Murray Christopher J L, Laakso Thomas, Shibuya Kenji, Hill Kenneth, Lopez Alan D
Institute for Health Metrics and Evaluation at the University of Washington, Seattle, WA 98102, USA.
Lancet. 2007 Sep 22;370(9592):1040-54. doi: 10.1016/S0140-6736(07)61478-0.
Global efforts have increased the accuracy and timeliness of estimates of under-5 mortality; however, these estimates fail to use all data available, do not use transparent and reproducible methods, do not distinguish predictions from measurements, and provide no indication of uncertainty around point estimates. We aimed to develop new reproducible methods and reanalyse existing data to elucidate detailed time trends.
We merged available databases, added to them when possible, and then applied Loess regression to estimate past trends and forecast to 2015 for 172 countries. We developed uncertainty estimates based on different model specifications and estimated levels and trends in neonatal, post-neonatal, and childhood mortality.
Global under-5 mortality has fallen from 110 (109-110) per 1000 in 1980 to 72 (70-74) per 1000 in 2005. Child deaths worldwide have decreased from 13.5 (13.4-13.6) million in 1980 to an estimated 9.7 (9.5-10.0) million in 2005. Global under-5 mortality is expected to decline by 27% from 1990 to 2015, substantially less than the target of Millennium Development Goal 4 (MDG4) of a 67% decrease. Several regions in Latin America, north Africa, the Middle East, Europe, and southeast Asia have had consistent annual rates of decline in excess of 4% over 35 years. Global progress on MDG4 is dominated by slow reductions in sub-Saharan Africa, which also has the slowest rates of decline in fertility.
Globally, we are not doing a better job of reducing child mortality now than we were three decades ago. Further improvements in the quality and timeliness of child-mortality measurements should be possible by more fully using existing datasets and applying standard analytical strategies.
全球范围内为提高5岁以下儿童死亡率估计的准确性和及时性做出了诸多努力；然而，这些估计未能利用所有可得数据，未采用透明且可重复的方法，未区分预测值与测量值，且未给出点估计周围不确定性的任何指示。我们旨在开发新的可重复方法并重新分析现有数据，以阐明详细的时间趋势。
我们合并了可用数据库，并在可能的情况下进行补充，然后应用局部加权回归（Loess回归）来估计过去的趋势并对172个国家到2015年的情况进行预测。我们基于不同的模型规格制定了不确定性估计，并估计了新生儿、新生儿后期和儿童期死亡率的水平及趋势。
全球5岁以下儿童死亡率已从1980年的每1000人110例（109 - 110例）降至2005年的每1000人72例（70 - 74例）。全球儿童死亡人数已从1980年的1350万（1340万 - 1360万）降至2005年估计的970万（950万 - 1000万）。预计1990年至2015年全球5岁以下儿童死亡率将下降27%，远低于千年发展目标4（MDG4）规定的67%的降幅目标。拉丁美洲、北非、中东、欧洲和东南亚的几个地区在35年里一直保持着超过4%的年下降率。MDG4的全球进展主要受撒哈拉以南非洲地区下降缓慢的影响，该地区的生育率下降速度也是最慢的。
在全球范围内，我们现在在降低儿童死亡率方面做得并不比三十年前更好。通过更充分地利用现有数据集并应用标准分析策略，应该有可能进一步提高儿童死亡率测量的质量和及时性。
