Related Experiment Video
Updated: Jul 11, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Higher perinatal mortality in National Public Health System hospitals in Belo Horizonte, Brazil, 1999: a
S Lansky1, S V Subramanian, E França
1Belo Horizonte Health Department, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. slansky@uol.com.br
Objective:
In Brazil, it was previously reported that in hospital perinatal, neonatal and infant mortality rates are higher for hospitals contracted to the National Public Health System (SUS) compared with non-SUS hospitals. We analyse whether this reflects a compositional effect (selection of patients) or a contextual effect.
Design:
Population-based cohort study.
Setting:
Belo Horizonte, Brazil, 1999.
Population:
A total of 36,469 births in 24 hospitals.
Methods:
A multilevel analysis was carried out using information gathered at the individual level on maternal education (used as an indicator of socio-economic status), maternal age, type of pregnancy and delivery, birthweight and sex of the fetus.
Main Outcome Measure:
Perinatal death.
Results:
Risk factors for perinatal death included male sex (OR = 1.25; 95% CI 1.01-1.55), birthweight of 1500-2500 g (OR = 7.65; 95% CI 5.74-10.20), birthweight of 500-1500 g (OR = 187.54; 95% CI 141.31-248.39), less than 4 years of maternal education (OR = 2.93; 95% CI 1.68-5.10), as well as birth at private-SUS (OR = 2.92; 95% CI 1.87-4.54) or philanthropic-SUS hospitals (OR = 1.81; 95% CI 1.12-2.92). After controlling for individual characteristics, there was still a significant variation in perinatal deaths between hospitals categories.
Conclusion:
Independent of compositional (or individual) characteristics, hospital factors exert an influence on the risk of perinatal death, primarily hospital category related to SUS. Considering the highest proportion of births in SUS hospitals in Brazil, especially private-SUS hospitals, improving hospital quality of care is an urgent priority for reducing the toll of perinatal and infant mortality, as well as inequalities in these outcomes.
Related Concept Videos
Bias in Epidemiological Studies
Regression Toward the Mean
Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Teratogenicity
Confounding in Epidemiological Studies
