China Center for Health Development Studies, Peking University, Beijing, China.
Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University School of Public Health, Beijing, China.
JAMA Netw Open. 2024 Nov 4;7(11):e2443423. doi: 10.1001/jamanetworkopen.2024.43423.
A negative association between neonatal mortality and hospital delivery has been found in some low- and lower-middle-income countries but not in rural settings characterized by poor quality of maternal and child health care.
To examine the association between neonatal mortality and hospital delivery in China across urban and rural regions, regional disparities, and varying levels of economic development.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used county-level data from 2008 to 2020 from the National Maternal & Child Health Statistics across mainland China. Statistical analysis was conducted from March to December 2023.
Since 2008, China has strategically leveraged hospital deliveries with national subsidies to diminish neonatal mortality, particularly in rural areas.
Neonatal mortality and hospital delivery rates were calculated, and their association was estimated using multivariable fixed-effects linear models of county-level cohort data to adjust for time-invariant differences across counties and controls for gross domestic product (GDP) per capita, women's years of education, hospital beds, and health workers.
The analysis included data from 2930 counties, with 198.7 million live births across 36 255 county-year records between 2008 and 2020. The mean (SD) neonatal mortality rate per 1000 live births decreased in rural areas from 12.3 (7.5) in 2008 to 3.9 (2.7) in 2020 and decreased in urban areas from 5.0 (3.1) in 2008 to 2.0 (1.3) in 2020. Hospital delivery rates increased in rural areas from a mean (SD) of 93.4% (11.8%) in 2008 to 99.9% (0.6%) in 2020 and increased in urban areas from 97.7% (6.1%) in 2008 to 100.0% (0.1%) in 2020. In rural areas, an increase of 10 percentage points in hospital deliveries was associated with a neonatal mortality rate of -1.4 (95% CI, -1.9 to -1.0; P < .001) per 1000 live births, whereas this negative association was not observed in urban areas. When the analysis was stratified by regions and incomes, the negative association became considerably stronger in the western and central regions of China, as well as in counties with lower GDP per capita.
This cohort study of more than 2900 counties in China suggests that an increase in hospital deliveries was associated with reduced neonatal mortality in rural and economically underdeveloped areas in China. To further reduce neonatal mortality and improve newborn health, it is imperative to increase the accessibility of hospital delivery services.
在一些低收入和中下等收入国家发现新生儿死亡率与医院分娩呈负相关，但在以孕产妇和儿童保健质量差为特征的农村地区并非如此。
在城乡、区域差异以及不同经济发展水平下，研究中国新生儿死亡率与医院分娩之间的关系。
设计、地点和参与者：本回顾性队列研究使用了 2008 年至 2020 年期间来自中国大陆国家母婴健康统计的县级数据。统计分析于 2023 年 3 月至 12 月进行。
自 2008 年以来，中国一直战略性地利用国家补贴促进医院分娩，以降低农村地区的新生儿死亡率。
计算了新生儿死亡率和医院分娩率，并使用多变量固定效应线性模型对县级队列数据进行了估计，以调整各县之间的时间不变差异，并控制人均国内生产总值（GDP）、女性受教育年限、病床和卫生工作者。
分析包括了来自 2930 个县的数据，涉及 2008 年至 2020 年期间 36255 个县年记录中的 19870 万活产儿。农村地区每 1000 例活产儿的新生儿死亡率从 2008 年的 12.3（7.5）降至 2020 年的 3.9（2.7），城市地区从 5.0（3.1）降至 2.0（1.3）。农村地区的医院分娩率从 2008 年的 93.4%（11.8%）上升到 2020 年的 99.9%（0.6%），城市地区从 97.7%（6.1%）上升到 2020 年的 100.0%（0.1%）。在农村地区，医院分娩率每增加 10 个百分点，新生儿死亡率就会降低 1.4（95%CI，-1.9 至-1.0；P<0.001）每 1000 例活产儿，而在城市地区则没有观察到这种负相关关系。当按地区和收入进行分层分析时，在中国西部和中部地区以及人均 GDP 较低的县，这种负相关关系变得更为显著。
这项针对中国 2900 多个县的队列研究表明，医院分娩率的增加与中国农村和经济欠发达地区的新生儿死亡率降低有关。为了进一步降低新生儿死亡率和改善新生儿健康，必须增加医院分娩服务的可及性。
