Centro de Epidemiología y Políticas de Salud (CEPS), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.
Programa de Investigación Asociativa de Cáncer Gástrico, Instituto de Matemática y Física, Universidad de Talca, Talca, Chile.
PLoS One. 2020 Sep 30;15(9):e0239974. doi: 10.1371/journal.pone.0239974. eCollection 2020.
Child health has been a health policy priority for more than a century in Chile. Since 2000, new health and intersectoral interventions have been implemented. However, no recent analyses have explored child mortality and equity in Chile, an indispensable input to guide policies towards the achievement of the Sustainable Development Goals, specially, in the context of a deeply unequal country such as many other Latin American countries. Thus, the objectives of this study are to analyze the variations in the risk and the causes of death among Chilean children aged <5 years, to identify the determinants, and to measure inequality of infant mortality from 1990 to 2016.
An observational study was conducted to analyze the Chilean children's mortality from 1990 to 2016 using under five deaths and live births data from the Vital Statistics System. To describe the variation in the risk of death, a time series analysis was performed for each of the under five mortality rate components. A comparative cause of death analysis was developed for Neonatal and 1-59 months' age groups. The determinants of infant mortality were studied with a descriptive analysis of yearly rates according to mother's and child factors and bivariate logistic regression models at the individual level. Finally, simple and complex measures of inequality at individual level were estimated considering three-year periods.
Regarding under 5 mortality: (i) Child survival has improved substantially in the last three decades, with a rapid decline in under five mortality rate between 1990 and 2001, followed by a slower reduction; (ii) early neonatal mortality has become the main component of the under five mortality rate (50.6%); (iii) congenital abnormalities have positioned as the leading cause of death; (iv) an important increase in live births below 1,000 grs. Regarding infant mortality: (i) birth weight and gestational age are the two most relevant risk factors in the neonatal period, while social variables are more significant for post-neonatal mortality and, (ii) the inequality according to mother's education has shown a steady decline, with persistent inequalities in post-neonatal period.
The Chilean experience illustrates child health achievements and challenges in a country that transitioned from middle-to high-income in recent decades. Although inequity is one of the main challenges for the country, the health sector by granting universal access was able to reduce disparities. However, closing the gap in post-neonatal mortality is still challenging. To overcome stagnation in neonatal mortality, new and specific strategies must address current priorities, emphasizing the access of vulnerable groups.
儿童健康一直是智利一个多世纪以来的卫生政策重点。自 2000 年以来，已经实施了新的卫生和部门间干预措施。然而，最近没有分析探讨智利儿童的死亡率和公平性，这是指导政策实现可持续发展目标的不可或缺的投入，特别是在像许多其他拉丁美洲国家一样的贫富差距悬殊的国家。因此，本研究的目的是分析智利 5 岁以下儿童的风险和死因变化，确定决定因素，并衡量 1990 年至 2016 年期间婴儿死亡率的不平等。
使用生命统计系统的五岁以下儿童死亡和活产数据，对 1990 年至 2016 年智利儿童死亡进行了一项观察性研究。为了描述死亡风险的变化，对每个五岁以下死亡率组成部分进行了时间序列分析。对新生儿和 1-59 月龄组进行了死因比较分析。使用按母亲和儿童因素分类的年度死亡率描述性分析和个体水平双变量逻辑回归模型研究婴儿死亡率的决定因素。最后，考虑到三年期，在个体水平上估计了简单和复杂的不平等衡量标准。
关于五岁以下儿童死亡率：（i）在过去三十年中，儿童生存状况有了显著改善，1990 年至 2001 年期间五岁以下死亡率迅速下降，随后下降速度放缓；（ii）早期新生儿死亡率已成为五岁以下死亡率的主要组成部分（50.6%）；（iii）先天性异常已成为主要死因；（iv）出生体重低于 1000 克的活产数显著增加。关于婴儿死亡率：（i）出生体重和胎龄是新生儿期最重要的两个风险因素，而社会变量对新生儿后期死亡率更为重要，（ii）按母亲教育程度划分的不平等呈稳步下降趋势，新生儿后期仍存在不平等现象。
智利的经验说明了在最近几十年从中等收入国家向高收入国家过渡的国家中儿童健康的成就和挑战。尽管不平等是该国面临的主要挑战之一，但卫生部门通过提供普遍获得服务的机会，减少了差距。然而，降低新生儿后期死亡率的差距仍然具有挑战性。为了克服新生儿死亡率的停滞不前，必须制定新的、具体的战略来解决当前的优先事项，强调弱势群体的获得机会。
