中国孕产妇卫生服务利用与孕产妇死亡：2009 年至 2016 年的纵向研究。
Maternal health services utilization and maternal mortality in China: a longitudinal study from 2009 to 2016.
机构信息
School of Public Health, Chinese Academy of Medical Science & Peking Union Medical College, No.5 Dongdansantiao, 100730, Beijing, People's Republic of China.
Nursing Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, 100034, Beijing, People's Republic of China.
出版信息
BMC Pregnancy Childbirth. 2020 Apr 15;20(1):220. doi: 10.1186/s12884-020-02900-4.
BACKGROUND
The Chinese government introduced the maternal health services as part of the Basic Public Health Service (BPHS) project in 2009. While China has made progress in reducing maternal mortality, the longitudinal association between the utilization rate of the maternal health services of the BPHS project and such reduction was rarely evaluated with robust methods.
METHODS
We conducted a longitudinal study on the maternal health service utilization rates of the BPHS project and the maternal mortality ratios (MMR) in mainland China and its 31 provincial regions. The data were extracted from the National Health Statistic Yearbooks (2009-2016). Panel data models were used to evaluate the association between the utilization rate and the MMR after adjusting for available covariates on healthcare resources. Stepwise regression models were used to gauge the direction and magnitude of omitted variable bias.
RESULTS
It was found that the service utilization rate increased from 79.24% in 2009 to 91.67% in 2016, while MMR decreased from 30.90 to 17.88 per 100,000 livebirths at the national level. The results of the fixed effects panel data model revealed that the utilization rate was associated with MMR deduction continuously. With every 1% increase in utilization rate, the maternal death would decrease by 0.35 per 100,000 livebirths after having the health resources variables adjusted.
CONCLUSIONS
The utilization of maternal health services increased continuously after the introduction of BPHS project in 2009 and MMR went downward from then on. The utilization of maternal health services did have significant association with MMR and could reduce MMR effectively. Such improvement could be attributed to the fact that this program was designed to serve the targeted population throughout the continuum of maternal care and the government's rigorous efforts in stressing equality and standard care in program implementation.
背景
中国政府于 2009 年推出了孕产妇健康服务，作为基本公共卫生服务（BPHS）项目的一部分。虽然中国在降低孕产妇死亡率方面取得了进展，但 BPHS 项目孕产妇健康服务利用率与死亡率降低之间的纵向关联很少用稳健的方法进行评估。
方法
我们对中国大陆及其 31 个省级地区 BPHS 项目孕产妇健康服务利用率和孕产妇死亡率（MMR）进行了纵向研究。数据取自《国家卫生统计年鉴》（2009-2016 年）。使用面板数据模型，在调整了医疗资源的可用协变量后，评估了利用率与 MMR 之间的关联。使用逐步回归模型来评估忽略变量偏差的方向和大小。
结果
研究发现，服务利用率从 2009 年的 79.24%增加到 2016 年的 91.67%，而全国孕产妇死亡率从每 10 万活产 30.90 人下降到 17.88 人。固定效应面板数据模型的结果表明，利用率与 MMR 降低呈连续相关。在调整了健康资源变量后，利用率每增加 1%，每 10 万活产的孕产妇死亡数就会减少 0.35 人。
结论
自 2009 年推出 BPHS 项目以来，孕产妇健康服务的利用率不断提高，孕产妇死亡率自此下降。孕产妇健康服务的利用率与 MMR 有显著关联，可有效降低 MMR。这种改善可归因于该计划旨在为孕产妇护理连续体中的目标人群服务，以及政府在项目实施中强调平等和标准护理方面的严格努力。
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