Racial and ethnic disparities in premature births among pregnant women in the NISAMI cohort, Brazil

Oliveira, Kelly Albuquerque de; Castro, Caroline Tianeze de; Pereira, Marcos; Cordeiro, Rosa Cândida; Ribeiro, Denize de Almeida; Rivemales, Maria da Conceição Costa; Araújo, Edna Maria de; Santos, Djanilson Barbosa dos

doi:10.1590/1413-81232024293.11862023

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

THEMATIC ARTICLE • Ciênc. saúde coletiva 29 (3) • Mar 2024 • https://doi.org/10.1590/1413-81232024293.11862023 copy

Racial and ethnic disparities in premature births among pregnant women in the NISAMI cohort, Brazil

Disparidades étnicas e raciais nos partos prematuros entre gestantes da coorte NISAMI, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The incidence of premature birth has increased worldwide, unequally distributed by race/ethnicity. Racism generates economic inequalities, educational disparities, and differential access to health care, which increases the risk of preterm birth. Thus, this study aimed to evaluate the factors associated with preterm birth and racial and ethnic disparities in premature birth among pregnant women attending prenatal care at the Brazilian Unified Health System health units in the urban area of Santo Antônio de Jesus, Bahia, Brazil. This study used data from 938 pregnant women aged between 18 to 45 years within the NISAMI prospective cohort. Premature birth prevalence was 11.8%, with a higher prevalence among black than non-black women (12.9% versus 6.0%, respectively). Maternal age between 18 and 24 years was the only factor associated with premature birth. A higher risk of premature birth was found among black women than non-black women (RR 3.22; 95%CI 1.42-7.32). These results reveal the existence of racial and social inequalities in the occurrence of premature birth.

Key words:
Premature; Health inequalities; Ethnicity and health; Cross-sectional studies; Prevalence

Variables		Total		Race				p-value
		Total		Black		Non-Black
		n	%	n	%	n	%
N		938	100.0	788	84.0	150	16.0
Age group (n=833)								0.773
	18-24 years	331	39.7	281	40.2	50	37.3
	25-34 years	424	50.9	352	50.4	72	53.7
	≥35 years	78	9.4	66	9.4	12	9.0
Marital status (n=930)								0.524
	Without a partner	157	16.9	129	16.5	28	18.7
	With a partner	773	83.1	651	83.5	122	81.3
Education (n=928)								0.763
	Illiterate	339	36.5	279	35.9	60	40.0
	Elementary/Middle School	136	14.7	114	14.7	22	14.7
	High School	399	43.0	340	43.7	59	39.3
	Post-secondary	54	5.8	45	5.8	09	6.0
Employment (n=920)								0.738
	Active	436	47.4	364	47.2	72	48.7
	Inactive	484	52.6	408	52.8	76	51.3
Household income (n=885)								0.037
	≤1 minimum wage	201	22.7	177	23.7	24	17.4
	2-4 times minimum wage	421	47.6	360	48.2	61	44.2
	≥5 times minimum wage	263	29.7	210	28.1	53	38.4
Alcohol Use (n=930)								0.779
	Yes	115	12.4	98	12.6	17	11.3
	Stopped	559	60.1	465	59.6	94	62.7
	No	256	27.5	217	27.8	39	26.0
Smoking (n=922)								0.962
	Yes	28	3.0	24	3.1	04	2.7
	Stopped	301	32.6	252	32.6	49	33.1
	No	593	64.3	498	64.3	95	64.2
Drug use (n=905)								0.853
	Yes	11	1.2	09	1.2	02	1.4
	No	894	98.8	750	98.8	144	98.6
Physical Activity (n=874)								0.798
	Yes	74	8.5	63	8.6	11	7.9
	No	800	91.5	672	91.4	128	92.1
Type of delivery (n=935)								0.797
	Cesarean	596	63.7	499	63.6	97	64.7
	Natural	339	36.3	286	36.4	53	35.3
Induced labor (n=928)								0.779
	Yes	203	21.9	170	21.7	33	22.8
	No	725	78.1	613	78.3	112	77.2
Sex of newborn (n=934)								0.278
	Male	480	51.4	409	52.2	71	47.3
	Female	454	48.6	375	47.8	79	52.7
Onset of prenatal care (n=887)								0.886
	1^st trimester	665	74.9	559	75.2	106	73.6
	2^nd trimester	202	22.8	167	22.5	35	24.3
	3^rd trimester	20	2.3	17	2.3	03	2.1
History of premature birth (n=380)								0.120
	Yes	50	13.2	39	12.0	11	19.6
	No	330	86.8	285	88.0	45	80.4

Variables		Total		Gestational age				RR	95%CI
		Total		Preterm		At Term
		n	%	n	%	n	%
N		938	100.0	111	11.8	827	88.2
Age group
	18-24 years	331	39.7	51	15.4	280	84.6	1.72	1.18-2.50
	25-34 years	424	50.9	38	9.0	386	91.0	1.00
	≥35 years	78	9.4	07	9.0	71	91.0	0.76	0.37-1.58
Marital Status
	Without a partner	157	16.9	23	14.6	134	85.4	1.30	0.85-1.99
	With a partner	773	83.1	87	11.3	686	88.7	1.00
Education
	Illiterate	339	36.5	44	13.0	295	87.0	1.16	0.81-1.66
	Elementary/Middle School	136	14.7	21	15.4	115	84.6	1.37	0.89-2.13
	High School	399	43.0	39	9.8	360	90.2	0.73	0.50-1.05
	Post-secondary	54	5.8	06	11.1	48	88.9	1.00
Employment
	Active	436	47.4	48	11.0	388	89.0	0.87	0.61-1.25
	Inactive	484	52.6	61	12.6	423	87.4	1.00
Household income
	≤1 minimum wage	201	22.7	27	13.4	174	86.6	1.25	0.83-1.90
	2-4 times minimum wage	421	47.6	45	10.7	376	89.3	0.90	0.62-1.31
	≥5 times minimum wage	263	29.7	28	10.6	235	89.4	1.00
Alcohol Use
	Yes	115	12.4	16	13.9	99	86.1	1.22	0.74-2.00
	Stopped	559	60.1	63	11.3	496	88.7	0.91	0.64-1.30
	No	256	27.5	30	11.7	226	88.3	1.00
Smoking
	Yes	28	3.0	04	14.3	24	85.7	1.23	0.49-3.10
	Stopped	301	32.6	30	10.0	271	90.0	0.79	0.53-1.18
	No	593	64.3	74	12.5	519	87.5	1.00
Drug use
	Yes	11	1.2	01	9.1	10	90.9	0.78	0.12-5.11
	No	894	98.8	104	11.6	790	88.4	1.00
Physical activity
	Yes	74	8.5	13	17.6	61	82.4	1.00
	No	800	91.5	88	11.0	712	89.0	0.63	0.37-1.07
Type of delivery
	Cesarean	596	63.7	68	11.4	528	88.6	0.92	0.64-1.32
	Natural	339	36.3	42	12.4	297	87.6	1.00
Induced labor
	Yes	203	21.9	16	7.9	187	92.1	0.62	0.37-1.03
	No	725	78.1	92	12.7	633	87.3	1.00
Sex of newborn
	Male	480	51.4	54	11.2	426	88.8	1.00
	Female	454	48.6	57	12.6	397	87.4	1.12	0.79-1.58
Onset of prenatal care
	1^st trimester	665	74.9	70	10.5	595	89.5	1.00
	2^nd trimester	202	22.8	23	11.4	179	88.6	1.07	0.69-1.66
	3^rd trimester	20	2.3	03	15.0	17	85.0	1.40	0.48-4.04
History of premature birth
	Yes	50	13.2	06	12.0	44	88.0	1.1	0.49-2.48
	No	330	86.8	36	10.9	294	89.1	1.00

Models	PR	95%CI	p-value
Crude	2.16	1.12-4.17	0.015
Adjusted*	3.22	1.42-7.32	0.005

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva