Infant mortality evolution in the metropolitan region of Sao Paulo (Brazil), 1980-2000

Objective To analyze IMR evolution in the Sao Paulo Metropolitan Area (SPMA) between 1980 and 2000, in terms of spatial, age and, causal differences. Methods SPMA municipalities were divided into 5 groups, based on their 1980 IMRs: (3)90% lb (Group 1); 70-89% lb (Group 2); 50-69% lb (Group 3); <50% lb (Group 4). Group 5 comprised the municipality of Sao Paulo itself (IMR=51% lb). The analysis of trends was carried out using exponential regression models. Results IMR and its components showed a statistically significant decrease (p<0.05), with coefficients of determination between 66 and 98%, indicating goodness of fit of the exponential model to all the time series analyzed. SPMA IMR fell 69.4% from 55.2 to 169% lb, and Groups 1-5 showed reductions of 83.9%, 76.2%, 71.3%, 58.7%, and 68.8%, indicating that the groups with highest IMRs also showed the greatest reductions during the studied period. Conclusions IMRs were homogenized at around 18% lb in all municipality groups in the SPMA. One-half of all deaths were concentrated within the first week of life, and were due primarily to conditions originating in the perinatal period, indicating that greater care during the pre- and post-delivery periods will he required if the IMR in the SPMA is to descend to levels compatible with those of developed countries.