Estimating the causes of 4 million neonatal deaths in the year 2000
Estimating the causes of 4 million neonatal deaths in the year 2000
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DOI：
10.1093/ije/dyl043
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发表时间：
2006-06-01
影响因子：
7.7
通讯作者：
Cousens, Simon N.
中科院分区：
文献类型：
--
作者：
Lawn, Joy E.;Wilczynska-Ketende, Katarzyna;Cousens, Simon N.
背景。在生命登记不足的国家发生的400万新生儿死亡中，98%缺乏死因信息。我们的目的是估计2000年各国新生儿死亡的分布情况，包括与规划有关的原因：窒息、早产、先天性异常、败血症/肺炎、新生儿破伤风、腹泻和“其他”方法。对新生儿死因数据的两个来源进行了审查：高覆盖率国家（约90%）的VR数据集，以及通过系统搜索确定的已发表和未发表的研究。采用多项回归对新生儿死亡分布进行建模。使用基于虚拟现实的模型来估计37个没有国家数据的低死亡率国家的死因分布。采用基于研究的模型获得111个高死亡率国家的估计数。不确定度估计是用折刀法得出的。来自44个有VR的国家（96 797例新生儿死亡）和56项研究（29个国家，13 685例新生儿死亡）的数据符合纳入标准。报告的死亡原因分布在不同国家和不同研究之间差异很大。根据193个国家的数据，估计全球新生儿死亡的主要原因是感染（败血症/肺炎、破伤风和腹泻，35%）、早产（28%）和窒息（23%）。地区差异很重要。这些估计存在很大的不确定性。这项工作突出表明，在大多数新生儿死亡发生的环境中缺乏可靠的死因数据。复杂的统计模型并不是万灵药。需要具有可比较的病例定义和一致的分层死因归因的代表性数据。
Background. Information on cause-of-death is lacking for 98% of the world's 4 million neonatal deaths that occur in countries with inadequate vital registration (VR). Our aim was to estimate, by country for the year 2000, the distribution of neonatal deaths across programme-relevant causes including: asphyxia, preterm birth, congenital abnormalities, sepsis/pneumonia, neonatal tetanus, diarrhoea, and 'other'.Methods. Two sources of neonatal cause-of-death data were examined: VR datasets for countries with high coverage (> 90%), and published and unpublished studies identified through systematic searches. Multinomial regression was used to model the distribution of neonatal deaths. A VR-based model was used to estimate the distribution of causes of death for 37 low-mortality countries without national data. A study-based model was applied to obtain estimates for 111 high-mortality countries. Uncertainty estimates were derived using the jackknife approach.Results. Data from 44 countries with VR (96 797 neonatal deaths) and from 56 studies (29 countries, 13 685 neonatal deaths) met inclusion criteria. The distribution of reported causes of death varied substantially between countries and across studies. Based on 193 countries, the major causes of neonatal death globally were estimated to be infections (sepsis/pneumonia, tetanus, and diarrhoea, 35%), preterm birth (28%), and asphyxia (23%). Regional variation is important. Substantial uncertainty surrounds these estimates.Conclusions. This exercise highlights the lack of reliable cause-of-death data in the settings in which most neonatal deaths occur. Complex statistical models are not a panacea. Representative data with comparable case definitions and consistent hierarchical cause-of-death attribution are required.