Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight
Summary Socio‐economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called...
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| creator | Silva, Antonio A. M. Bettiol, Heloísa Barbieri, Marco A. Pereira, Márcio M. Brito, Luiz G. O. Ribeiro, Valdinar S. Aragão, Vânia M. F. |
| description | Summary
Socio‐economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called ‘the epidemiological paradox of low birthweight’. Natality data from Brazil revealed the existence of a similar paradox: LBW rates are higher in more developed than in less developed regions within the country. In this study, data from two population‐based cohort studies carried out in the nineties, including 2439 births in São Luís, a poor city in north‐eastern Brazil, and 2839 births in Ribeirão Preto, a socio‐economically well‐off city in south‐eastern Brazil, were used to explore this paradox.
The method proposed by Wilcox and Russell and a graphic analysis of the frequency distribution of birthweight according to gestational age were used to provide indirect information about possible gestational age misclassification. Contrary to expectations, the LBW rate was higher in Ribeirão Preto than in São Luís (10.7 vs. 7.6%, P |
| doi_str_mv | 10.1111/j.1365-3016.2004.00624.x |
| format | Article |
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Socio‐economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called ‘the epidemiological paradox of low birthweight’. Natality data from Brazil revealed the existence of a similar paradox: LBW rates are higher in more developed than in less developed regions within the country. In this study, data from two population‐based cohort studies carried out in the nineties, including 2439 births in São Luís, a poor city in north‐eastern Brazil, and 2839 births in Ribeirão Preto, a socio‐economically well‐off city in south‐eastern Brazil, were used to explore this paradox.
The method proposed by Wilcox and Russell and a graphic analysis of the frequency distribution of birthweight according to gestational age were used to provide indirect information about possible gestational age misclassification. Contrary to expectations, the LBW rate was higher in Ribeirão Preto than in São Luís (10.7 vs. 7.6%, P < 0.001), while preterm birth (PTB) rate (12.7 vs. 12.1%, P = 0.520) and percentage of small‐for‐gestational‐age (SGA) infants (12.5 vs. 13.5%, P = 0.290) were similar for the two cities. However, SGA rate among preterm infants was higher in Ribeirão Preto (16.4 vs. 9.8%, P = 0.014). A bimodal distribution of birthweight was observed for children with less than 32 weeks in São Luís. As estimated by the Wilcox and Russell method, the residual distribution was greater in Ribeirão Preto than in São Luís (3.4 vs. 2.4%). Part of the LBW paradox observed for the two cities was due to the higher PTB rate and higher number of preterm SGA infants in Ribeirão Preto.
Factors such as greater medical intervention in preterm newborns close to the end of pregnancy in more developed municipalities, artefacts in the determination of gestational age, and the under‐registration of livebirths and registration of livebirths as stillbirths in less developed municipalities may explain why LBW rates in Brazil are higher in richer than in poorer municipalities.</description><identifier>ISSN: 0269-5022</identifier><identifier>EISSN: 1365-3016</identifier><identifier>DOI: 10.1111/j.1365-3016.2004.00624.x</identifier><identifier>PMID: 15670108</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Birth Weight - physiology ; Brazil - epidemiology ; Chi-Square Distribution ; Cohort Studies ; Gestational Age ; Humans ; Infant, Low Birth Weight - physiology ; Infant, Newborn ; Premature Birth - epidemiology ; Prevalence ; Socioeconomic Factors ; Urban Health</subject><ispartof>Paediatric and perinatal epidemiology, 2005-01, Vol.19 (1), p.43-49</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4544-eb170ae1a99b22267ffd579bbbdf643b2d3dfc0b23fd99fda6fa448a1e8943df3</citedby><cites>FETCH-LOGICAL-c4544-eb170ae1a99b22267ffd579bbbdf643b2d3dfc0b23fd99fda6fa448a1e8943df3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-3016.2004.00624.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-3016.2004.00624.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15670108$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Silva, Antonio A. M.</creatorcontrib><creatorcontrib>Bettiol, Heloísa</creatorcontrib><creatorcontrib>Barbieri, Marco A.</creatorcontrib><creatorcontrib>Pereira, Márcio M.</creatorcontrib><creatorcontrib>Brito, Luiz G. O.</creatorcontrib><creatorcontrib>Ribeiro, Valdinar S.</creatorcontrib><creatorcontrib>Aragão, Vânia M. F.</creatorcontrib><title>Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight</title><title>Paediatric and perinatal epidemiology</title><addtitle>Paediatr Perinat Epidemiol</addtitle><description>Summary
Socio‐economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called ‘the epidemiological paradox of low birthweight’. Natality data from Brazil revealed the existence of a similar paradox: LBW rates are higher in more developed than in less developed regions within the country. In this study, data from two population‐based cohort studies carried out in the nineties, including 2439 births in São Luís, a poor city in north‐eastern Brazil, and 2839 births in Ribeirão Preto, a socio‐economically well‐off city in south‐eastern Brazil, were used to explore this paradox.
The method proposed by Wilcox and Russell and a graphic analysis of the frequency distribution of birthweight according to gestational age were used to provide indirect information about possible gestational age misclassification. Contrary to expectations, the LBW rate was higher in Ribeirão Preto than in São Luís (10.7 vs. 7.6%, P < 0.001), while preterm birth (PTB) rate (12.7 vs. 12.1%, P = 0.520) and percentage of small‐for‐gestational‐age (SGA) infants (12.5 vs. 13.5%, P = 0.290) were similar for the two cities. However, SGA rate among preterm infants was higher in Ribeirão Preto (16.4 vs. 9.8%, P = 0.014). A bimodal distribution of birthweight was observed for children with less than 32 weeks in São Luís. As estimated by the Wilcox and Russell method, the residual distribution was greater in Ribeirão Preto than in São Luís (3.4 vs. 2.4%). Part of the LBW paradox observed for the two cities was due to the higher PTB rate and higher number of preterm SGA infants in Ribeirão Preto.
Factors such as greater medical intervention in preterm newborns close to the end of pregnancy in more developed municipalities, artefacts in the determination of gestational age, and the under‐registration of livebirths and registration of livebirths as stillbirths in less developed municipalities may explain why LBW rates in Brazil are higher in richer than in poorer municipalities.</description><subject>Birth Weight - physiology</subject><subject>Brazil - epidemiology</subject><subject>Chi-Square Distribution</subject><subject>Cohort Studies</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant, Low Birth Weight - physiology</subject><subject>Infant, Newborn</subject><subject>Premature Birth - epidemiology</subject><subject>Prevalence</subject><subject>Socioeconomic Factors</subject><subject>Urban Health</subject><issn>0269-5022</issn><issn>1365-3016</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUV1v0zAUtRBo68b-AvITb8lsx_mSkBCd2g1pgj6A9mg5yXXj4sTBTtWU38EPxlmrIfGEX3w_zjn36h6EMCUxDe92F9MkS6OE0CxmhPCYkIzxeHqFFi-N12hBWFZGKWHsEl15vyMBlZbsAl3SNMsJJcUC_X5qj1g6wGML2NgDrrQb2wPobTtiJ0fwWPd46eQvbXAbquDmgtP1HI2t7Od0sNaFtNv3utaDNHrU4D_i1TQY63S_fVaHQTfQaWvsVtfS4EE62dgJW_Xv4LfojZLGw835v0bf16tvdw_R49f7z3efHqOap5xHUNGcSKCyLCvGWJYr1aR5WVVVozKeVKxJGlWTiiWqKUvVyExJzgtJoSh5aCXX6P1Jd3D25x78KDrtazBG9mD3XmR5UnDCaAAWJ2DtrPcOlBic7qQ7CkrE7IjYifnwYj68mB0Rz46IKVDfnWfsqw6av8SzBQHw4QQ4aAPH_xYWm80qBIEenejajzC90KX7Ma-fp-Lpy72gmyVbF-uleEj-AHqcrMY</recordid><startdate>200501</startdate><enddate>200501</enddate><creator>Silva, Antonio A. M.</creator><creator>Bettiol, Heloísa</creator><creator>Barbieri, Marco A.</creator><creator>Pereira, Márcio M.</creator><creator>Brito, Luiz G. O.</creator><creator>Ribeiro, Valdinar S.</creator><creator>Aragão, Vânia M. F.</creator><general>Blackwell Science Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200501</creationdate><title>Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight</title><author>Silva, Antonio A. M. ; Bettiol, Heloísa ; Barbieri, Marco A. ; Pereira, Márcio M. ; Brito, Luiz G. O. ; Ribeiro, Valdinar S. ; Aragão, Vânia M. F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4544-eb170ae1a99b22267ffd579bbbdf643b2d3dfc0b23fd99fda6fa448a1e8943df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Birth Weight - physiology</topic><topic>Brazil - epidemiology</topic><topic>Chi-Square Distribution</topic><topic>Cohort Studies</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant, Low Birth Weight - physiology</topic><topic>Infant, Newborn</topic><topic>Premature Birth - epidemiology</topic><topic>Prevalence</topic><topic>Socioeconomic Factors</topic><topic>Urban Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Silva, Antonio A. M.</creatorcontrib><creatorcontrib>Bettiol, Heloísa</creatorcontrib><creatorcontrib>Barbieri, Marco A.</creatorcontrib><creatorcontrib>Pereira, Márcio M.</creatorcontrib><creatorcontrib>Brito, Luiz G. O.</creatorcontrib><creatorcontrib>Ribeiro, Valdinar S.</creatorcontrib><creatorcontrib>Aragão, Vânia M. F.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Paediatric and perinatal epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silva, Antonio A. M.</au><au>Bettiol, Heloísa</au><au>Barbieri, Marco A.</au><au>Pereira, Márcio M.</au><au>Brito, Luiz G. O.</au><au>Ribeiro, Valdinar S.</au><au>Aragão, Vânia M. F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight</atitle><jtitle>Paediatric and perinatal epidemiology</jtitle><addtitle>Paediatr Perinat Epidemiol</addtitle><date>2005-01</date><risdate>2005</risdate><volume>19</volume><issue>1</issue><spage>43</spage><epage>49</epage><pages>43-49</pages><issn>0269-5022</issn><eissn>1365-3016</eissn><abstract>Summary
Socio‐economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called ‘the epidemiological paradox of low birthweight’. Natality data from Brazil revealed the existence of a similar paradox: LBW rates are higher in more developed than in less developed regions within the country. In this study, data from two population‐based cohort studies carried out in the nineties, including 2439 births in São Luís, a poor city in north‐eastern Brazil, and 2839 births in Ribeirão Preto, a socio‐economically well‐off city in south‐eastern Brazil, were used to explore this paradox.
The method proposed by Wilcox and Russell and a graphic analysis of the frequency distribution of birthweight according to gestational age were used to provide indirect information about possible gestational age misclassification. Contrary to expectations, the LBW rate was higher in Ribeirão Preto than in São Luís (10.7 vs. 7.6%, P < 0.001), while preterm birth (PTB) rate (12.7 vs. 12.1%, P = 0.520) and percentage of small‐for‐gestational‐age (SGA) infants (12.5 vs. 13.5%, P = 0.290) were similar for the two cities. However, SGA rate among preterm infants was higher in Ribeirão Preto (16.4 vs. 9.8%, P = 0.014). A bimodal distribution of birthweight was observed for children with less than 32 weeks in São Luís. As estimated by the Wilcox and Russell method, the residual distribution was greater in Ribeirão Preto than in São Luís (3.4 vs. 2.4%). Part of the LBW paradox observed for the two cities was due to the higher PTB rate and higher number of preterm SGA infants in Ribeirão Preto.
Factors such as greater medical intervention in preterm newborns close to the end of pregnancy in more developed municipalities, artefacts in the determination of gestational age, and the under‐registration of livebirths and registration of livebirths as stillbirths in less developed municipalities may explain why LBW rates in Brazil are higher in richer than in poorer municipalities.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>15670108</pmid><doi>10.1111/j.1365-3016.2004.00624.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Birth Weight - physiology Brazil - epidemiology Chi-Square Distribution Cohort Studies Gestational Age Humans Infant, Low Birth Weight - physiology Infant, Newborn Premature Birth - epidemiology Prevalence Socioeconomic Factors Urban Health |
| title | Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight |
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