National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals.
National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals.
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1996 - 2015年中国国家和地区全因原因和特定儿童死亡率：系统分析，对可持续发展目标有影响。
DOI：
10.1016/s2214-109x(16)30334-5
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发表时间：
2017-02
期刊：
影响因子：
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通讯作者：
Zhu J
中科院分区：
文献类型：
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作者：
He C;Liu L;Chu Y;Perin J;Dai L;Li X;Miao L;Kang L;Li Q;Scherpbier R;Guo S;Rudan I;Song P;Chan KY;Guo Y;Black RE;Wang Y;Zhu J
中国已实现千年发展目标4，即在1990年至2015年期间将5岁以下儿童死亡率降低三分之二。在这项研究中，我们估计了1996年至2015年中国每年的国家和地方儿童死亡率水平和原因，以得出中国和其他低收入和中等收入国家实现可持续发展目标的启示。在这项系统分析中，我们调整了中国妇幼健康监测系统收集的儿童死亡率水平和原因的经验数据，以生成国家和地方各级的代表性估计值。在调整数据时，我们考虑了抽样设计和概率，应用平滑技术来产生稳定的趋势，将活产和年龄特异性死亡估计值与联合国产生的国家估计值进行拟合以进行国际比较，并将独立来源产生的罕见原因的国家估计值划分为国家以下一级。1996年至2015年，中国5岁以下儿童死亡率从50.8/1000活产儿下降到10.7/1000活产儿，年均下降8.2%。然而，仍有181600名儿童在5岁之前死亡，其中93400名（51.5%）死亡发生在新生儿中。 各区域之间以及城市和农村地区之间的儿童死亡率存在着很大的不平等。2015年5岁以下儿童死亡的主要原因是先天性异常（35700例死亡，95%不确定性范围[UR] 28400 - 45200），早产并发症（30900例死亡，24200 - 40800）和伤害（26600例死亡，21000 - 33400）。 西部地区肺炎死亡比例高于东部和中部地区，伤害是农村地区的主要死因。还检查了不同年龄死亡原因构成的变化。早产并发症对死亡率的贡献在新生儿期之后下降;先天性异常仍然是整个婴儿期死亡率的重要原因，而伤害对死亡率的贡献在生命的第一年之后增加。1996-2015年，中国实现了儿童死亡率的快速下降。这一下降在各地区、城市和农村地区、各年龄组和死因类别中普遍存在，但仍存在很大差异。西部地区和农村地区，特别是西部农村地区，应在可持续发展目标时代通过加强政策和方案，在改善儿童生存方面得到最多关注。继续投资对于在全国范围内预防先天性畸形、早产并发症和伤害造成的死亡以及西部农村地区预防肺炎造成的死亡的初级和二级预防至关重要。这项研究还对改善其他低收入和中等收入国家的儿童生存、民事登记和生命统计产生了影响。比尔和梅林达·盖茨基金会。
China has achieved Millennium Development Goal 4 to reduce under-5 mortality rate by two-thirds between 1990 and 2015. In this study, we estimated the national and subnational levels and causes of child mortality in China annually from 1996 to 2015 to draw implications for achievement of the SDGs for China and other low-income and middle-income countries. In this systematic analysis, we adjusted empirical data on levels and causes of child mortality collected in the China Maternal and Child Health Surveillance System to generate representative estimates at the national and subnational levels. In adjusting the data, we considered the sampling design and probability, applied smoothing techniques to produce stable trends, fitted livebirth and age-specific death estimates to natvional estimates produced by the UN for international comparison, and partitioned national estimates of infrequent causes produced by independent sources to the subnational level. Between 1996 and 2015, the under-5 mortality rate in China declined from 50·8 per 1000 livebirths to 10·7 per 1000 livebirths, at an average annual rate of reduction of 8·2%. However, 181 600 children still died before their fifth birthday, with 93 400 (51·5%) deaths occurring in neonates. Great inequity exists in child mortality across regions and in urban versus rural areas. The leading causes of under-5 mortality in 2015 were congenital abnormalities (35 700 deaths, 95% uncertainty range [UR] 28 400–45 200), preterm birth complications (30 900 deaths, 24 200–40 800), and injuries (26 600 deaths, 21 000–33 400). Pneumonia contributed to a higher proportion of deaths in the western region of China than in the eastern and central regions, and injury was a main cause of death in rural areas. Variations in cause-of-death composition by age were also examined. The contribution of preterm birth complications to mortality decreased after the neonatal period; congenital abnormalities remained an important cause of mortality throughout infancy, whereas the contribution of injuries to mortality increased after the first year of life. China has achieved a rapid reduction in child mortality in 1996–2015. The decline has been widespread across regions, urban and rural areas, age groups, and cause-of-death categories, but great disparities remain. The western region and rural areas and especially western rural areas should receive most attention in improving child survival through enhanced policy and programmes in the Sustainable Development Goals era. Continued investment is crucial in primary and secondary prevention of deaths due to congenital abnormalities, preterm birth complications, and injuries nationally, and of deaths due to pneumonia in western rural areas. The study also has implications for improving child survival and civil registration and vital statistics in other low-income and middle-income countries. Bill & Melinda Gates Foundation.