{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:56:36Z","timestamp":1785797796551,"version":"3.56.0"},"reference-count":44,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010897","name":"Newton Fund","doi-asserted-by":"publisher","award":["527418645"],"award-info":[{"award-number":["527418645"]}],"id":[{"id":"10.13039\/100010897","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["213589\/Z\/18\/Z"],"award-info":[{"award-number":["213589\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006506","name":"Minist\u00e9rio da Sa\u00fade","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006506","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2022,8,29]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>While it is well known that socioeconomic markers are associated with a higher risk of arbovirus infections, research on the relationship between socioeconomic factors and congenital Zika syndrome (CZS) remains limited. This study investigates the relationship between socioeconomic risk markers and live births with CZS in Brazil. We conducted a population-based study using data from all registered live births in Brazil (Live Births Information System) linked with the Public Health Event Record from 1 January 2015 to 31 December 2018. We used logistic regression models to estimate the OR and 95% CIs of CZS based on a three-level framework. In an analysis of 11 366 686 live births, of which 3353 had CZS, we observed that live births of self-identified black or mixed race\/brown mothers (1.72 (95% CI 1.47 to 2.01) and 1.37 (95% CI 1.24 to 1.51)) were associated with a higher odds of CZS. Live births from single women compared with married women and those from women with less than 12 years of education compared with those with more than 12 years of education also had higher odds of CZS. In addition, live births following fewer prenatal care appointments had increased odds of CZS in the nationwide data. However, in the analyses conducted in the Northeast region (where the microcephaly epidemic started before the link with Zika virus was established and before preventive measures were known or disseminated), no statistical association was found between the number of prenatal care appointments and the odds of CZS. This study shows that live births of the most socially vulnerable women in Brazil had the greatest odds of CZS. This disproportionate distribution of risk places an even greater burden on already socioeconomically disadvantaged groups, and the lifelong disabilities caused by this syndrome may reinforce existing social and health inequalities.<\/jats:p>","DOI":"10.1136\/bmjgh-2022-009600","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T11:35:15Z","timestamp":1664451315000},"page":"e009600","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil"],"prefix":"10.1136","volume":"7","author":[{"given":"Enny S","family":"Paix\u00e3o","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Center of Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qeren Hapuk R Ferreira","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Center of Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana L","family":"Cardim","sequence":"additional","affiliation":[{"name":"Center of Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M","family":"Pescarini","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Conceicao N","family":"Costa","sequence":"additional","affiliation":[{"name":"Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ila R","family":"Falc\u00e3o","sequence":"additional","affiliation":[{"name":"Center of Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0280-2288","authenticated-orcid":false,"given":"Elizabeth B","family":"Brickley","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreia Costa","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Portela Souza","sequence":"additional","affiliation":[{"name":"School of Economics and Center for Applied Microeconomic Studies, Getulio Vargas Foundation, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita de Cassia Oliveira","family":"Carvalho-Sauer","sequence":"additional","affiliation":[{"name":"East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Smeeth","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio L","family":"Barreto","sequence":"additional","affiliation":[{"name":"Center of Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Gloria","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"2025072914145082000_7.9.e009600.1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aaf8160"},{"key":"2025072914145082000_7.9.e009600.2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00072-15"},{"key":"2025072914145082000_7.9.e009600.3","unstructured":"PAHO\/WHO . 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