Trata-se de um estudo ecológico exploratório tipo comparação de múltiplos grupos. Objetivo: descrever o padrão de mortalidade da população a partir de estratos homogêneos de vulnerabilidade social dos municípios no Estado de São Paulo de 2003 a 2005. Método: Construção de estratos homogêneos, através de indicador composto por variáveis socioeconômicas e demográficas e comparação dos padrões de mortalidade através de taxas padronizadas. Resultados: Construção de cinco estratos homogêneos de vulnerabilidade social (Muito Fraca, Fraca, Intermediária, Intensa e Muito Intensa). Estimativas de risco mais elevadas para mortes maternas (27,82 a 56,22 %000 nascidos vivos), mortes infantis (12,48 a 16,20%0 nascidos vivos) e acidentes de transporte (14,68 a 24,06%000 hab.) foram mostradas nos estratos de maior vulnerabilidade declinando para os de menor vulnerabilidade. Para as Neoplasias (80,85 a 104,96 %000 hab.) e D. Infecciosas e Parasitárias (23,21 a 27,52 a %000 hab.) as mais elevadas ocorreram nos estratos de menor vulnerabilidade, declinando para os de maior vulnerabilidade. Para Diabetes Mellitus (17,36 a 23,57%000 hab.), D. Circulatórias (174,03 a 206,87%000 hab.), Homicídios (11,50 a 21,24%000 hab.) e, D. Respiratórias (62,58 a 75,54 %000 hab.), as mais elevadas situaram-se no estrato de vulnerabilidade social intermediária, declinando para os de maior vulnerabilidade, à exceção da Diabetes Mellitus. Conclusões: Foram evidenciadas desigualdades de mortalidade, apontando para grupos humanos com maiores necessidades de saúde, estratificação do risco epidemiológico e identificação de áreas críticas que indicam para a necessidade do desenvolvimento de políticas de saúde mais equitativas. / This is an ecologic exploratory study employing multiple group comparison. Objective: to describe mortality patterns of the population from homogeneous social vulnerable strata of the cities in the State of São Paulo, from 2003 to 2005. Method: Construction of homogeneous strata employing an indicator composed of socioeconomic and demographic variables and comparison of mortality patters through standardized rates. Results: Construction of five homogeneous social vulnerability strata (Very Weak, Weak, Intermediate, Intense and Very Intense). Risk estimates higher for maternal deaths (27,82 to 56,22 %000 live births), children deaths (12,48 to 16,20%0 live births) and transportation accidents (14,68 to 24,06%000 inhabitants) were shown in the strata of higher vulnerability, declining for those in lower vulnerability. For Neoplasias (80,85 to 104,96 %000 inhabitants) and Infectious and Parasitic diseases (23,21 a 27,52 a %000 inhabitants) higher rates corresponded to lower vulnerability strata, declining for those in higher vulnerability. Diabetes Mellitus (17,36 a 23,57%000 inhabitants), Homicides (11,50 a 21,24%000 inhabitants) and Respiratory Diseases (62,58 a 75,54 %000 inhabitants) higher rates were found at the intermediate social vulnerability stratum, declining for those in higher vulnerability, except for Diabetes Mellitus. Conclusions: Mortality inequalities became evident, pointing to human groups in higher health needs, stratification of the epidemiologic risk and identification of critical areas that show the need to develop more equitable health policies.

Trata-se de um estudo ecológico exploratório tipo comparação de múltiplos grupos. Objetivo: descrever o padrão de mortalidade da população a partir de estratos homogêneos de vulnerabilidade social dos municípios no Estado de São Paulo de 2003 a 2005. Método: Construção de estratos homogêneos, através de indicador composto por variáveis socioeconômicas e demográficas e comparação dos padrões de mortalidade através de taxas padronizadas. Resultados: Construção de cinco estratos homogêneos de vulnerabilidade social (Muito Fraca, Fraca, Intermediária, Intensa e Muito Intensa). Estimativas de risco mais elevadas para mortes maternas (27,82 a 56,22 %000 nascidos vivos), mortes infantis (12,48 a 16,20%0 nascidos vivos) e acidentes de transporte (14,68 a 24,06%000 hab.) foram mostradas nos estratos de maior vulnerabilidade declinando para os de menor vulnerabilidade. Para as Neoplasias (80,85 a 104,96 %000 hab.) e D. Infecciosas e Parasitárias (23,21 a 27,52 a %000 hab.) as mais elevadas ocorreram nos estratos de menor vulnerabilidade, declinando para os de maior vulnerabilidade. Para Diabetes Mellitus (17,36 a 23,57%000 hab.), D. Circulatórias (174,03 a 206,87%000 hab.), Homicídios (11,50 a 21,24%000 hab.) e, D. Respiratórias (62,58 a 75,54 %000 hab.), as mais elevadas situaram-se no estrato de vulnerabilidade social intermediária, declinando para os de maior vulnerabilidade, à exceção da Diabetes Mellitus. Conclusões: Foram evidenciadas desigualdades de mortalidade, apontando para grupos humanos com maiores necessidades de saúde, estratificação do risco epidemiológico e identificação de áreas críticas que indicam para a necessidade do desenvolvimento de políticas de saúde mais equitativas. / This is an ecologic exploratory study employing multiple group comparison. Objective: to describe mortality patterns of the population from homogeneous social vulnerable strata of the cities in the State of São Paulo, from 2003 to 2005. Method: Construction of homogeneous strata employing an indicator composed of socioeconomic and demographic variables and comparison of mortality patters through standardized rates. Results: Construction of five homogeneous social vulnerability strata (Very Weak, Weak, Intermediate, Intense and Very Intense). Risk estimates higher for maternal deaths (27,82 to 56,22 %000 live births), children deaths (12,48 to 16,20%0 live births) and transportation accidents (14,68 to 24,06%000 inhabitants) were shown in the strata of higher vulnerability, declining for those in lower vulnerability. For Neoplasias (80,85 to 104,96 %000 inhabitants) and Infectious and Parasitic diseases (23,21 a 27,52 a %000 inhabitants) higher rates corresponded to lower vulnerability strata, declining for those in higher vulnerability. Diabetes Mellitus (17,36 a 23,57%000 inhabitants), Homicides (11,50 a 21,24%000 inhabitants) and Respiratory Diseases (62,58 a 75,54 %000 inhabitants) higher rates were found at the intermediate social vulnerability stratum, declining for those in higher vulnerability, except for Diabetes Mellitus. Conclusions: Mortality inequalities became evident, pointing to human groups in higher health needs, stratification of the epidemiologic risk and identification of critical areas that show the need to develop more equitable health policies.

Background: Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. Methods: We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Results: Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007–2008 onwards. The departments with the highest annual stunting reduction were Cusco (−2.31%), Amazonas (−1.57%), Puno (−1.54%), Huanuco (−1.52%), and Ancash (−1.44). Those with the lowest reduction were Ica (−0.67%), Ucayali (−0.64%), Tumbes (−0.45%), Lima (−0.37%), and Tacna (−0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Conclusions: Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children’s nutrition. / Revisión por pares