: Evidence from a population-based national survey. Pediatr Int Off J Jpn Pediatr Soc. 2017; 59(2): 190-200. doi: http:// dx.doi.org/10.1111/ped.13086.
20. Dettrick Z, Jimenez-Soto E, Hodge A. Socioeconomic and geographical disparities in under-five and neonatal mortality in Uttar Pradesh, India. Matern Child Health J. 2014;18(4): 960-969. doi: http://dx.doi.org/10.1007/s10995-013-1324-8.
21. Kayode GA, Ansah E, Agyepong IA, Amoakoh- Coleman M, Grobbee DE, Klipstein-Grobusch K. Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis. BMC Pregnancy Childbirth. 2014; 14(1): 1-22. doi: http:// dx.doi.org/10.1186/1471-2393-14-165.
22. Almeida MCS, Gomes CMS, Nascimento LFC. Spatial analysis of neonatal mortality in the state of São Paulo, 2006-2010. Rev Paul Pediatr. 2014; 32(4): 374-380. doi: http://dx.doi.org/10.1590/ S0103-05822014000400014.
23. Dai D. Black residential segregation, disparities in spatial access to health care facilities, and late-stage breast cancer diagnosis in metropolitan Detroit. Health Place. 2010; 16(5):1038-1052. doi: http:// dx.doi.org/10.1016/j.healthplace.2010.06.012.
24. Luo J, Tian L, Luo L, Yi H, Wang F. Two-step optimization for spatial accessibility improvement: a case study of health care planning in rural China. Biomed Res Int. 2017; 2094654. doi: http://dx.doi. org/10.1155/2017/2094654.
25. Panciera R, Khan A, Rizvi SJR, Ahmed S, Ahmed T, Islam R, et al. The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study. BMC Pregnancy Childbirth. 2016; 16: 240. doi: http:// dx.doi.org/10.1186/s12884-016-1032-7.
26. Maredza M, Chola L, Hofman K. Economic evaluations of interventions to reduce neonatal morbidity and mortality: a review of the evidence in LMICs and its implications for South Africa. Cost Eff Resour Alloc. 2016; 14(1): 2. doi: http://dx.doi. org/10.1186/s12962-015-0049-5.
27. Marmot Michael. An inverse care law for our time BMJ 2018; 362: k3216. https://doi.org/10.1136/ bmj.k3216.
28. Cendales R, Pardo C. Quality of death certification in Colombia. Colomb Médica. 2018;121-7. https:// doi.org/10.25100/cm.v49i1.3155.
29. Ribotta B, Salazar L, Bertone C. Evaluaciones subnacionales de la cobertura de las estadísticas vitales. Estudios recientes en América Latina. Rev Gerenc Polit Salud. 2018;18(36). doi: https://doi. org/10.11144/Javeriana.rgps18-36.esce.
30. Rodríguez Morales MM. La invisibilidad estadística étnico-racial negra, afrocolombiana, raizal y palenquera en Colombia. Trab Soc. 2010;12: 89-99.
31. Mikkelsen L, Phillips DE, AbouZahr C, Setel PW, de Savigny D, Lozano R, et al. A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet. 2015; 386(10001): 1395-1406. doi: https://doi.org/10.1016/S0140-6736(15)60171-4.
32. Phillips DE, Adair T, Lopez AD. How useful are registered birth statistics for health and social policy? A global systematic assessment of the availability and quality of birth registration data. Popul Health Metrics. 2018; 16(1):21. doi: https:// doi.org/10.1186/s12963-018-0180-6.
33. Peralta A, Benach J, Espinel-Flores V, Gotsens M, Borrell C, Marí-Dell’Olmo M. Studying Geographic Inequalities in Mortality in Contexts with Deficient Data Sources: Lessons from Ecuador. Epidemiology. 2020; 31(2): 290-300. doi: https://doi.org/10.1097/ EDE.0000000000001146.
34. Marmot M, Bell R. Social inequalities in health: a proper concern of epidemiology. Ann Epidemiol. 2016; 26(4): 238-240. doi: https://doi.org/10.1016/j. annepidem.2016.02.003.
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