Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000
Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000
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DOI：
10.1016/s0140-6736(12)60560-1
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发表时间：
2012-06-09
期刊：
影响因子：
168.9
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Liu, Li;Johnson, Hope L.;Black, Robert E.
应定期更新关于儿童死亡原因分布和时间趋势的资料。方法采用2000年以来中国0-27 d和1-59月龄儿童死亡总数的最新数据，与中国各地区儿童死因分布进行比较。我们做了以下工作来得出1-59个月儿童的死亡人数：我们使用了具有适当生命登记系统的国家的生命登记数据;我们对没有适当生命登记的低死亡率国家的生命登记数据应用了多项逻辑回归模型;我们对高死亡率国家的死因推断数据使用了类似的多项逻辑回归;我们为印度和中国开发了国家模式。结果在2010年的760万例5岁以下儿童死亡中，64.0%（487.9万）的死亡原因是感染，40.3%（307.2万）发生在新生儿中。早产并发症（14.1%; 107.8万，不确定性范围[UR] 0.916-1.325）、产时相关并发症（9.4%; 71.7万，0.610-0.876）和败血症或脑膜炎（5.2%; 39.3万，0.252-0.552）是新生儿死亡的主要原因。在年龄较大的儿童中，肺炎（14.1%; 107.1万，0.977-1.176）、腹泻（9.9%; 75.1万，0.538-1.031）和疟疾（7.4%; 56.4万，0.432-0.709）夺去了最多的生命。尽管为确定相关数据做出了巨大努力，但2010年，只有2.7%（20.5万）的5岁以下儿童死亡原因得到医学证明。2000年至2010年期间，全球5岁以下儿童死亡人数减少了200万，其中肺炎、麻疹和腹泻对总体减少的贡献最大（分别为45.1万[0.339-0.547]、36.3万[0.283-0.419]和35.9万[0.215-0.476]）。然而，只有破伤风、麻疹、艾滋病和疟疾（非洲）的年下降率足以实现千年发展目标4。解释儿童生存战略应将资源用于儿童死亡的主要原因，重点关注传染病和新生儿原因。从2010年到2015年，要想更快地下降，就需要加速减少最常见的死亡原因，特别是肺炎和早产并发症。继续努力收集高质量的数据和改进估计方法对于改进今后的估计至关重要。
Background Information about the distribution of causes of and time trends for child mortality should be periodically updated. We report the latest estimates of causes of child mortality in 2010 with time trends since 2000.Methods Updated total numbers of deaths in children aged 0-27 days and 1-59 months were applied to the corresponding country-specific distribution of deaths by cause. We did the following to derive the number of deaths in children aged 1-59 months: we used vital registration data for countries with an adequate vital registration system; we applied a multinomial logistic regression model to vital registration data for low-mortality countries without adequate vital registration; we used a similar multinomial logistic regression with verbal autopsy data for high-mortality countries; for India and China, we developed national models. We aggregated country results to generate regional and global estimates.Findings Of 7.6 million deaths in children younger than 5 years in 2010, 64.0% (4.879 million) were attributable to infectious causes and 40.3% (3.072 million) occurred in neonates. Preterm birth complications (14.1%; 1.078 million, uncertainty range [UR] 0.916-1.325), intrapartum-related complications (9.4%; 0.717 million, 0.610-0.876), and sepsis or meningitis (5.2%; 0.393 million, 0.252-0.552) were the leading causes of neonatal death. In older children, pneumonia (14.1%; 1.071 million, 0.977-1.176), diarrhoea (9.9%; 0.751 million, 0.538-1.031), and malaria (7.4%; 0.564 million, 0.432-0.709) claimed the most lives. Despite tremendous efforts to identify relevant data, the causes of only 2.7% (0.205 million) of deaths in children younger than 5 years were medically certified in 2010. Between 2000 and 2010, the global burden of deaths in children younger than 5 years decreased by 2 million, of which pneumonia, measles, and diarrhoea contributed the most to the overall reduction (0.451 million [0.339-0.547], 0.363 million [0.283-0.419], and 0.359 million [0.215-0.476], respectively). However, only tetanus, measles, AIDS, and malaria (in Africa) decreased at an annual rate sufficient to attain the Millennium Development Goal 4.Interpretation Child survival strategies should direct resources toward the leading causes of child mortality, with attention focusing on infectious and neonatal causes. More rapid decreases from 2010-15 will need accelerated reduction for the most common causes of death, notably pneumonia and preterm birth compli cations. Continued efforts to gather high-quality data and enhance estimation methods are essential for the improvement of future estimates.