Research Fellow Professor, Division of General Pediatrics, Department of Pediatrics Professor, Division of Biostatistics, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA Researcher, Department of Healthcare Epidemiology, Kyoto University School of Medicine and Public Health, Sakyo-ku, Kyoto, Japan.
J Eval Clin Pract. 2013 Oct;19(5):849-54. doi: 10.1111/j.1365-2753.2012.01862.x. Epub 2012 May 29.
To determine IMR trends and regional variations among 47 prefectures in Japan and to identify associated population-based factors.
We conducted an ecological study of infant mortality rate (IMR) by analyzing publicly available data from the Ministry of Health, Labour and Welfare of Japan. Outcome measure for trend is the IMR for each of 47 prefectures from 1999 to 2007; for variation, IMRs for 2006 and 2007 in each prefecture were averaged. We considered as covariates prefecture-level variables related to public health, socio-economic status, clinical services and health care facilities. We conducted multivariate statistical analyses to determine covariates most strongly associated with both 1999-2007 IMR trends and 2006-2007 IMR.
The mean IMR decreased from 3.42 deaths per 1000 live births (range 2.1 to 5.1) in 1999 to 2.54 (range 1.5 to 4.4) in 2007; reductions were greater in prefectures with higher concentrations of public health nurses (PHNs) and nurses. In 2006-2007, nine prefectures had IMRs ≤ 2.25; eight had IMRs ≥ 3.0. When low-, moderate- and high-IMR prefectures were compared, per capita PHNs, maternal education, centralized water supply and household income were identified as significant covariates.
Both national and prefecture-level IMR in Japan decreased from 1999 to 2007; however, the degree of reduction varied by prefecture. Given that more nurses and PHNs per capita were associated with greater IMR reductions from 1999 to 2007 and more PHNs with lower 2006-2007 IMRs, distribution of preventive health services may play a major role in reducing regional disparities in IMR.
确定日本 47 个都道府县的婴儿死亡率（IMR）趋势和地区差异，并确定相关的基于人群的因素。
我们通过分析日本厚生劳动省提供的公开数据，对婴儿死亡率（IMR）进行了生态研究。趋势的结果衡量是 1999 年至 2007 年期间每个都道府县的 IMR；对于变异，每个都道府县的 2006 年和 2007 年的 IMR 进行了平均处理。我们考虑了与公共卫生、社会经济状况、临床服务和医疗保健设施相关的都道府县一级变量作为协变量。我们进行了多元统计分析，以确定与 1999-2007 年 IMR 趋势和 2006-2007 年 IMR 最密切相关的协变量。
平均 IMR 从 1999 年的每 1000 例活产 3.42 例死亡（范围为 2.1 至 5.1）降至 2007 年的 2.54 例死亡（范围为 1.5 至 4.4）；公共卫生护士（PHN）和护士浓度较高的都道府县降幅更大。2006-2007 年，有 9 个都道府县的 IMR≤2.25；有 8 个都道府县的 IMR≥3.0。在比较低、中、高 IMR 都道府县时，发现每千人 PHN、产妇教育、集中供水和家庭收入是重要的协变量。
1999 年至 2007 年，日本的全国和都道府县 IMR 均有所下降；然而，减少的程度因都道府县而异。鉴于每千人拥有更多的护士和 PHN 与 1999 年至 2007 年 IMR 降低幅度更大相关，而更多的 PHN 与 2006-2007 年较低的 IMR 相关，因此预防保健服务的分布可能在降低 IMR 的地区差异方面发挥重要作用。
