National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment.
National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment.
复制标题
DOI：
10.1016/s2214-109x(18)30059-7
复制
发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Alkema L
中科院分区：
文献类型：
--
作者：
Chao F;You D;Pedersen J;Hug L;Alkema L
自1990年以来，在实现降低5岁以下儿童死亡率的第四项千年发展目标方面取得了显著进展。然而，在可持续发展目标时代仍有工作要做。国家一级5岁以下儿童死亡率的估计数可能掩盖国家内部的差异。我们评估了低收入和中等收入国家（LMICs）家庭经济状况在5岁以下儿童死亡率方面的差异。我们使用贝叶斯统计模型，根据1990年至2016年137个中低收入国家的家庭财富指数，按财富五分位数估计了各国特定年份的5岁以下儿童死亡率。我们估计了五分位数与全国5岁以下儿童死亡率之间的关联。我们评估了最贫穷和最富有的五分之一人口之间以及所有五分之一人口之间5岁以下儿童死亡率的绝对和相对差距的水平和趋势。2016年，所有中低收入国家（不包括中国），5岁以下儿童总死亡率为64.6（90%不确定区间[UI] 61·1-70·1）最贫困家庭每千名活产婴儿的死亡率最富裕家庭（第五个五分位数）每1 000名活产婴儿死亡31·3（29·5-34·2），中间五分位数介于这两个结果之间。1990年至2016年，五岁以下儿童死亡率绝对下降幅度最大的是两个最贫困的五分之一人口：最贫困的五分之一人口每1000例活产死亡77.6（90% UI 71.2 - 82.6）例，第二贫困的五分之一人口每1000例活产死亡77.9（72.0 - 82.2）例。1990年至2016年，最贫穷和最富有的五分之一人口之间5岁以下儿童死亡率的差异显著下降，每1000例活产死亡38.8例（90% UI 32.9 - 43.8）。然而，最贫穷与最富有的5岁以下儿童死亡率比率保持相似（1990年为2.03 [90%UI 1.94 - 2.11]，2000年为1.99 [1.91 - 2.08]，2016年为2.06 [1.92 - 2.20]）。在1990-2016年期间，5岁以下儿童死亡总数中约有一半发生在最贫穷的两个五分之一人口中（1990年和2000年为48.5%，2016年为49.5%），不到三分之一发生在最富有的两个五分之一人口中（1990年为30.4%，2000年为30.5%，2016年为29.9%）。就所有区域而言，五分之一和五分之五之间5岁以下儿童死亡率的差异显著下降，从东欧和中亚的每1 000例活产死亡20.6（90% UI 15.9 - 25.1）例下降到南亚的每1 000例活产死亡59.5（48.5 - 70.4）例。2016年，第一个五分位数的5岁以下儿童死亡率与第五个五分位数的5岁以下儿童死亡率之比在两个地区显著高于2·00，东亚和太平洋地区（不包括中国）为2·49（90%UI 2·15-2·87），南亚为2·41（2·05-2·80）。东部和南部非洲在2016年的比例最小，为1.62（90%UI 1.48 - 1.76）。我们的模型表明，随着全国5岁以下儿童死亡率的下降，第一个五分位数的5岁以下儿童死亡率与第五个五分位数的5岁以下儿童死亡率的预期比率会上升。就所有低收入国家（不包括中国）而言，最贫穷和最富有家庭之间5岁以下儿童死亡率的绝对差距自1990年以来已大大缩小，而相对差距则保持稳定。为了进一步缩小5岁以下儿童死亡率的相对贫富差距，需要采取以最贫穷人口为重点的有针对性的干预措施。新加坡国立大学、联合国儿童基金会、美国国际开发署以及比尔及梅琳达·盖茨基金会。
The progress to achieve the fourth Millennium Development Goal in reducing mortality rate in children younger than 5 years since 1990 has been remarkable. However, work remains to be done in the Sustainable Development Goal era. Estimates of under-5 mortality rates at the national level can hide disparities within countries. We assessed disparities in under-5 mortality rates by household economic status in low-income and middle-income countries (LMICs). We estimated country-year-specific under-5 mortality rates by wealth quintile on the basis of household wealth indices for 137 LMICs from 1990 to 2016, using a Bayesian statistical model. We estimated the association between quintile-specific and national-level under-5 mortality rates. We assessed the levels and trends of absolute and relative disparity in under-5 mortality rate between the poorest and richest quintiles, and among all quintiles. In 2016, for all LMICs (excluding China), the aggregated under-5 mortality rate was 64·6 (90% uncertainty interval [UI] 61·1–70·1) deaths per 1000 livebirths in the poorest households (first quintile), 31·3 (29·5–34·2) deaths per 1000 livebirths in the richest households (fifth quintile), and in between those outcomes for the middle quintiles. Between 1990 and 2016, the largest absolute decline in under-5 mortality rate occurred in the two poorest quintiles: 77·6 (90% UI 71·2–82·6) deaths per 1000 livebirths in the poorest quintile and 77·9 (72·0–82·2) deaths per 1000 livebirths in the second poorest quintile. The difference in under-5 mortality rate between the poorest and richest quintiles decreased significantly by 38·8 (90% UI 32·9–43·8) deaths per 1000 livebirths between 1990 and 2016. The poorest to richest under-5 mortality rate ratio, however, remained similar (2·03 [90% UI 1·94–2·11] in 1990, 1·99 [1·91–2·08] in 2000, and 2·06 [1·92–2·20] in 2016). During 1990–2016, around half of the total under-5 deaths occurred in the poorest two quintiles (48·5% in 1990 and 2000, 49·5% in 2016) and less than a third were in the richest two quintiles (30·4% in 1990, 30·5% in 2000, 29·9% in 2016). For all regions, differences in the under-5 mortality rate between the first and fifth quintiles decreased significantly, ranging from 20·6 (90% UI 15·9–25·1) deaths per 1000 livebirths in eastern Europe and central Asia to 59·5 (48·5–70·4) deaths per 1000 livebirths in south Asia. In 2016, the ratios of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile were significantly above 2·00 in two regions, with 2·49 (90% UI 2·15–2·87) in east Asia and Pacific (excluding China) and 2·41 (2·05–2·80) in south Asia. Eastern and southern Africa had the smallest ratio in 2016 at 1·62 (90% UI 1·48–1·76). Our model suggested that the expected ratio of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile increases as national-level under-5 mortality rate decreases. For all LMICs (excluding China) combined, the absolute disparities in under-5 mortality rate between the poorest and richest households have narrowed significantly since 1990, whereas the relative differences have remained stable. To further narrow the rich-and-poor gap in under-5 mortality rate on the relative scale, targeted interventions that focus on the poorest populations are needed. National University of Singapore, UN Children's Fund, United States Agency for International Development, and the Bill & Melinda Gates Foundation.