International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas. Marechal Deodoro, 1160, 3rd floor, Pelotas, 96020-220, Brazil.
BMC Pediatr. 2021 Jan 26;21(1):55. doi: 10.1186/s12887-021-02503-8.
While assessment of sex differentials in child mortality is straightforward, their interpretation must consider that, in the absence of gender bias, boys are more likely to die than girls. The expected differences are also influenced by levels and causes of death. However, there is no standard approach for determining expected sex differences.
We performed a scoping review of studies on sex differentials in under-five mortality, using PubMed, Web of Science, and Scopus databases. Publication characteristics were described, and studies were grouped according to their methodology.
From the 17,693 references initially retrieved we included 154 studies published since 1929. Indian, Bangladeshi, and Chinese populations were the focus of 44% of the works, and most studies addressed infant mortality. Fourteen publications were classified as reference studies, as these aimed to estimate expected sex differentials based upon the demographic experience of selected populations, either considered as gender-neutral or not. These studies used a variety of methods - from simple averages to sophisticated modeling - to define values against which observed estimates could be compared. The 21 comparative studies mostly used life tables from European populations as standard for expected values, but also relied on groups without assuming those values as expected, otherwise, just as comparison parameters. The remaining 119 studies were categorized as narrative and did not use reference values, being limited to reporting observed sex-specific estimates or used a variety of statistical models, and in general, did not account for mortality levels.
Studies aimed at identifying sex differentials in child mortality should consider overall mortality levels, and report on more than one age group. The comparison of results with one or more reference values, and the use of statistical testing, are strongly recommended. Time trends analyses will help understand changes in population characteristics and interpret findings from a historical perspective.
虽然评估儿童死亡率的性别差异很简单，但在没有性别偏见的情况下，男孩的死亡率高于女孩，这一点必须在解释性别差异时予以考虑。预期的性别差异还受到死亡水平和原因的影响。然而，目前还没有确定预期性别差异的标准方法。
我们使用 PubMed、Web of Science 和 Scopus 数据库对五岁以下儿童死亡率性别差异的研究进行了范围界定审查。描述了出版物的特征，并根据方法对研究进行了分组。
从最初检索到的 17693 篇参考文献中，我们纳入了自 1929 年以来发表的 154 篇研究。印度、孟加拉国和中国人口是 44%的研究的重点，大多数研究都涉及婴儿死亡率。有 14 篇出版物被归类为参考研究，因为这些研究旨在根据选定人群的人口统计学经验来估计预期的性别差异，这些人群被认为是无性别差异的或不是无性别差异的。这些研究使用了各种方法——从简单的平均值到复杂的建模——来定义可以与观察到的估计值进行比较的数值。21 项比较研究主要使用来自欧洲人群的生命表作为预期值的标准，但也依赖于没有假设这些值为预期值的群体，否则，只是作为比较参数。其余 119 项研究被归类为叙述性研究，没有使用参考值，仅限于报告观察到的性别特异性估计值，或者使用各种统计模型，通常不考虑死亡率水平。
旨在确定儿童死亡率性别差异的研究应考虑总体死亡率水平，并报告一个以上的年龄组。强烈建议将结果与一个或多个参考值进行比较，并使用统计检验。时间趋势分析将有助于了解人口特征的变化，并从历史角度解释研究结果。
