National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis
National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis
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DOI：
10.1016/s2214-109x(19)30163-9
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发表时间：
2019-06-01
影响因子：
34.3
通讯作者：
Wakefield, John
中科院分区：
文献类型：
--
作者：
Hug, Lucia;Alexander, Monica;Wakefield, John
降低新生儿死亡率是第三个可持续发展目标（SDG）的重要组成部分，即消除可预防的儿童死亡。为了实现这一目标，需要了解新生儿死亡率的水平和趋势。因此，我们的目标是通过使用可用于评估可持续发展目标时代进展的统计模型来估计新生儿死亡率的水平和趋势。根据1990 - 2017年的新生儿死亡率估计值，我们旨在评估不同的新生儿死亡率目标如何影响2018 - 2030年的新生儿死亡负担。方法在本系统分析中，我们使用了具有全国代表性的新生儿死亡相关经验数据，包括生命登记系统、抽样登记系统和住户调查数据，估计1990年（或现有数据的最早年份）至2017年期间所有国家的特定国家新生儿死亡率（NMR;出生后28天内死亡的概率）。在我们的分析中，我们使用了联合国儿童死亡率估计机构间小组每年汇编的数据库中所有公开可用的新生儿死亡率数据，这些数据是在2018年7月31日或之前提取的，涉及1950年至2017年期间的数据。对所有具有国家代表性的数据进行了评估。我们使用了贝叶斯分层惩罚B样条回归模型，该模型允许对来自不同来源的数据进行不同的加权，以考虑变量偏倚和待评估的NMR的不确定性。该模型同时估计了NMR与5岁以下儿童死亡率之间的全球关联以及特定国家和特定时间的影响，这使我们能够确定NMR高于或低于预期的国家。在国家一级，利用新生儿死亡率的当前水平和趋势以及实现国家目标所需的历史或年度下降率，进行了基于情景的预测。我们评估的主要结果是新生儿死亡率的水平和趋势以及1990年至2017年的全球和区域NMR。（90%不确定性区间[UI] 46-54），从1990年的每1000例活产死亡36.6例（35.5-37.8）降至2017年的每1000例活产死亡18.0例（17.0-19.9）。同期新生儿死亡人数估计从500万（490万至520万）下降到250万（240万至280万）。世界各地的年度NMR差异很大，但西非和中非以及南亚在2017年的NMR最高。自1990年以来，所有区域都报告了新生儿死亡率的下降，与1990-2000年相比，大多数区域在2000- 2017年在降低新生儿死亡率方面加快了进展。在2018年至2030年期间，如果每个国家保持目前的NMR减少速度，我们预计将有2780万儿童在出生后的第一个月内死亡。如果每个国家到2030年实现每1000例活产新生儿死亡12例或更少的可持续发展目标，我们预计到2030年累计新生儿死亡人数将达到2270万。60多个国家需要加快进展，以实现到2030年的新生儿死亡率可持续发展目标。解释尽管自1990年以来在降低新生儿死亡率方面取得了实质性进展，但仍需要加大努力，以改善进展，以实现到2030年的可持续发展目标。在核磁共振高的区域和国家，特别是在撒哈拉以南非洲和南亚，最需要加速改进。版权所有（C）2019作者。爱思唯尔有限公司出版
Background Reducing neonatal mortality is an essential part of the third Sustainable Development Goal (SDG), to end preventable child deaths. To achieve this aim will require an understanding of the levels of and trends in neonatal mortality. We therefore aimed to estimate the levels of and trends in neonatal mortality by use of a statistical model that can be used to assess progress in the SDG era. With these estimates of neonatal mortality between 1990 and 2017, we then aimed to assess how different targets for neonatal mortality could affect the burden of neonatal mortality from 2018 to 2030.Methods In this systematic analysis, we used nationally-representative empirical data related to neonatal mortality, including data from vital registration systems, sample registration systems, and household surveys, to estimate country-specific neonatal mortality rates (NMR; the probability of dying during the first 28 days of life) for all countries between 1990 (or the earliest year of available data) and 2017. For our analysis, we used all publicly available data on neonatal mortality from databases compiled annually by the UN Inter-agency Group for Child Mortality Estimation, which were extracted on or before July 31,2018, for data relating to the period between 1950 and 2017. All nationally representative data were assessed. We used a Bayesian hierarchical penalised B-splines regression model, which allowed for data from different sources to be weighted differently, to account for variable biases and for the uncertainty in NMR to be assessed. The model simultaneously estimated a global association between NMR and under-5 mortality rate and country-specific and time-specific effects, which enabled us to identify countries with an NMR that was higher or lower than expected. Scenario-based projections were made at the county level by use of current levels of and trends in neonatal mortality and historic or annual rates of reduction that would be required to achieve national targets. The main outcome that we assessed was the levels of and trends in neonatal mortality and the global and regional NMRs from 1990 to 2017.Findings Between 1990 and 2017, the global NMR decreased by 51% (90% uncertainty interval [UI] 46-54), from 36.6 deaths per 1000 livebirths (35.5-37.8) in 1990, to 18.0 deaths per 1000 livebirths (17.0-19.9) in 2017. The estimated number of neonatal deaths during the same period decreased from 5.0 million (4.9 million-5.2 million ) to 2.5 million (2.4 million-2.8 million). Annual NMRs vary widely across the world, but west and central Africa and south Asia had the highest NMRs in 2017. All regions have reported reductions in NMRs since 1990, and most regions accelerated progress in reducing neonatal mortality in 2000-17 versus 1990-2000. Between 2018 and 2030, we project that 27.8 million children will die in their first month of life if each country maintains its current rate of reduction in NMR. If each country achieves the SDG neonatal mortality target of 12 deaths per 1000 livebirths or fewer by 2030, we project 22.7 million cumulative neonatal deaths by 2030. More than 60 countries need to accelerate their progress to reach the neonatal mortality SDG target by 2030.Interpretation Although substantial progress has been made in reducing neonatal mortality since 1990, increased efforts to improve progress are still needed to achieve the SDG target by 2030. Accelerated improvements are most needed in the regions and countries with high NMR, particularly in sub-Saharan Africa and south Asia. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.