Freemantle C Jane, Read Anne W, de Klerk Nicholas H, McAullay Daniel, Anderson Ian P, Stanley Fiona J
Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia.
Lancet. 2006 May 27;367(9524):1758-66. doi: 10.1016/S0140-6736(06)68771-0.
Since there are known disparities between Aboriginal and non-Aboriginal populations in Australia, trends in infant mortality rates can be used to assess the effectiveness of programmes designed to improve the health of Aboriginal populations. We have examined mortality rates in these populations in Western Australia.
We used the most comprehensive and valid total population data available for an Australian state to determine all-cause and cause-specific mortality for Aboriginal and non-Aboriginal infants born in Western Australia from 1980 to 2001.
Overall, infant mortality rates fell in both populations, but less so in Aboriginal (from 25.0 in 1980-84 to 16.1 in 1998-2001) than in non-Aboriginal infants (from 8.4 in 1980-84 to 3.7 in 1998-2001) such that disparities between the two groups increased for all major causes of infant death. The relative risk for Aboriginal compared with non-Aboriginal infants rose from 3.0 (95% CI 2.5-3.6) to 4.4 (3.5-5.5), and there were significantly more potentially preventable deaths, such as those caused by infections (5.9 per 1000 livebirths vs 0.7 per 1000 livebirths, RR 8.5, 95% CI 7.1-10.2). Additionally, for Aboriginal infants, postneonatal mortality rates were higher than neonatal mortality rates (11.2 per 1000 livebirths vs 9.7 per 1000 livebirths), trend analyses showed that previous reductions in deaths due to preterm birth (4.3 per 1000 livebirths--1.4 per 1000 livebirths from 1980-97) were not sustained in the most recent years studied (3.5 per 1000 livebirths), and rates of sudden infant death syndrome did not fall significantly (4.9 per 1000 livebirths vs 4.7 per 1000 livebirths).
These increasing disparities between Aboriginal and non-Aboriginal infants, especially in remote areas, demand immediate action in partnership with Aboriginal communities, focusing on both access to primary health care and better living conditions. Implementation and assessment of policies to reduce the continuing social and economic disadvantage faced by Aboriginal families are vital.
由于澳大利亚原住民与非原住民人口之间存在已知差异，婴儿死亡率趋势可用于评估旨在改善原住民人口健康的项目的有效性。我们研究了西澳大利亚州这些人群的死亡率。
我们使用了澳大利亚一个州可获得的最全面、有效的总人口数据，以确定1980年至2001年在西澳大利亚州出生的原住民和非原住民婴儿的全因死亡率和特定原因死亡率。
总体而言，两组人群的婴儿死亡率均有所下降，但原住民婴儿死亡率下降幅度较小（从1980 - 1984年的25.0降至1998 - 2001年的16.1），低于非原住民婴儿（从1980 - 1984年的8.4降至1998 - 2001年的3.7），以至于两组在所有主要婴儿死亡原因上的差距都有所扩大。与非原住民婴儿相比，原住民婴儿的相对风险从3.0（95%置信区间2.5 - 3.6）升至4.4（3.5 - 5.5），且有更多潜在可预防的死亡，如感染导致的死亡（每1000例活产中有5.9例，而非原住民为每1000例活产中有0.7例，相对风险8.5，95%置信区间7.1 - 10.2）。此外，对于原住民婴儿，新生儿后期死亡率高于新生儿死亡率（每1000例活产中有11.2例对9.7例），趋势分析表明，早产导致的死亡此前有所下降（从1980 - 1997年的每1000例活产4.3例降至1.4例），但在最近研究的年份中未持续（每1000例活产3.5例），婴儿猝死综合征的发生率也没有显著下降（每1000例活产4.9例对4.7例）。
原住民与非原住民婴儿之间日益扩大的差距，尤其是在偏远地区，需要与原住民社区合作立即采取行动，重点关注获得初级卫生保健的机会和改善生活条件。实施和评估旨在减少原住民家庭持续面临的社会和经济劣势的政策至关重要。
