Intermunicipal healthcare flows and perinatal births and deaths in Greater Metropolitan Rio de Janeiro, Brazil, in 2011 and 2014

The regionalization of perinatal care should consider existing healthcare structures for facilitating access. This spatial-temporal ecological study identified intermunicipal flows of perinatal births and deaths in Greater Metropolitan Rio de Janeiro, Brazil, in 2011 and 2014, defined parameters, and systematized proposals for organizing the regionalization of perinatal care. The data sources were the Brazilian Information System on Live Births, Mortality Information System, National Registry of Healthcare Establishments, and 2010 Population Census. The study identified existing relations between the mothers’ municipalities of residence and the occurrence of perinatal births and deaths. Each municipality was analyzed singly and pairwise (residence/occurrence) according to the vital event, healthcare resources, and pragmatic criteria of life-threatening conditions at birth. We conducted descriptive analyses of dominant flows, exploratory principal components analysis, and cluster analysis. The existing healthcare networks were identified, and 47 variables were summarized in three factors (analytical dimensions) - availability of beds, risk of life-threatening conditions, and socioeconomic status - accounting for 60%/80%, 20%/30%, 13%/22%, respectively, of the variance pertaining to each year analyzed. The factors were used to form clusters, classified in 3 to 5 strata. Three proposals were drafted for perinatal health regions. The study’s principal contribution was having presented parameters for monitoring the regionalization and systematic reevaluation of this process based on administrative records.

围产期保健区划（regionalization of perinatal care）应考量现有医疗架构以提升服务可及性。本项时空生态学研究针对2011年与2014年巴西大里约热内卢都会区的围产期分娩与死亡市际流动情况展开，明确了相关参数，并系统化提出了围产期保健区划的组织方案。本研究的数据来源包括巴西活产信息系统（Brazilian Information System on Live Births）、死亡信息系统（Mortality Information System）、全国医疗机构注册系统（National Registry of Healthcare Establishments）以及2010年人口普查（2010 Population Census）数据。研究识别了产妇居住市政区与围产期分娩、死亡事件发生地之间的既有关联。针对各类生命事件、医疗资源及出生时危重症的实用判定标准，本研究对各市政区进行了单独分析与配对（居住/事件发生地）分析。我们对主导流动模式开展描述性分析，同时进行了探索性主成分分析（exploratory principal components analysis）与聚类分析（cluster analysis）。本研究明确了现有医疗网络架构，并将47项变量归纳为3个分析维度因子：床位可及性、危重症发生风险与社会经济地位，三者分别解释了对应分析年份60%/80%、20%/30%、13%/22%的方差变异。基于上述因子完成聚类分析后，将聚类结果划分为3至5个层级。最终拟定了3项围产期健康区划方案。本研究的核心贡献在于提出了围产期保健区划的监测参数，以及基于行政记录对该流程开展系统性再评估的方法。