全球范围内，国家间全因死亡率和死因特异性死亡率的不平等现象是否有所减少？

Have inequalities in all-cause and cause-specific child mortality between countries declined across the world?

机构信息

Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, 37554, South Korea.

Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.

出版信息

Int J Equity Health. 2019 Dec 31;19(1):1. doi: 10.1186/s12939-019-1102-3.

DOI:10.1186/s12939-019-1102-3

PMID:31892330

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6938619/

Abstract

BACKGROUND

Comparing the distribution of all cause or cause-specific child mortality in countries by income and its progress over time has not been rigorously monitored, and hence remains unknown. We therefore aimed to analyze child mortality disparities between countries with respect to income level and progression for the period 2000-2015, and further explored the convergence of unequal income levels across the globe.

METHODS

Four types of measures were used to assess the degree of inequality across countries: difference and ratio of child mortality rate, the concentration index, and the Erreygers index. To assess the longitudinal trend of unequal child mortality rate by wealth ranking, hierarchical mixed effect analysis was used to examine any significant changes in the slope of under-5 child mortality rate by GDP per capita between 2000 and 2015.

RESULTS

All four measures reveal significant inequalities across the countries by income level. Compared with children in the least deprived socioeconomic quintile, the mortality rate for children in the most deprived socioeconomic quintile was nearly 20.7 times higher (95% Confidence Interval: 20.5-20.8) in 2000, and 12.2 times (95% CI: 12.1-12.3) higher in 2015. Globally, the relative and absolute inequality of child mortality between the first and fifth quintiles have declined over time in all diseases, but was more pronounced for infectious diseases (pneumonia, diarrhea, measles, and meningitis). In 2000, post-neonatal children in the first quintile had 105.3 times (95% CI: 100.8-110.0) and 216.3 times (95% CI: 202.5-231.2) higher risks of pneumonia- and diarrhea-specific child mortality than children in the fifth quintile. In 2015, the corresponding rate ratios had decreased to 59.3 (95% CI: 56.5-62.1) and 101.9 (95% CI: 94.3-110.0) times. However, compared with non-communicable disease, infectious diseases still show a far more severe disparity between income quintile. Mixed effect analysis demonstrates the convergence of under-5 mortality in 194 countries across income levels.

CONCLUSION

Grand convergence in child mortality, particularly in post neonatal children, suggests that the global community has witnessed success to some extent in controlling infectious diseases. To our knowledge, this study is the first to assess worldwide inequalities in cause-specific child mortality and its time trend by wealth.

摘要

背景

比较不同收入水平国家的全因或特定病因儿童死亡率分布及其随时间的变化情况尚未得到严格监测，因此尚不清楚。因此，我们旨在分析 2000-2015 年间国家间的儿童死亡率差异，以及进一步探讨全球不平等收入水平的趋同情况。

方法

使用了四种类型的指标来评估国家间的不平等程度：儿童死亡率的差异和比率、集中指数和 Erreygers 指数。为了评估按财富排名的不平等儿童死亡率的纵向趋势，我们使用分层混合效应分析来检验 2000 年至 2015 年间按人均 GDP 划分的 5 岁以下儿童死亡率斜率是否有任何显著变化。

结果

所有四种指标都显示出按收入水平划分的国家间存在显著的不平等。与最不受社会经济剥夺的五分位数组的儿童相比，最受社会经济剥夺的五分位数组的儿童死亡率在 2000 年时几乎高出 20.7 倍（95%置信区间：20.5-20.8），在 2015 年时高出 12.2 倍（95%置信区间：12.1-12.3）。在所有疾病中，全球范围内，第一和第五五分位数之间的儿童死亡率的相对和绝对不平等在随时间下降，但在传染病（肺炎、腹泻、麻疹和脑膜炎）中更为明显。2000 年，第一五分位数的新生儿后儿童患肺炎和腹泻特定儿童死亡率的风险分别比第五五分位数高出 105.3 倍（95%置信区间：100.8-110.0）和 216.3 倍（95%置信区间：202.5-231.2）。2015 年，相应的比率已降至 59.3（95%置信区间：56.5-62.1）和 101.9（95%置信区间：94.3-110.0）倍。然而，与非传染性疾病相比，传染病在收入五分位数之间仍然显示出更为严重的差距。混合效应分析表明，194 个国家在所有收入水平上的 5 岁以下儿童死亡率趋同。