Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation
Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation
复制标题
DOI：
10.1016/s0140-6736(15)00120-8
复制
发表时间：
2015-12-05
期刊：
影响因子：
168.9
通讯作者：
Alkema, Leontine
中科院分区：
文献类型：
--
作者：
You, Danzhen;Hug, Lucia;Alkema, Leontine
背景2000年，世界各国领导人商定了千年发展目标（MDGs）。千年发展目标4要求在1990年至2015年期间将5岁以下儿童死亡率降低三分之二。我们的目标是估计1990年至2015年195个国家5岁以下儿童死亡率的水平和趋势，以评估千年发展目标4的实现情况，然后打算预测2015年后各种目标和观察到的变化率将如何影响2016年至2030年5岁以下儿童死亡的负担。方法我们更新了联合国儿童死亡率估计机构间小组（UN IGME）拥有5700个国家年数据点的数据库。截至2015年7月，该数据库包含195个国家5岁以下儿童死亡率的约17000个国家年数据点，并包括来自生命登记系统、人口普查、住户调查和抽样登记系统的所有可用的国家代表性数据。我们使用这些数据，使用贝叶斯B样条偏差减少模型（B3模型）生成5岁以下（0-4岁）死亡率的估计值（具有不确定性区间）。该模型包括一个数据模型，用于调整与不同类型数据源相关的系统性偏差。为了深入了解与2015年后目标相关的全球和区域5岁以下儿童死亡负担，我们构建了2016年至2030年5岁以下儿童死亡率的五个基于里约热内卢的预测，并估计了国家，区域，结果全球5岁以下儿童死亡率已从每千人死亡90.6人下降到每千人死亡100.5人，1990年的出生率（90%不确定区间89.3-92.2）降至2015年的42.5（40.9-45.6）。同期，全世界每年5岁以下儿童死亡人数从1 270万（1 260万至1 300万）降至590万（570万至640万）。全球5岁以下儿童死亡率在过去25年中下降了53%（50-55%），因此未能实现千年发展目标4的具体目标。根据点估计，东亚和太平洋以及拉丁美洲和加勒比这两个区域实现了千年发展目标4的具体目标。62个国家实现了千年发展目标4，其中24个是低收入和中低收入国家。在2016年至2030年期间，如果每个国家的2015年死亡率保持不变，预计将有9 440万儿童在5岁前死亡，如果每个国家继续以2000年至2015年估计的速度降低死亡率，预计将有6 880万儿童死亡。如果所有国家都实现到2030年将5岁以下儿童死亡率降至每1000例活产25例或更低的可持续发展目标，我们预计到2030年将有5600万人死亡。尽管在降低儿童死亡率方面取得了实质性进展，但仍有必要作出协调一致的努力，以在未来几年避免可预防的5岁以下儿童死亡，并在进一步改善儿童生存方面加快取得进展。在5岁以下儿童死亡率高的区域和国家，特别是撒哈拉以南非洲和南亚，最需要采取紧急行动。
Background In 2000, world leaders agreed on the Millennium Development Goals (MDGs). MDG 4 called for a two-thirds reduction in the under-5 mortality rate between 1990 and 2015. We aimed to estimate levels and trends in under-5 mortality for 195 countries from 1990 to 2015 to assess MDG 4 achievement and then intended to project how various post-2015 targets and observed rates of change will affect the burden of under-5 deaths from 2016 to 2030.Methods We updated the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database with 5700 country-year datapoints. As of July, 2015, the database contains about 17 000 country-year datapoints for mortality of children younger than 5 years for 195 countries, and includes all available nationally-representative data from vital registration systems, population censuses, household surveys, and sample registration systems. We used these data to generate estimates, with uncertainty intervals, of under-5 (age 0-4 years) mortality using a Bayesian B-spline bias-reduction model (B3 model). This model includes a data model to adjust for systematic biases associated with different types of data sources. To provide insights into the global and regional burden of under-5 deaths associated with post-2015 targets, we constructed five scenario-based projections for under-5 mortality from 2016 to 2030 and estimated national, regional, and global under-5 mortality rates up to 2030 for each scenario.Results The global under-5 mortality rate has fallen from 90.6 deaths per 1000 live-births (90% uncertainty interval 89.3-92.2) in 1990 to 42.5 (40.9-45.6) in 2015. During the same period, the annual number of under-5 deaths worldwide dropped from 12.7 million (12.6 million-13.0 million) to 5.9 million (5.7 million-6.4 million). The global under-5 mortality rate reduced by 53% (50-55%) in the past 25 years and therefore missed the MDG 4 target. Based on point estimates, two regions-east Asia and the Pacific, and Latin America and the Caribbean-achieved the MDG 4 target. 62 countries achieved the MDG 4 target, of which 24 were low-income and lower-middle income countries. Between 2016 and 2030, 94.4 million children are projected to die before the age of 5 years if the 2015 mortality rate remains constant in each country, and 68.8 million would die if each country continues to reduce its mortality rate at the pace estimated from 2000 to 2015. If all countries achieve the Sustainable Development Goal of an under-5 mortality rate of 25 or fewer deaths per 1000 livebirths by 2030, we project 56.0 million deaths by 2030. About two-thirds of all sub-Saharan African countries need to accelerate progress to achieve this target.Interpretation Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable under-5 deaths in the coming years and to accelerate progress in improving child survival further. Urgent actions are needed most in the regions and countries with high under-5 mortality rates, particularly those in sub-Saharan Africa and south Asia.