Fujita T, Minowa M, Miura Y
Department of Epidemiology, Institute of Public Health.
Nihon Koshu Eisei Zasshi. 1994 Feb;41(2):114-25.
Infant death certificates were linked with birth certificates for infants born to residents of Tohoku, Tokai and Kyushu regions in 1989 (n = 409, 679, or about one-third of all births in Japan), to examine the effects of variables, as reported on birth certificates, on cause-specific infant mortality. "Certain conditions originating in the perinatal period" and "congenital anomalies" accounted for nearly 90 percent of neonatal deaths, while "congenital anomalies", "injuries and poisoning" and "sudden infant death" were responsible for about 65 percent of postneonatal deaths. Mortality rates for almost all causes of infant deaths, except injuries and poisonings, increased as birth weight decreased not only in the neonatal period but also in the postneonatal period. This suggests that low birth weight places some infants at higher risk of death, and conditions that lead to low birth weight independently contribute to the risk of infant death. Cox's proportional hazards linear model was used to assess the effects of variables on infant mortalities by causes of death. An extremely strong birth weight effect was noted for "certain conditions originating in the perinatal period" and "congenital anomalies". Being a male infant and late order of birth in multiparity were other risk factors for deaths from "congenital anomalies", while being a male infant, resident of Tohoku region and maternal stillbirth experience related to deaths from "certain conditions originating in the perinatal period". Elevated risks of sudden infant death syndrome (SIDS), of which mortality rate in Japan was considerably lower than those in most developed Western countries, i.e. 0.23 per 1,000 live births in 1989, were associated with low birth weight, being a male infant, low maternal age, late order of birth in multiparity and illegitimacy. Low maternal age, late order of birth in multiparity and illegitimacy, also, related significantly to increased risk of infant deaths for "injuries and poisoning". These results suggest the independent contributions of socioeconomic factors to infant mortality, especially postneonatal mortality, from SIDS, "injuries and poisonings".
将1989年在东北、东海和九州地区出生的婴儿的死亡证明与出生证明进行关联（n = 409,679，约占日本所有出生人数的三分之一），以研究出生证明上所报告的变量对特定病因婴儿死亡率的影响。“围生期起源的某些情况”和“先天性异常”占新生儿死亡的近90%，而“先天性异常”、“损伤和中毒”以及“婴儿猝死”约占新生儿后期死亡的65%。除损伤和中毒外，几乎所有婴儿死亡原因的死亡率都随着出生体重的降低而上升，不仅在新生儿期如此，在新生儿后期也是如此。这表明低出生体重使一些婴儿面临更高的死亡风险，导致低出生体重的情况独立地增加了婴儿死亡的风险。采用Cox比例风险线性模型来评估变量对按死亡原因划分的婴儿死亡率的影响。对于“围生期起源的某些情况”和“先天性异常”，出生体重的影响极为显著。男婴和多胎妊娠中的晚产顺序是“先天性异常”死亡的其他风险因素，而男婴、东北地区居民以及母亲有死产经历与“围生期起源的某些情况”导致的死亡有关。婴儿猝死综合征（SIDS）的风险升高，日本的死亡率（1989年为每1000例活产0.23例）远低于大多数西方发达国家，其与低出生体重、男婴、母亲年龄低、多胎妊娠中的晚产顺序以及非婚生有关。母亲年龄低、多胎妊娠中的晚产顺序以及非婚生也与“损伤和中毒”导致的婴儿死亡风险显著增加有关。这些结果表明社会经济因素对婴儿死亡率，尤其是新生儿后期由SIDS、“损伤和中毒”导致的死亡率有独立影响。
