Child mortality estimation: a comparison of UN IGME and IHME estimates of levels and trends in under-five mortality rates and deaths.
Child mortality estimation: a comparison of UN IGME and IHME estimates of levels and trends in under-five mortality rates and deaths.
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DOI：
10.1371/journal.pmed.1001288
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发表时间：
2012
期刊：
影响因子：
15.8
通讯作者：
You D
中科院分区：
文献类型：
--
作者：
Alkema L;You D
你比较和总结了公布全球5岁以下儿童死亡率数据的两个关键群体所使用的基础数据和建模方法的差异。千年发展目标4呼吁在1990年至2015年期间将5岁以下儿童死亡率降低三分之二。2011年，联合国儿童死亡率估算机构间小组（儿童死亡率估算小组）和卫生计量与评价研究所（卫生计量与评价研究所）公布了估计数。两个研究小组得出的五岁以下儿童死亡率估计数相差10%以上，相当于1990年所有国家中10%的国家和2010年所有国家中20%的国家每1 000例活产死亡10人以上，这可能导致关于各国进展的相互矛盾的结论。为了了解导致估计差异的原因，我们总结了两组使用的基础数据和建模方法的差异，并分析了它们的影响。联合国IGME和IHME的估算方法在数据库的构建和数据的预处理、趋势拟合程序、数据序列的纳入和排除以及额外的调整程序等方面有所不同。在发生冲突或内乱的国家、艾滋病毒流行率高的国家以及用于得出估计数的基础数据不同的国家，联合国IGME和IHME之间的5岁以下儿童死亡率估计值存在很大差异，特别是在两个研究小组之间排除的数据系列不同的情况下。对差异的分解表明，使用不同数据（包括数据序列和数据预处理）造成的估计差异平均大于使用不同趋势拟合方法造成的差异。由于所使用的数据和建模假设的各种差异，联合国IGME和IHME对五岁以下儿童死亡率和五岁以下儿童死亡人数的估计存在巨大的国别差异。差异往往说明缺乏可靠的数据，并可能随着获得更多的数据而减少。提高所用方法和数据的透明度将有助于增进对造成这些差异的原因的了解。请参阅文章后面的编辑总结。2010年，700多万儿童在五岁前死亡，全球五岁以下儿童死亡率（在文献中也表示为U5MR和5q0）为每1 000例活产57例死亡。大多数5岁前的死亡发生在发展中国家（大约一半发生在五个国家——印度、尼日利亚、刚果民主共和国、巴基斯坦和中国），大多数是由肺炎、腹泻和疟疾等可预防或可治疗的疾病引起的。面对这种基本上可以避免的年轻生命的丧失，1990年，联合国世界儿童问题首脑会议承诺改善儿童的生存状况。后来，在2000年，世界各国领导人制定了到2015年将五岁以下儿童死亡率降至1990年水平（1200万）的三分之一的具体目标，作为千年发展目标4。这一目标与其他七项目标一起，旨在改善世界上最贫穷国家的社会、经济和卫生条件。尽管实现千年发展目标4的进展正在加快，但实现千年发展目标4的可能性不大。因此，重要的是要了解哪些国家在实现千年发展目标4方面进展不佳，以便将额外资源集中在这些领域。为了监测国家和全球进展，准确、最新的5岁以下儿童死亡率估计至关重要。估计五岁以下儿童死亡率的第一步是收集儿童死亡数据，通常是通过发达国家的生命登记系统（记录所有出生和死亡）和发展中国家的调查，向妇女询问其活着和死去的孩子的情况。根据这些数据，使用一种称为趋势拟合的统计过程，得出了各国间和不同时期的具体u5死亡率估计值。联合国儿童死亡率估算机构间小组（UN IGME）和卫生计量与评估研究所（IHME）这两个小组最近公布了对世界各地5岁以下儿童死亡率和5岁以下儿童死亡水平和趋势的新估计。然而，它们的估计有所不同，对一些国家来说，在实现千年发展目标4的进展方面存在分歧。在这里，研究人员检查了UN IGME和IHME使用的基础数据和趋势拟合方法的差异，试图理解为什么他们的估计不同。研究人员首先比较了两组人的估计。从1990年到2010年，联合国IGME对5岁以下儿童死亡率和5岁以下儿童死亡的全球估计数始终略高于IHME的估计数。例如，2010年，联合国IGME和IMHE对5岁以下儿童死亡率的估计分别为每1 000例分娩死亡56.7人和53.9人。然而，尽管两组的全球估计数大致相似，但在国家一级，两组估计数之间存在重大差异，特别是在发生冲突或内乱的国家（例如索马里）或艾滋病毒高流行率的国家。然后，研究人员检查了两组用于估计五岁以下儿童死亡和五岁以下儿童死亡率的数据、用于五岁以下儿童死亡率趋势拟合的方法以及额外的调整程序（例如，联合国IGME在其估计中纳入了专家和国家磋商的反馈）。联合国IGME和IHME的估计方法包括所有这些领域的差异，但所使用数据的差异造成的估计差异平均比使用不同趋势拟合方法造成的差异更大。这些调查结果表明，联合国IGME和IHME对五岁以下儿童死亡率和五岁以下儿童死亡人数的估计数之间存在巨大的国别差异，这是两组使用的数据和趋势拟合方法之间存在若干差异的结果。具体而言，调查结果表明，许多发展中国家缺乏可靠的数据，特别是那些存在内乱或持续冲突的国家，往往是造成估计数差异的原因。因此，随着获得更可靠的数据，这些差异应该会减少。然而，就目前而言，联合国IGME和IHME对儿童死亡率的国家估计之间的差异可能会导致人们对千年发展目标4的真正进展程度感到困惑，如果不明确差异的原因，可能会导致政策不活跃。因此，研究人员呼吁提高估算五岁以下儿童死亡率所用方法和数据的透明度，并呼吁各国政府、联合国机构和非政府组织共同努力，改进关于儿童死亡的可靠数据的收集。请通过本摘要的在线版本（http://dx.doi.org/10.1371/journal.pmed.1001288）访问这些网站。这篇论文是《公共科学图书馆医学》上发表的关于儿童死亡率估计方法的论文合集的一部分联合国儿童基金会（UNICEF）在世界各地为儿童的权利、生存、发展和保护而工作；它提供关于千年发展目标4的信息，其儿童信息网站提供关于儿童生存和健康的详细统计数据，包括联合国儿童死亡率估算机构间小组的说明及其数据库链接；卫生计量和评价研究所网站载有其2011年5岁以下儿童死亡率和5岁以下儿童死亡分析摘要。世界卫生组织也有关于千年发展目标4的信息，并提供儿童死亡率估计数（部分信息以几种语言提供）
Leontine Alkema and Danzhen You compare and summarize differences in underlying data and modelling approaches used by two key groups who publish data on global under-5 mortality rates Millennium Development Goal 4 calls for a reduction in the under-five mortality rate (U5MR) by two-thirds between 1990 and 2015. In 2011, estimates were published by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) and the Institute for Health Metrics and Evaluation (IHME). The difference in the U5MR estimates produced by the two research groups was more than 10% and corresponded to more than ten deaths per 1,000 live births for 10% of all countries in 1990 and 20% of all countries in 2010, which can lead to conflicting conclusions with respect to countries' progress. To understand what caused the differences in estimates, we summarised differences in underlying data and modelling approaches used by the two groups, and analysed their effects. UN IGME and IHME estimation approaches differ with respect to the construction of databases and the pre-processing of data, trend fitting procedures, inclusion and exclusion of data series, and additional adjustment procedures. Large differences in U5MR estimates between the UN IGME and the IHME exist in countries with conflicts or civil unrest, countries with high HIV prevalence, and countries where the underlying data used to derive the estimates were different, especially if the exclusion of data series differed between the two research groups. A decomposition of the differences showed that differences in estimates due to using different data (inclusion of data series and pre-processing of data) are on average larger than the differences due to using different trend fitting methods. Substantial country-specific differences between UN IGME and IHME estimates for U5MR and the number of under-five deaths exist because of various differences in data and modelling assumptions used. Often differences are illustrative of the lack of reliable data and likely to decrease as more data become available. Improved transparency on methods and data used will help to improve understanding about the drivers of the differences. Please see later in the article for the Editors' Summary. In 2010, more than seven million children died before they reached their fifth birthday, and the global under-five mortality rate (also denoted in the literature as U5MR and 5q0) was 57 deaths per 1,000 live births. Most deaths before the age of five years occur in developing countries (about half occur in just five countries—India, Nigeria, the Democratic Republic of the Congo, Pakistan, and China), and most are caused by preventable or treatable diseases such as pneumonia, diarrhea, and malaria. Faced with this largely avoidable loss of young lives, in 1990, the United Nations (UN) World Summit for Children pledged to improve the survival of children. Later, in 2000, world leaders set a target of reducing under-five mortality to one-third of its 1990 level (12 million) by 2015, as Millennium Development Goal 4 (MDG 4). This goal, together with seven others, is designed to improve the social, economic, and health conditions in the world's poorest countries. Although progress towards MDG 4 is accelerating, MDG 4 is unlikely to be reached. It is important, therefore, to know which countries are making poor progress towards MDG 4 so that extra resources can be concentrated in these areas. To monitor both national and global progress, accurate, up-to-date estimates of U5MR are essential. The first step in estimating U5MR is the collection of data on child deaths, usually through vital registration systems (which record all births and deaths) in developed countries and through surveys that ask women about their living and dead children in developing countries. Country-specific U5MR estimates that are comparable over time and across countries are obtained from these data using a statistical process called trend fitting. Two groups—the UN Inter-agency Group for Child Mortality Estimation (UN IGME) and the Institute for Health Metrics and Evaluation (IHME)—recently published new estimates of the levels and trends in U5MR and under-five deaths across the world. However, their estimates differ somewhat and, for some countries, disagree on the progress being made towards MDG 4. Here, the researchers examine the differences in the underlying data and the trend fitting approaches used by the UN IGME and the IHME to try to understand why their estimates are different. The researchers first compared the estimates produced by the two groups. From 1990 to 2010, the UN IGME's global estimates of U5MR and under-five deaths were consistently slightly higher than those of the IHME. For example, in 2010, the UN IGME and IMHE estimates of U5MR were 56.7 and 53.9 deaths per 1,000 births, respectively. However, although the global estimates from the two groups were broadly similar, there were important differences between the two sets of estimates at the country level, particularly in countries where there was conflict or civil unrest (for example, Somalia) or high HIV prevalence. The researchers then examined the data used by the two groups to estimate under-five deaths and U5MR, the method used for U5MR trend fitting, and additional adjustment procedures (for example, the UN IGME incorporates feedback from experts and country consultations in its estimates). The UN IGME and IHME estimation approaches included differences in all of these areas, but differences in the data used caused on average larger differences in the estimates than the use of different trend fitting methods did. These findings show that the substantial country-specific differences between UN IGME and IHME estimates for U5MR and the number of under-five deaths are the result of several differences between the data and trend fitting methods used by the two groups. In particular, the findings indicate that the lack of reliable data in many developing countries, especially those where there is civil unrest or ongoing conflicts, is often responsible for differences in estimates. These differences should, therefore, decrease as more reliable data become available. For now, though, the differences between the UN IGME and IHME national estimates of child mortality may cause confusion about the true extent of progress towards MDG 4 and could foster policy inactivity if the reasons for the discrepancies are not made clear. The researchers call, therefore, for more transparency on the methods and data used in the estimation of U5MR and for a concerted effort by governments, UN agencies, and non-governmental organizations to improve the collection of reliable data on child deaths. Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001288. This paper is part of a collection of papers on Child Mortality Estimation Methods published in PLOS Medicine The United Nations Childrens Fund (UNICEF) works for children's rights, survival, development, and protection around the world; it provides information on Millennium Development Goal 4, and its Childinfo website provides detailed statistics about child survival and health, including a description of the UN Inter-agency Group for Child Mortality Estimation and a link to its database; the 2011 UN IGME report on Levels and Trends in Child Mortality is available The Institute for Health Metrics and Evaluation website includes a summary of their 2011 analysis of U5MR and under-five deaths The World Health Organization also has information about Millennium Development Goal 4 and provides estimates of child mortality rates (some information in several languages) Further information about the Millennium Development Goals is available
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影响因子：
168.9
作者：
Rajaratnam, Julie Knoll;Marcus, Jake R.;Murray, Chnstopher J. L.
通讯作者：
Murray, Chnstopher J. L.
影响因子：
15.8
作者：
Hill K;You D;Inoue M;Oestergaard MZ;Technical Advisory Group of United Nations Inter-agency Group for Child Mortality Estimation
通讯作者：
Technical Advisory Group of United Nations Inter-agency Group for Child Mortality Estimation
影响因子：
15.8
作者：
Pedersen, Jon;Liu, Jing
通讯作者：
Liu, Jing
DOI：
10.2471/blt.09.071779
发表时间：
2010-10-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Hallett, Timothy B;Gregson, Simon;Nyamukapa, Constance A
通讯作者：
Nyamukapa, Constance A
影响因子：
168.9
作者：
Lozano, Rafael;Wang, Haidong;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.