Sanhueza Antonio, Carvajal-Vélez Liliana, Mújica Oscar J, Vidaletti Luis Paulo, Victora Cesar G, Barros Aluisio Jd
Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América.
Fondo de las Naciones Unidas para la Infancia (UNICEF) Nueva York Estados Unidos de América Fondo de las Naciones Unidas para la Infancia (UNICEF), Nueva York, Estados Unidos de América.
Rev Panam Salud Publica. 2022 Aug 18;46:e100. doi: 10.26633/RPSP.2022.100. eCollection 2022.
Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored.
We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016.
The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries.
Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures.
In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman's age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries.
Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.
拉丁美洲和加勒比地区（LAC）国家在国家层面朝着实现与健康相关的可持续发展目标（SDG）目标（SDG3）取得了重要进展。然而，国内仍存在巨大的健康不平等现象。我们提供了该地区健康不平等的基线，据此可以监测在实现可持续发展目标方面取得的进展。
我们利用2011年至2016年进行的人口与健康调查以及多指标类集调查的数据，对拉丁美洲和加勒比地区的21个国家进行了研究。
这些调查采用多阶段抽样方法收集关于妇女和儿童的具有全国代表性的数据。在这21个国家中，共有288207名妇女和195092名儿童参与了调查。
研究了五个与生殖和孕产妇健康相关的健康干预指标，以及青少年生育率、新生儿死亡率和五岁以下儿童死亡率。通过绝对和相对指标评估了这些指标中的不平等现象。
在大多数国家，几乎所有妇女、儿童和青少年（WCA）指标在国家以下层面都存在地理健康梯度。与农村地区和较贫困的五分位数人群相比，关键干预措施的覆盖率在城市地区和最富人群中更高。按妇女年龄进行的分析表明，在计划生育指标方面，少女的覆盖率低于年长妇女。在大多数国家，死亡率方面也存在有利于城市和富裕人群的不平等现象。
区域平均水平掩盖了国家之间重要的健康不平等现象，但国家层面的估计又掩盖了妇女、儿童和青少年亚群体之间更大的不平等现象。为了实现可持续发展目标3的目标并不让任何人掉队，缩小国家内部以及国家之间的健康不平等差距至关重要。
