1990-2017 年中国及其省份孕产妇卫生服务利用与 5 岁以下儿童死亡率的关系。

Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990-2017.

机构信息

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi , 710049, China.

School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, China.

出版信息

BMC Pregnancy Childbirth. 2024 Apr 26;24(1):326. doi: 10.1186/s12884-024-06437-8.

DOI:10.1186/s12884-024-06437-8

PMID:38671364

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11055253/

Abstract

BACKGROUND

The United Nations (UN) Sustainable Development Goal - 3.2 aims to eliminate all preventable under-five mortality rate (U5MR). In China, government have made efforts to provide maternal health services and reduce U5MR. Hence, we aimed to explore maternal health service utilization in relation to U5MR in China and its provinces in 1990-2017.

METHODS

We obtained data from Global Burden of Disease 2017, China Health Statistics Yearbook, China Statistical Yearbook, and Human Development Report China Special Edition. The trend of U5MR in each province of China from 1990 to 2017 was analyzed using Joinpoint Regression model. We measured the inequities in maternal health services using HEAT Plus, a health inequity measurement tool developed by the UN. The generalized estimating equation model was used to explore the association between maternal health service utilization (including prenatal screening, hospital delivery and postpartum visits) and U5MR.

RESULTS

First, in China, the U5MR per 1000 live births decreased from 50 in 1990 to 12 in 2017 and the average annual percentage change (AAPC) was - 5.2 (p < 0.05). Secondly, China had a high maternal health service utilization in 2017, with 96.5% for prenatal visits, 99.9% for hospital delivery, and 94% for postnatal visits. Inequity in maternal health services between provinces is declining, with hospital delivery rate showing the greatest decrease (SII, 14.01 to 1.87, 2010 to 2017). Third, an increase in the rate of hospital delivery rate can significantly reduce U5MR (OR 0.991, 95%CI 0.987 to 0.995). Postpartum visits rate with a one-year lag can reduce U5MR (OR 0.993, 95%CI 0.987 to 0.999). However, prenatal screening rate did not have a significant effect on U5MR.

CONCLUSION

The decline in U5MR in China was associated with hospital delivery and postpartum visits. The design and implementation of maternal health services may provide references to other low-income and middle-income countries.

摘要

背景

联合国可持续发展目标 3.2 旨在消除所有可预防的五岁以下儿童死亡率（U5MR）。在中国，政府已努力提供孕产妇保健服务并降低 U5MR。因此，我们旨在探讨 1990 年至 2017 年中国及其各省孕产妇保健服务利用与 U5MR 的关系。

方法

我们从全球疾病负担 2017 年、中国卫生统计年鉴、中国统计年鉴和人类发展报告中国特刊中获取数据。使用 Joinpoint 回归模型分析了 1990 年至 2017 年中国各省的 U5MR 趋势。我们使用联合国开发的卫生不公平性衡量工具 HEAT Plus 衡量孕产妇保健服务的不公平性。使用广义估计方程模型探讨了孕产妇保健服务利用（包括产前筛查、医院分娩和产后访视）与 U5MR 的关系。

结果

首先，中国每 1000 例活产的 U5MR 从 1990 年的 50 例下降到 2017 年的 12 例，年均变化百分比（AAPC）为-5.2（p<0.05）。其次，中国在 2017 年孕产妇保健服务利用率较高，产前检查率为 96.5%，医院分娩率为 99.9%，产后访视率为 94%。各省之间孕产妇保健服务不公平性呈下降趋势，其中医院分娩率降幅最大（SII，14.01 至 1.87，2010 年至 2017 年）。第三，提高医院分娩率可显著降低 U5MR（OR 0.991，95%CI 0.987 至 0.995）。滞后一年的产后访视率可降低 U5MR（OR 0.993，95%CI 0.987 至 0.999）。然而，产前筛查率对 U5MR 没有显著影响。