Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
复制标题
DOI：
10.1016/s0140-6736(14)60696-6
复制
发表时间：
2014-09-13
期刊：
影响因子：
168.9
通讯作者：
Coggeshall, M. S.
中科院分区：
文献类型：
--
作者：
Kassebaum, N. J.;Bertozzi-Villa, A.;Coggeshall, M. S.
第五个千年发展目标（千年发展目标5）确立了在1990年至2015年期间将孕产妇死亡率降低75%的目标。我们的目标是衡量孕产妇死亡率的水平和跟踪趋势，这是导致孕产妇死亡的主要原因，也是孕产妇死亡与分娩有关的时间。我们使用强大的统计方法，包括死亡原因综合模型（CODEm），分析了7065个地点年的数据数据库，并估计了1990年至2013年期间188个国家所有原因导致的孕产妇死亡人数。我们根据对艾滋病毒阳性妇女与艾滋病毒阴性妇女在怀孕期间死亡的相对风险进行的系统回顾，估计了艾滋病毒引起的妊娠相关死亡人数。我们还根据系统回顾估计了这些死亡中因妊娠而加重的比例。为了估计9种不同原因导致的孕产妇死亡人数，我们从系统性综述和943个研究中心-年的生命登记数据中确定了61个来源。我们还对有关孕产妇死亡时间的报告进行了系统回顾，确定了142个来源用于我们的分析。我们使用贝叶斯元回归对每个国家的1990-2013年进行了估计。我们估计了所有值的95%不确定性区间（UI）。2013年发生了292 982例（95% UI 261 017-327 792）孕产妇死亡，而1990年为376 034例（343 483-407 574）。1990年至2003年，全球孕产妇死亡率的年变化率为-0.3%（-1.1至0.6），2003年至2013年为-2.7%（-3.9至-1.5），有证据表明孕产妇死亡率的年变化率在继续加速。1990年至2013年间，南亚、东亚和东南亚的孕产妇死亡率持续下降，但撒哈拉以南非洲大部分地区的孕产妇死亡率在20世纪90年代有所上升。2013年，2070例（1290-2866）孕产妇死亡与艾滋病毒有关，占全球总数的0.4%（0.2 - 0.6）。在1990年和2013年，最老年龄组的孕产妇死亡率最高。2013年，大多数死亡发生在分娩期间或产后。1990年至2013年期间，原因因地区而异。我们记录了2013年各国孕产妇死亡率的显著变化，从南苏丹的956.8（685.1 - 1262.8）到冰岛的2.4（1.6 - 3.6）。全球变化率表明，到2015年只有16个国家将实现千年发展目标5。自2000年《千年宣言》发表以来，随着孕产妇、新生儿和儿童健康发展援助的增加，减少的速度加快。为2015年后制定目标和相关干预措施需要认真考虑进展缓慢的区域，如西非和中非。比尔和梅林达·盖茨基金会。
The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990–2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. 292 982 (95% UI 261 017–327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483–407 574) in 1990. The global annual rate of change in the MMR was −0·3% (−1·1 to 0·6) from 1990 to 2003, and −2·7% (−3·9 to −1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290–2866) maternal deaths were related to HIV in 2013, 0·4% (0·2–0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1–1262·8) in South Sudan to 2·4 (1·6–3·6) in Iceland. Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Bill & Melinda Gates Foundation.