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        "titulo" => "Iniquidades socioecon&#244;micas em nascimentos prematuros em quatro estudos brasileiros de coortes de nascimento"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Iniquidade com rela&#231;&#227;o a nascimento prematuro&#44; entre quatro estudos de coorte de nascimento&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A ocorr&#234;ncia global de nascimento prematuro &#40;PT&#41; varia de 3&#44;8 a 17&#44;5&#37; de nascidos vivos&#44; &#233; menor em pa&#237;ses de alta renda do que em pa&#237;ses de baixa&#47;m&#233;dia renda&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> O Brasil est&#225; entre os dez pa&#237;ses com os maiores n&#250;meros de PT&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Os fatores de risco maternos para PT espont&#226;neo podem ou n&#227;o ser anteriores &#224; concep&#231;&#227;o e incluir uma posi&#231;&#227;o socioecon&#244;mica n&#227;o privilegiada&#44; etnia negra&#44; baixo n&#237;vel de escolaridade&#44; baixa estatura&#44; idade abaixo de 20 ou acima de 35&#44; ser solteira&#44; trabalho exaustivo ou presen&#231;a de doen&#231;as maternas&#44; como press&#227;o arterial alta e diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#8211;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A rela&#231;&#227;o de pobreza&#47;prematuridade e altas taxas de mortalidade neonatal &#233; muito bem conhecida&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a> As fam&#237;lias de baixa renda podem compartilhar outros fatores de risco que podem influenciar iniquidade&#44; como cor de pele negra&#44; menores n&#237;veis de escolaridade e desemprego&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As iniquidades socioecon&#244;micas continuam um grande desafio para as pol&#237;ticas ou estrat&#233;gias do setor de sa&#250;de em pa&#237;ses de baixe&#47;m&#233;dia renda&#46; O <span class="elsevierStyleItalic">slope index of inequality</span> &#40;SII&#41; e o <span class="elsevierStyleItalic">relative index of inequality</span> &#40;RII&#41; podem ser usados para avaliar iniquidades&#44; mostrar as magnitudes de diferen&#231;as absolutas e relativas&#44; respectivamente&#44; dos indicadores de posi&#231;&#227;o socioecon&#244;mica&#44; em compara&#231;&#227;o com tend&#234;ncias temporais dos resultados neonatais em estudos epidemiol&#243;gicos&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">O objetivo deste estudo foi analisar as iniquidades de renda familiar &#40;absolutas e relativas&#41; com rela&#231;&#227;o &#224; ocorr&#234;ncia de PT em quatro coortes de nascimento feitas em Pelotas&#44; RS&#44; na Regi&#227;o Sul do Brasil&#44; em 1982&#44; 1993&#44; 2004 e 2011&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Foram identificados todos os nascimentos em hospitais em 1982&#44; 1993 e 2004 e inclu&#237;dos nas coortes aqueles cujas m&#227;es moravam na &#225;rea urbana de Pelotas&#46; Logo ap&#243;s o nascimento&#44; as m&#227;es foram entrevistadas com um question&#225;rio estruturado previamente testado e os rec&#233;m&#8208;nascidos foram examinados e medidos&#46; Os detalhes metodol&#243;gicos de cada coorte &#40;1982&#44; 1993 e 2004&#41; foram descritos em publica&#231;&#245;es anteriores&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Os dados de 2011 foram obtidos do estudo multic&#234;ntrico Cons&#243;rcio Internacional de</p><p id="par0050" class="elsevierStylePara elsevierViewall">Crescimento Fetal e Neonatal para o S&#233;culo XXI &#40;<span class="elsevierStyleItalic">Intergrowth 21</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">st</span></span>&#41;&#46; Os crit&#233;rios de inclus&#227;o&#44; amostragem e log&#237;stica foram semelhante &#224;queles de outros estudos de coorte&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A vari&#225;vel de resultado foi PT&#44; ou seja&#44; nascimento em idade gestacional &#40;IG&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>37 semanas&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> A IG em semanas completas pode der determinada a partir&#58; &#40;i&#41; do decurso de tempo desde o primeiro dia do &#250;ltimo per&#237;odo menstrual &#40;LMP&#41;&#59; &#40;ii&#41; da data de nascimento estimada de acordo com o ultrassom obst&#233;trico precoce &#40;US&#41;&#59; e&#47;ou &#40;iii&#41; do exame f&#237;sico do rec&#233;m&#8208;nascido com o escore de Dubowitz&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Em todos os estudos de coorte&#44; LMP foi o m&#233;todo usado para calcular a IG&#46; Em 20&#37; dos neonatos em 1982&#44; a IG foi determinada pelo escore de Dubowitz&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Em 1993&#44; 2004 e 2011&#44; a IG foi calculada de acordo com o LMP&#44; complementado por exame f&#237;sico e US nas duas &#250;ltimas coortes&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;11&#44;12</span></a> A ocorr&#234;ncia de PT pode ser subdividida com base na IG&#44; da seguinte forma&#58; extremamente prematuro &#40;&#60; 28 semanas completas de gesta&#231;&#227;o&#41;&#44; muito prematuro &#40;28&#8805; a<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>32 semanas&#41; ou prematuro moderado &#40;32&#8805; a<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>37 semanas&#41;&#46; A ocorr&#234;ncia de PT moderado pode ser dividida ainda em precoces e tardios&#44; s&#227;o denominados nascimento prematuro tardio &#40;LPT&#41; aqueles com nascimento entre 34 a 37 semanas&#46; Pode ser dividida tamb&#233;m com ou sem baixo peso ao nascer &#40;BPN&#41;&#44; ou seja&#44; situa&#231;&#245;es em que o peso ao nascer foi inferior a 2&#46;500<span class="elsevierStyleHsp" style=""></span>g&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A principal exposi&#231;&#227;o foi a renda familiar mensal &#40;geralmente de um ou ambos os pais&#41;&#44; calculada a partir da soma das rendas individuais coletadas como vari&#225;vel cont&#237;nua e classificada&#44; posteriormente&#44; em quintis de renda&#46; As poss&#237;veis vari&#225;veis de confus&#227;o inclu&#237;ram cor de pele da m&#227;e&#44; classificada como branca&#44; negra ou outras pelo entrevistador e autorrelatada em 2011&#59; a escolaridade da m&#227;e em anos completos&#44; expressos em quatro categorias&#58; menor do que quatro anos&#44; cinco a oito anos&#44; nove a 11 anos ou &#8805; 12 anos&#59; idade da m&#227;e em anos completos&#44; categorizada em<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20 anos&#44; 20 a 34 anos ou &#8805; anos&#59; e estado civil da m&#227;e&#44; expresso em se a m&#227;e morava com um parceiro ou n&#227;o&#44; independentemente da condi&#231;&#227;o jur&#237;dica do casamento&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">As iniquidades de renda absolutas e relativas foram calculadas com o SII e RII&#44; respectivamente&#46; O SII &#233; obtido da an&#225;lise de regress&#227;o log&#237;stica sobre o resultado de PT&#44; como a m&#233;dia da classifica&#231;&#227;o de renda relativa&#44; com valores que variam de 0 a 1&#44; &#233; calculado por meio da ordena&#231;&#227;o dos grupos dos menores quintis de renda para os maiores para calcular o ponto m&#233;dio da distribui&#231;&#227;o nessa classifica&#231;&#227;o&#46; Cada ponto m&#233;dio de cada quintil foi estabelecido em 0&#44;1&#44; 0&#44;3&#44; 0&#44;5&#44; 0&#44;7 e 0&#44;9&#46; O SII resultou da regress&#227;o em cada resultado da posi&#231;&#227;o do ponto m&#233;dio e foi interpretado como a diferen&#231;a absoluta no resultado entre o grupo de indiv&#237;duos no menor ponto da distribui&#231;&#227;o ou o primeiro quintil &#40;Q1&#44; o mais pobre&#41; e o grupo de indiv&#237;duos no maior ponto da distribui&#231;&#227;o de renda &#40;Q5&#44; o mais rico&#41;&#46; Quando o <span class="elsevierStyleItalic">slope</span> da linha de regress&#227;o for est&#225;vel&#44; o SII &#233; 0&#46; Os valores positivos resultam do fato de a prematuridade ser mais prevalente entre indiv&#237;duos mais ricos&#59; ao passo que os valores negativos significam que esse indicador &#233; mais prevalente entre os indiv&#237;duos mais pobres&#46; O RII foi expresso por raz&#227;o de chance &#40;RC&#41; com intervalo de confian&#231;a de 95&#37;&#46; Os resultados foram interpretados por meio da compara&#231;&#227;o dos extremos de renda&#44; com a diferen&#231;a entre Q1&#8208;Q5 e o SII relacionado a iniquidade absoluta&#44; expressa como pontos percentuais &#40;PP&#41;&#44; ao passo que o &#237;ndice de Q1&#8208;Q5&#47;RII indicou iniquidade relativa com base na chance de que o grupo de indiv&#237;duos possa apresentar o resultado&#46; O SII e o RII determinaram uma rela&#231;&#227;o direta com o n&#237;vel de iniquidade na hierarquia socioecon&#244;mica&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;14</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A iniquidade entre a renda e a incid&#234;ncia de PT nos quatro estudos foi observada por meio da dist&#226;ncia entre os quintis de renda em um gr&#225;fico de iniquidade &#40;gr&#225;ficos de cinco pontos&#41;&#46; Pode ser classificado como um padr&#227;o inferior &#40;o mais pobre muito distante dos outros&#41;&#44; padr&#227;o superior &#40;o mais rico muito distante dos outros&#41; ou padr&#227;o linear &#40;dist&#226;ncias semelhantes entre os grupos analisados&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">As an&#225;lises foram restritas a nascidos vivos &#40;a defini&#231;&#227;o de PT n&#227;o inclui natimortos&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> e parto &#250;nico&#44; evitam&#8208;se dados repetidos da mesma fam&#237;lia &#40;no caso de g&#234;meos&#41;&#46; Foram exclu&#237;dos os rec&#233;m&#8208;nascidos com malforma&#231;&#245;es e&#47;ou doen&#231;as cong&#234;nitas&#44; assim que detectadas durante as entrevistas ou exames f&#237;sicos nos rec&#233;m&#8208;nascidos nas maternidades&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O teste qui&#8208;quadrado &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span>&#41; foi usado para comparar a distribui&#231;&#227;o de caracter&#237;sticas maternas nas quatro coortes e&#44; quando poss&#237;vel&#44; foi calculado o <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span> para tend&#234;ncia&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A an&#225;lise ajustada incluiu as vari&#225;veis de cor de pele&#44; escolaridade&#44; idade e estado civil da m&#227;e no modelo final para determinar as contribui&#231;&#245;es independentes da renda familiar para o resultado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Todas as an&#225;lises foram feitas com o <span class="elsevierStyleItalic">software</span> Stata 13&#46;1 &#40;StataCorp&#46; 2013&#46;&#160;<span class="elsevierStyleItalic">Stata Statistical Software&#58; Release 13</span>&#46; College Station&#44; TX&#44; EUA&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A aprova&#231;&#227;o &#233;tica dos estudos n&#227;o foi necess&#225;ria no Brasil at&#233; 1996&#46; Contudo&#44; foram aprovados todos os acompanhamentos feitos nas coortes de 1982 e 1993 ap&#243;s esse ano&#46; O Comit&#234; de &#201;tica da Faculdade de Medicina&#44; Universidade Federal de Pelotas &#40;UFPel&#41;&#44; aprovou o estudo de 2004 &#40;021&#47;2003&#41; e o <span class="elsevierStyleItalic">Intergrowth&#8208;21</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">st</span></span> &#40;051&#47;09&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume as principais frequ&#234;ncias das vari&#225;veis avaliadas em cada coorte de rec&#233;m&#8208;nascidos&#46; Houve um aumento na preval&#234;ncia de PT de 5&#44;8&#37; para 14&#37; &#40;p para tend&#234;ncia<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; at&#233; 2004 e estabiliza&#231;&#227;o em 2011&#46; A incid&#234;ncia de LPT mostrou a maior ocorr&#234;ncia &#40;80&#37; de PT&#41;&#44; com quedas nos estudos de 2004 e 2011&#46; Os maiores n&#250;meros de ocorr&#234;ncia de PT associado a baixo peso ao nascer foram observados em 1993&#44; com uma redu&#231;&#227;o em 2004 e novo aumento em 2011&#44; representaram quase 60&#37; das ocorr&#234;ncias de PT&#46; As ocorr&#234;ncias de LPT com BPN foi mais prevalente no estudo de 1982&#44; se tornou menor em 1993&#44; aumentou novamente em 2004 e permaneceu est&#225;vel em 2011 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">A cor de pele maternal predominante foi branca em todos os estudos&#44; com aumento nas propor&#231;&#245;es de negra e outras cores em estudos mais recentes&#46; A propor&#231;&#227;o de cor de pele materna negra entre as ocorr&#234;ncias de PT &#40;inclusive LPT&#41; foi menor em 1982&#44; por&#233;m maior em 1993&#44; 2004 e 2011&#59; contudo&#44; quando as ocorr&#234;ncias de PT estiveram associadas a BPN&#44; foi semelhante ou maior em todas as quatro coortes&#46; Com rela&#231;&#227;o &#224; escolaridade maternal&#44; ocorreu um aumento no n&#250;mero de anos de escolaridade&#46; As m&#227;es com menos escolaridade apresentaram maior preval&#234;ncia de PT e LPT com ou sem BPN&#44; exceto em 1982&#46; A preval&#234;ncia de m&#227;es adolescentes variou de 15&#44;6 a 19&#44;1&#37;&#44; com maior percentual na coorte de 2004 e queda em 2011&#44; apesar de a propor&#231;&#227;o das m&#227;es com mais de 35 anos ter variado de 9&#44;8 a 13&#44;3&#37;&#44; permaneceu est&#225;vel nos &#250;ltimos dois estudos&#46; A presen&#231;a de PT e LPT&#44; associada ou n&#227;o a BPN&#44; em adolescentes foi maior em todas as coortes de estudo&#44; principalmente em 2004 e 2011&#46; M&#227;es mais velhas apresentaram achados compar&#225;veis com m&#227;es adolescentes&#44; principalmente para PT e LPT com BPN em 1982&#44; e para PT em 2004 e 2011&#46; O n&#250;mero de mulheres sem um relacionamento est&#225;vel aumentou de 8&#44;2 para 16&#44;4&#37;&#44; at&#233; 2004&#44; com queda subsequente para 13&#44;5&#37; em 2011&#46; As m&#227;es solteiras apresentaram menores &#237;ndices de PT e LPT com BPN em 1982&#44; em compara&#231;&#227;o com outras coortes&#44; exceto para LPT com LBP em 2004&#46; As mulheres solteiras em 2011 apresentaram maiores taxas de PT e LPT isoladamente ou com BPN &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A maior preval&#234;ncia de PT foi observada entre as fam&#237;lias mais pobres &#40;primeiro quintil&#41;&#44; em todos os quatros estudos analisados&#46; O maior aumento na prematuridade ocorreu entre as coortes de 1982 e 1993&#44; principalmente entre as m&#227;es mais pobres &#40;quintil de renda 2&#41; &#40;351&#44;9&#37;&#41; e m&#227;es ricas &#40;quintil de renda 4&#41; &#40;82&#44;1&#37;&#41;&#46; A maior redu&#231;&#227;o ocorreu entre 2004 e 2011 entre as m&#227;es mais pobres &#40;Q1&#41; &#40;&#8208;16&#44;3&#37;&#41;&#44; seguida pelas mais ricas &#40;Q5&#41; &#40;&#8208;9&#44;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">As iniquidades nas ocorr&#234;ncias de PT foram observadas por meio da an&#225;lise de SII bruta e ajustada&#46; A maior iniquidade de renda do SII com rela&#231;&#227;o a PT foi observada em 2004&#44; com a diferen&#231;a entre as m&#227;es mais pobres &#40;Q1&#41; e mais ricas &#40;Q5&#41;&#44; de 6&#44;3 PP&#46; Essas diferen&#231;as n&#227;o foram observadas em 1982&#44; 1993 ou 2011 como intervalos de confian&#231;a &#40;IC&#41; que inclu&#237;am zero &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Para RII&#44; foi observado que nas coortes de 1993&#44; 2004 e 2011 as m&#227;es mais pobres apresentaram maior chance de ter PT&#44; em compara&#231;&#227;o com as mais ricas&#46; O ajuste dos fatores de confus&#227;o reduziu a raz&#227;o de chance &#40;RC&#41; e apenas em 2004 as m&#227;es mais pobres apresentaram maior chance de PT &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Houve um padr&#227;o inferior de iniquidade em 2004 e um padr&#227;o superior em 2011&#44; ao contr&#225;rio do padr&#227;o linear mostrado em 1982 e 1993&#46; Houve um aumento na ocorr&#234;ncia de PT at&#233; 2004 e uma leve redu&#231;&#227;o em 2011&#44; observado principalmente na popula&#231;&#227;o mais pobre &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0130" class="elsevierStylePara elsevierViewall">Esses quatro estudos com maior volume de informa&#231;&#245;es coletadas das coortes de nascimento da mesma cidade brasileira tornaram poss&#237;vel comparar os aspectos socioecon&#244;micos para avaliar as iniquidades de PT&#46; A iniquidade socioecon&#244;mica de acordo com a renda foi demonstrada em todos os estudos&#44; por&#233;m&#44; ap&#243;s ajuste&#44; foi mostrada uma RC significativa apenas na coorte de 2004&#46; Foi observado um aumento na preval&#234;ncia de PT&#44; principalmente entre as m&#227;es mais pobres&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A iniquidade de sa&#250;de ocorreu por diferen&#231;as entre os grupos mais privilegiados em uma categoria escolhida de fatores determinantes sociais de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Os fatores determinantes mais importantes relacionados a iniquidade s&#227;o etnia&#44; religi&#227;o&#44; posi&#231;&#227;o socioecon&#244;mica &#40;riqueza&#44; renda&#44; escolaridade ou profiss&#227;o&#41;&#44; estado civil e idade&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;15</span></a> A m&#227;e e seu feto est&#227;o expostos a muitos fatores de iniquidade que levam a resultados neonatais indesej&#225;veis&#44; em todo o mundo&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;16</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">As maiores diferen&#231;as relacionadas a importantes ocorr&#234;ncias de PT foram vistas em m&#227;es com cor de pele negra&#44; baixa escolaridade&#44; solteiras&#44; com idades entre &#60; 20 ou &#8805; 35 nos estudos de 1993&#44; 2004 2011&#59; mais evidente em m&#227;es negras e com &#60; 4 anos de escolaridade em 1993 e 2004&#46; Essas diferen&#231;as tamb&#233;m foram encontradas em outros pa&#237;ses&#44; associadas a etnia&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;17&#44;18</span></a> escolaridade&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#8211;21</span></a> renda<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> ou todos&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">A renda &#233; um dos fatores de risco que determinam a posi&#231;&#227;o social do indiv&#237;duo e a baixa renda pode estar relacionada a exclus&#227;o social de indiv&#237;duos em suas comunidades e&#44; portanto&#44; est&#225; relacionada a iniquidades de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Al&#233;m disso&#44; pode determinar mudan&#231;as na sa&#250;de materna e infantil&#44; afetar morbidades neonatais e na inf&#226;ncia com reflexo no futuro da crian&#231;a&#46; A influ&#234;ncia da renda sobre a sa&#250;de materna e infantil pode decorrer de dificuldades antes da gravidez&#44; como acesso a alimentos de boa qualidade&#47;quantidade&#44; acompanhamento pr&#233;&#8208;natal adequado e identifica&#231;&#227;o precoce de morbidades&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">A an&#225;lise sobre as diferentes declara&#231;&#245;es de renda mostrou que a coorte de 2004 apresentou quase o dobro da ocorr&#234;ncia de PT entre as m&#227;es mais pobres&#46; Esse resultado foi observado em menor grau na coorte de 2011&#44; por&#233;m sem efeito sobre o RII ou SII&#46; Os maiores n&#237;veis de PT que ocorreram entre as m&#227;es mais pobres nos estudos de 1982&#44; 1993 e 2004 tamb&#233;m foram vistos entre as m&#227;es mais ricas &#40;apesar de menos intensamente&#41;&#46; Houve uma queda significativa em 2011 entre as m&#227;es mais pobres e menos entre as mais ricas&#46; Apesar da estabiliza&#231;&#227;o da propor&#231;&#227;o de PT em 2011&#44; as taxas ainda eram maiores entre as m&#227;es mais pobres&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">&#201; importante observar que LPT representou a maior propor&#231;&#227;o de PT e sua ocorr&#234;ncia estava inversamente relacionada &#224; ocorr&#234;ncia de PT&#46; Como n&#227;o houve confirma&#231;&#227;o da IG por meio da medi&#231;&#227;o mais precisa &#40;ultrassom no primeiro trimestre&#41; at&#233; 2004&#44; pode haver c&#225;lculo err&#244;neo da IG&#44; o que explica o comportamento de LPT&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;24</span></a> Pequenas mudan&#231;as na ocorr&#234;ncia de PT com BPN foram encontradas nos estudos&#44; muito semelhantes para prematuridade em si&#44; por&#233;m inclu&#237;ram LPT associado a BPN apenas nos estudos de 2004 e 2011&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A prematuridade &#233; mais prevalente em pa&#237;ses de renda m&#233;dia&#47;baixa&#44; por&#233;m a taxa de sobrevida nos prematuros &#233; muito maior em pa&#237;ses de alta renda&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a> A taxa de PT relatada no Brasil varia de 9&#44;3&#37; a 10&#44;5&#37; &#40;2011&#41; de todos os nascimentos&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Silveira et al&#46; destacaram que houve grandes diferen&#231;as na preval&#234;ncia de PT de acordo com a regi&#227;o brasileira estudada&#46; As maiores taxas foram nas regi&#245;es Sul e Sudeste &#40;3&#44;4&#37; a 15&#44;0&#37;&#44; de 1978 a 2004&#41; e as menores foram na Regi&#227;o Nordeste &#40;3&#44;8&#37; a 10&#44;2&#37;&#44; de 1984 a 1998&#41;&#46; Em todas as regi&#245;es&#44; houve uma tend&#234;ncia com rela&#231;&#227;o a aumentos graduais&#46; Os relatos de diferentes cidades brasileiras mostram que o percentual total de PT no Brasil pode ter sido subestimado&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Um estudo multic&#234;ntrico nacional que incluiu 191 cidades constatou uma taxa de PT de 12&#44;5&#37; e discutiu a import&#226;ncia de classifica&#231;&#245;es err&#244;neas de LPT como nascimentos a termo e o grande n&#250;mero de interven&#231;&#245;es cir&#250;rgicas como poss&#237;veis causas evit&#225;veis desse resultado&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Os aumentos na renda&#44; os anos de escolaridade e o tipo de trabalho podem influenciar as iniquidades de sa&#250;de&#44; com um impacto sobre o indiv&#237;duo e a sa&#250;de comunit&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Uma publica&#231;&#227;o anterior que usou dados das mesmas coortes demonstrou uma iniquidade econ&#244;mica significativa relacionada &#224; renda familiar para pequeno para a idade gestacional &#40;PIG&#41; e rec&#233;m&#8208;nascidos BPN e sugeriu que as melhorias na economia brasileira podem ter modificado a preval&#234;ncia desses resultados em todas as coortes&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Essas mudan&#231;as socioecon&#244;micas tamb&#233;m podem ter ajudado na redu&#231;&#227;o da prematuridade&#46; Contudo&#44; outros fatores influenciaram as taxas de PT&#44; como o tipo de parto&#46; A grande maioria de PT acontece espontaneamente&#46; Outros fatores culturais&#44; indu&#231;&#227;o precoce de trabalho de parto e indica&#231;&#227;o inapropriada de ces&#225;reas podem aumentar a preval&#234;ncia de PT&#44; independentemente da posi&#231;&#227;o socioecon&#244;mica da m&#227;e&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4&#44;16</span></a> Infelizmente&#44; entre as pessoas que s&#227;o menos favorecidas economicamente&#44; h&#225; dificuldade de acesso a acompanhamento pr&#233;&#8208;natal&#44; o que piora a preval&#234;ncia real da prematuridade nesse grupo&#46; Essa dificuldade inclui tamb&#233;m a baixa precis&#227;o do uso do LMP ou Dubowitz<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> em vez de ultrassom obst&#233;trico precoce &#40;padr&#227;o de base de diagn&#243;stico para idade gestacional&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">O aumento na preval&#234;ncia de PT e na grande maioria de LPT pode ser explicado &#40;em parte&#41; por taxas alarmantes e crescentes de ces&#225;reas no Brasil&#44; com maior propor&#231;&#227;o entre as usu&#225;rias de conv&#234;nio m&#233;dio particular&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Uma an&#225;lise sobre as indica&#231;&#245;es de interven&#231;&#227;o cir&#250;rgica mostrou que 35&#37; dos partos foram eletivos&#46; Al&#233;m disso&#44; as classes sociais socioeconomicamente privilegiadas podem ter concep&#231;&#245;es impr&#243;prias de parto normal como uma causa de &#8220;dor e sofrimento&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Al&#233;m disso&#44; fatores culturais e outras causas question&#225;veis de indica&#231;&#227;o de ces&#225;rea atribu&#237;dos por profissionais de servi&#231;os de sa&#250;de est&#227;o associados a indica&#231;&#245;es de parto n&#227;o natural&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">As melhorias na sobrevida de rec&#233;m&#8208;nascidos de PT&#44; devido a avan&#231;os na neonatologia e melhor acesso a atendimento especializado&#44; principalmente para beb&#234;s muito prematuros&#44; culminaram em redu&#231;&#245;es da mortalidade de rec&#233;m&#8208;nascido e crian&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Contudo&#44; a escala dessas redu&#231;&#245;es desses &#237;ndices continua a ser menor do que a esperado&#46; H&#225; uma grande preocupa&#231;&#227;o com rela&#231;&#227;o ao LPT&#44; que pode levar a uma maior probabilidade de n&#227;o apenas morbidez e mortalidade infantil&#44; mas tamb&#233;m de maior taxa de mortalidade entre adultos jovens&#46; Adicionalmente&#44; as morbidades e sequelas de PT s&#227;o consequ&#234;ncias s&#233;rias impostas a fam&#237;lias socioeconomicamente n&#227;o privilegiadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3&#44;30</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Uma das poss&#237;veis limita&#231;&#245;es &#233; o fato de que este estudo n&#227;o comparou os tipos de parto ou outros dados relacionados &#224; sa&#250;de materna e&#47;ou gravidezes anteriores&#44; como IMC&#44; hist&#243;rico anterior de prematuridade ou h&#225;bitos maternos&#44; como nutri&#231;&#227;o ou consumo de drogas il&#237;citas ou l&#237;citas&#44; como &#225;lcool e tabaco&#46; Esses fatores pode ter uma influ&#234;ncia com rela&#231;&#227;o a resultados neonatais inadequados&#44; como PT ou mesmo morbimortalidade de lactantes e crian&#231;as&#46; Al&#233;m disso&#44; a falta de explora&#231;&#227;o de outras dimens&#245;es de iniquidade&#44; como escolaridade e etnia como o resultado principal&#44; constitui uma das limita&#231;&#245;es deste estudo&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Pode haver outras limita&#231;&#245;es&#44; pois os m&#233;todos para determinar a IG mudaram com o passar do tempo&#46; O uso de m&#233;todos combinados pode aumentar a precis&#227;o para determinar a real preval&#234;ncia de PT&#44; principalmente pelo uso do ultrassom no primeiro e segundo trimestres &#40;&#8804; 23 semanas&#41;&#44; observado nas &#250;ltimas coortes &#40;2004 e 2011&#41;&#46; Contudo&#44; com exce&#231;&#227;o de 1982&#44; todos os estudos apresentaram a preval&#234;ncia de PT com pequena varia&#231;&#227;o e os dados estat&#237;sticos foram mensurados com a mesma distribui&#231;&#227;o de quintis de renda&#44; minimizaram varia&#231;&#245;es no resultado dos &#237;ndices de iniquidade&#46; Esses fatos refor&#231;am o resultado deste estudo&#44; apesar de haver suspeita de discrep&#226;ncia da IG&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">O nascimento prematuro esteve relacionado a iniquidades de renda at&#233; 2004&#44; com redu&#231;&#227;o em 2011&#44; apesar de a taxa de PT permanecer mais elevada entre m&#227;es mais pobres em todos os estudos&#46; Esses resultados destacam a import&#226;ncia de pol&#237;ticas de sa&#250;de p&#250;blica&#44; inclus&#227;o social e promo&#231;&#227;o de melhoria na renda e nos n&#237;veis de escolaridade entre fam&#237;lias com vulnerabilidade socioecon&#244;mica&#44; como parte dos esfor&#231;os para promover os resultados de rec&#233;m&#8208;nascidos saud&#225;veis e reduzir o nascimento prematuro&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiamento</span><p id="par0200" class="elsevierStylePara elsevierViewall">Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior &#40;Capes&#41;&#59; Associa&#231;&#227;o Brasileira de Sa&#250;de Coletiva &#40;Abrasco&#41;&#59; <span class="elsevierStyleItalic">Wellcome Trust</span>&#59; <span class="elsevierStyleItalic">The International Development Research Center</span>&#59; Organiza&#231;&#227;o Mundial de Sa&#250;de&#59; <span class="elsevierStyleItalic">Overseas Development Administration</span>&#59; Uni&#227;o Europeia&#59; Programa Nacional de Apoio a N&#250;cleos de Excel&#234;ncia &#40;Pronex&#41;&#59; Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;CNPq&#41;&#59; Minist&#233;rio da Sa&#250;de&#59; Pastoral da Crian&#231;a&#59; Funda&#231;&#227;o Bill &#38; Melinda Gates&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0205" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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    "fechaRecibido" => "2016-11-19"
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            2 => "Socioeconomic factors"
            3 => "Poverty"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze economic inequality &#40;absolute and relative&#41; due to family income in relation to the occurrence of preterm births in Southern Brazil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Four birth cohort studies were conducted in the years 1982&#44; 1993&#44; 2004&#44; and 2011&#46; The main exposure was monthly family income and the primary outcome was preterm birth&#46; The inequalities were calculated using the slope index of inequality and the relative index of inequality&#44; adjusted for maternal skin color&#44; education&#44; age&#44; and marital status&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The prevalence of preterm births increased from 5&#46;8&#37; to approximately 14&#37; &#40;p&#8208;trend<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Late preterm births comprised the highest proportion among the preterm births in all studies&#44; although their rates decreased over the years&#46; The analysis on the slope index of inequality demonstrated that income inequity arose in the 1993&#44; 2004&#44; and 2011 studies&#46; After adjustment&#44; only the 2004 study maintained the difference between the poorest and the richest subjects&#44; which was 6&#46;3 percentage points&#46; The relative index of inequality showed that&#44; in all studies&#44; the poorest mothers were more likely to have preterm newborns than the richest&#46; After adjustment for confounding factors&#44; it was observed that the poorest mothers only had a greater chance of this outcome in 2004&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In a final model&#44; economic inequities resulting from income were found in relation to preterm births only in 2004&#44; although a higher prevalence of prematurity continued to be observed in the poorest population&#44; in all the studies&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analisar a iniquidade econ&#244;mica &#40;absoluta e relativa&#41; decorrente da renda familiar na ocorr&#234;ncia de prematuros no Sul do Brasil&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram feitos quatro estudos do tipo coorte de nascimentos em 1982&#44; 1993&#44; 2004 e 2011&#46; A exposi&#231;&#227;o principal foi a renda familiar mensal e o desfecho foi nascer prematuro&#46; Foram calculadas as iniquidades atrav&#233;s do <span class="elsevierStyleItalic">slope index of inequality</span> e o <span class="elsevierStyleItalic">relative index of inequality</span>&#44; ajustados por cor da pele&#44; escolaridade&#44; idade e estado civil maternos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Houve aumento da preval&#234;ncia de prematuros de 5&#44;8 para 14&#37; &#40;<span class="elsevierStyleItalic">p</span> de tend&#234;ncia<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; O prematuro tardio foi a maior propor&#231;&#227;o encontrada dentre os que nasceram prematuros em todos os estudos&#44; embora com taxas reduzidas ao longo dos anos&#46; A an&#225;lise do <span class="elsevierStyleItalic">slope index of inequality</span> demonstrou iniquidade decorrente de renda nos estudos de 1993&#44; 2004 e 2011&#46; Ap&#243;s ajuste&#44; apenas o estudo de 2004 manteve a diferen&#231;a entre os mais pobres e os mais ricos&#44; que foi de 6&#44;3 pontos percentuais&#46; Atrav&#233;s do <span class="elsevierStyleItalic">relative index of inequality</span>&#44; observou&#8208;se que&#44; em todos os estudos&#44; as m&#227;es mais pobres tiveram maior chance de ter prematuros&#44; em compara&#231;&#227;o com as mais ricas&#46; O ajuste para fatores de confus&#227;o demonstrou a manuten&#231;&#227;o dos mais pobres com maior chance do desfecho apenas em 2004&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">No modelo final&#44; iniquidades econ&#244;micas decorrentes da renda foram encontradas no nascimento de prematuros apenas em 2004&#44; apesar da manuten&#231;&#227;o de maior ocorr&#234;ncia da prematuridade na popula&#231;&#227;o mais pobre&#44; em todos os estudos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Como citar este artigo&#58; Sadovsky AD&#44; Matijasevich A&#44; Santos IS&#44; Barros FC&#44; Miranda AE&#44; Silveira MF&#46; Socioeconomic inequality in preterm birth in four Brazilian birth cohort studies&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;15&#8211;22&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pelotas 1982 n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Escolaridade materna &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>5 &#8211; 8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Idade &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Com parceiro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">475 &#40;8&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">679 &#40;16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">827 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Caracter&#237;sticas de PT</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negra ou mista&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Escolaridade materna &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">79 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">189 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">123 &#40;21&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Idade &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Caracter&#237;sticas de LPT</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Escolaridade materna &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Idade &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>M&#227;e solteira</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Caracter&#237;sticas de PT e BPN</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Etnia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negra ou mista&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">180 &#40;36&#44;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Escolaridade materna &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62; 12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Idade &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62; 35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>M&#227;e solteira</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Caracter&#237;sticas de LPT e BPN</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Etnia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negra ou mista&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas maternas e infantis de todos os nascimentos e prematuros &#40;PT&#41; e prematuros tardios &#40;LPT&#41; com ou sem baixo peso ao nascer&#44; em quatro estudos de coorte de nascimento</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nascimento prematuro &#40;&#37;&#41;</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2004<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#176; &#40;mais pobre&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelos de nascimento prematuro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pelotas 1982&nbsp;\t\t\t\t\t\t\n
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