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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.075986v1 97/5/867    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Lansky, S. Articles by Kawachi, I. Search for Related Content PubMed PubMed Citation Articles by Lansky, S. Articles by Kawachi, I. Related Collections Epidemiology Health Care Facilities/Services Quality of Care Birth Outcomes Socioeconomic Factors Mortality

Sônia Lansky, MD, PhD, Elisabeth França, MD, PhD and Ichiro Kawachi, MD, PhD

At the time of the study, Sônia Lansky was with the Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass; the Federal University of Minas Gerais, Brazil; and the City Health Department, Belo Horizonte, Brazil. Elisabeth França is with the Department of Social and Preventive Medicine, Federal University of Minas Gerais, Brazil. Ichiro Kawachi is with the Department of Society, Human Development and Health, Harvard School of Public Health, Boston.

Correspondence: Requests for reprints should be sent to Sônia Lansky, MD, PhD, Avenida Afonso Pena 2336 5^o andar, Belo Horizonte, Minas Gerais 30130 007, Brazil (e-mail: slansky{at}uol.com.br).

Objectives. We examined the contribution of hospital type and quality of care to perinatal mortality rates in the city of Belo Horizonte, Brazil.

Methods. We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in1999. After adjusting for maternal education and birthweight, we compared mortality rates according to hospital category—defined by a hospital’s relation to the national Universal Public Health System (SUS)—and quality of care. We used the Wigglesworth Classification to examine perinatal deaths.

Results. After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS-contracted hospitals (relative to private, non-SUS-contracted hospitals). Hospital quality was also directly associated with perinatal death rates. Mortality rates were especially high for normal-birthweight babies born in private SUS-contracted hospitals. Intrapartum asphyxia was the leading cause of preventable death.

Conclusions. In a class-segregated health care system, such as Brazil’s, disparities in quality of care between SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality.