用捕获-再捕获法估计三峡库区居民出生和死亡水平

目的 评价出生死亡监测质量，校正三峡库区报告人口出生率和死亡率。方法 采用分层随机整群抽样方法，对抽取的7061户居民逐户调查人口出生和死亡情况，再与同期监测系统所报告的出生、死亡资料进行核对，计算漏报率以及总体出生率和死亡率95％可信区间（C1）。结果 三峡库区人群健康监测系统出生漏报率为13．91％，死亡漏报率为15．60％，婴儿死亡漏报率为33．33％。校正报告出生率为8．92‰，估计总体出生率95％CI：8．38‰～9．45‰，校正报告死亡率为6．88‰，估计总体死亡率95％CI：6．37‰～7．38‰。结论 三峡库区人群健康监测系统出生和死亡报告质量符合国家疾病监测点质量要求。2002—2004年三峡库区人口出生率和死亡率在10．00‰以下。     

期望寿命与婴儿死亡率的预测

[目的]预测中国婴儿死亡率与期望寿命。[方法]以人均国民收入(购买力平价)为自变量,同期各国婴儿死亡率为应变量,作曲线拟合,寻找最优预测模型;以婴儿死亡率为自变量,同期各国期望寿命为应变量,作线性回归。[结果]建立乘幂函数模型预测婴儿死亡率,决定系数为0.858,模型拟合效果较好。2007年中国婴儿死亡率预测值为20.86‰,实际报告值为19.00‰;建立线性回归模型预测期望寿命,调整决定系数为0.926,模型拟合效果较好。2007中国人口期望寿命预测值为72.36岁,报告值为74岁。预测2020年中国人口婴儿死亡率为8.46‰,期望寿命为75.25岁。[结论]2007年中国人均国民收入偏低,但是在降低婴儿死亡率和提高期望寿命方面优于同等经济实力国家的平均水平。择选与预测指标关系最为紧密的变量,保证足够大的样本含量,通过传统回归方法同样可以较好预测出婴儿死亡率和期望寿命。     

辉煌的30年

1978-2008年．是中国以开放的胸襟融入世界的30年，是中国经济承载着民族复兴的百年梦想腾飞的30年．也是山东卫生事业发生天翻地覆变化的30年。改革开放30年来，我省孕产妇死亡率、婴儿死亡率分别降至21．91／10万和10．76‰，人均期望寿命达到75．02岁，这是世界上衡量国民健康水平的三大指标．也是我省卫生事业发展成就的明证。     

深化改革完善政策促进卫生服务公平与效率协同发展

江苏省南通市是一座正在蓬勃发展的沿海对外开放城市。市区现有人口75.45万人,面积350Km~2,2000年人均GDP为24 539元,人均可支配收入7 910元,恩格尔系数为33％,人口自然增长率1.68‰,婴儿死亡率6.88‰,孕产妇死亡率24.56/10万(“九五”期间平均值:婴儿残废率9.45‰,孕产妇死亡率4.8/10万),人均期望寿命75.5岁,男73.3岁,女78.6岁,市区每千人拥有病床数8.16张,每千人拥有医生4.61人,平均每床占建筑面积100m~2。2000年市区卫生事业费财政拨款7301.31万元,占财政支出的5.7％,人均卫生事业费96.83元。     

健康中国2020——基于中国国情的卫生经济学战咯思考

一、中国卫生事业发展取得的成效 1．健康状况得到极大改善新 中国成立60年来,中国人民的健康状况得到极大改善。人均期望寿命、婴儿死亡率、孕产妇死亡率等综合反映居民健康水平的指标持续改善（见图1）。婴儿死亡率从解放前的200%降低到2007年的15．3‰;     

绩效考核助推卫生事业跨越发展

2010年以来,我市卫生部门创新目标管理机制,全面推行绩效考核,取得了显著成效,作为衡量一个地区卫生事业发展水平的主要指标——人均期望寿命、孕产妇死亡率、婴儿死亡率,盐城市分别为74.2岁(全国73岁)、0(全国26.1/10万)、2.66‰     

兜牢医疗网底 推进健康扶贫

"十三五"以来,贵州省岑巩县卫生事业着力深化医药卫生体制改革,织密健康扶贫网络,城乡居民健康水平持续提高。居民人均预期寿命由"十二五"末的72.99岁提高到2020年的75岁,孕产妇死亡率从34.7/10万下降到0,婴儿死亡率从7.56‰下降到6.54‰,5岁以下儿童死亡率从9.71‰下降到8.95‰。全县每千人口医疗卫生机构床位数达到10.49张,每千人口执业(助理)医师数3.14人,千人口注册护士数4.77人,每万常住人口全科医师数2.38人,建成健全完善的"15分钟城市社区健康服务圈"和"30分钟乡村健康服务圈"。     

小康社会健康评价指标提出

中国卫生经济学会第10次学术年会上,卫生经济学家提出了我国小康社会人群健康素质的评价指标和实现策略。健康素质目标性指标包括:期望寿命75-79岁,婴儿死亡率6‰,5岁以下儿童死亡率7.5‰,孕产妇死亡率12/10万,残障流行率14:5‰,肥胖症成人(儿童)比例     

围绕“一条主线”补齐“三个短板”

2019年云南省卫生健康工作在以下几方面取得进展:主要健康指标显著提升。据初步估算,人均预期寿命达到75.1岁,孕产妇死亡率、5岁以下儿童死亡率、婴儿死亡率继续控制在14.79/10万、7.02‰、4.78‰的较低水平。健康扶贫成效进一步巩固提升。     

上海市黄浦区居民50年期望寿命变迁分析

[目的]收集黄浦区人口出生率、死亡率、期望寿命指标,探索黄浦区居民期望寿命水平及相关因素。[方法]通过上海市死亡数据登记系统软件和手工报表资料,分析近50年黄浦区人口出生率、死亡率、期望寿命指标。[结果]1951年黄浦区居民死亡率南片为13.55‰,北片为9.44‰;出生率南片为44.00‰,北片为29.20‰;1976年黄浦区居民死亡率南片为6.89‰,北片为6.66‰;出生率南片为7.10‰,北片为6.56‰;2006年黄浦区居民全死因(南北片合并)为8.50‰,出生率(南北片合并)为5.08‰。1951年黄浦区居民期望寿命为47.56岁(南片),1976年期望寿命为71.18岁(南片),2006年黄浦区居民期望寿命为81.98岁(南北片合并)。[结论]半个世纪以来,黄浦区居民死亡率、出生率大幅下降;居民期望寿命不断上升,2006年黄浦区居民期望寿命较1951年上升72.37%,较1976年上升15.17%,比上海市同年居民期望寿命80.97岁高1.01岁,与世界发达国家居民期望寿命相近。     

An epidemiologic study of craniosynostosis: risk indicators for the occurrence of craniosynostosis in Colorado

This population-based case-control study was designed to investigate risk indicators for the occurrence of the birth defect craniosynostosis in Colorado. A total of 173 children who underwent craniectomy for craniosynostosis and 759 children without craniosynostosis were included in the study. Multivariable logistic regression analysis of birth certificate data showed that male sex (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.1-2.2), maternal five-year age "increase" (OR = 1.3, 95% CI = 1.1-1.5), plural birth (OR = 3.0, 95% CI = 1.2-7.1) and black maternal race (OR = 0.0, 95 per cent CI = 0.0-0.6) were independently associated with craniosynostosis. There was a weak positive association between craniosynostosis and the altitude of the town closest to the maternal residence, but no association was found with maternal education, marital status, number of previous births, or previous pregnancy termination. The association of craniosynostosis with plural birth is consistent with the hypothesis of fetal head constraint.     

Risk indicators for talipes equinovarus in Washington State, 1987-1989

To identify risk indicators for talipes equinovarus, we compared 175 case children with talipes equinovarus of unknown etiology identified through the Washington State Birth Defect Registry with 1,470 control children sampled from resident live births. Infant gender, maternal smoking, death of a preterm sibling, and marital status were independently related to talipes equinovarus in an analysis based on information from birth certificate records. The findings differed by infant gender. The prevalence odds ratio for maternal smoking was 2.6 (95% confidence interval: 1.6-4.0) in males and 1.4 (95% confidence interval:0.6-3.2) in females.     

Excess mortality in an inner-city area: the case of Ciutat Vella in Barcelona]

The purpose of this study is to compare mortality indicators in the district of Ciutat Vella (the more socio-economically deprived in Barcelona) with the entire city, for the 1983-87 period. Crude death rates, as well as age, sex and cause-specific deaths rates were calculated from vital statistics data; life expectancy, years of potential life lost (YPLL), the Comparative Mortality Figure (CMF) and avoidable mortality rates were also computed. All indicators point out at an excess of mortality in Ciutat Vella, when compared to the whole city. Life expectancy was 73 years (4 years less than for Barcelona as a whole); infant mortality was 15.6 per 1,000 births (as opposed to 9 for Barcelona). The CMF was 129 (95% confidence interval: 126.2-131.8), while the YPLL ratio was 182.1 (95% confidence interval: 173.1-191.8), mainly attributed to excess mortality due to tuberculosis, cirrhosis and to homicides and drug-related deaths. The percentage of avoidable deaths was 9.5% in Ciutat Vella compared with 8.23% for Barcelona as a whole. These data confirm the need to actively pursue intervention programs to improve health in Ciutat Vella, although further small-area analysis at the level of neighbourhood and of health care areas would be advisable.     

成都市龙泉驿区2001-2010年妇幼卫生指标完成情况分析

目的通过分析成都市龙泉驿区2001-2010年妇幼卫生指标完成情况,为指导今后妇幼卫生工作提供依据。方法回顾性分析2001-2010年成都市龙泉驿区《龙泉驿区妇女发展规划（2001-2010年）》和《龙泉驿区儿童发展规划（2001-2010年）》（＂两纲＂）主要妇幼卫生指标。结果 2010年新生儿死亡率、5岁以下儿童死亡率分别为5.27‰、9.32‰,且均呈下降趋势;出生缺陷的发生率逐年增高,2010年出生缺陷发生率为103.9/万;低出生体重儿发生率、5岁以下儿童中、重度营养不良发生率均处于较低水平;新生儿肺炎总体发生率较低且持续下降,2007-2010年连续4年无腹泻死亡发生;孕产妇死亡率波动不稳定,2010年孕产妇死亡率为20.27/10万;孕产妇系统管理率不断上升,在2010达到近年来最高的95.01%;婚检率先后受消强制婚检和政府实施免费婚检影响,先低后高,在2010年上升到96.60%。结论龙泉驿区实施妇幼＂两纲＂工作成绩显著,除孕产妇死亡率和出生缺陷发生率外均已达到了＂两纲＂目标要求。     

上海市卢湾区1961—2008年婴儿死亡率动态分析

【目的】 监测上海市卢湾区婴儿死亡的变化趋势,观察婴儿死亡率对平均期望寿命的影响,采取相应措施降低婴儿死亡率。 【方法】 对卢湾区1961—2008年出生的194 195名活产婴儿以及同期死亡的2 379名婴儿的死亡资料以动态数列的方法分析。 【结果】 婴儿死亡率从1961年的25.20‰下降至2008年的1.64‰,下降速度为93.50%;新生儿死亡率从8.98‰下降至1.64‰,下降速度为81.76%,受之影响卢湾区人均期望寿命也逐年上升。婴儿死亡的前四位主要死因分别为先天异常、肺炎、早产儿和未成熟儿、产伤窒息。 【结论】 随着本区医疗事业的发展,婴儿死亡率显著降低。为降低婴儿死亡率,提高平均期望寿命,现阶段应以加强出生缺陷监测工作和提倡围生期保健作为工作重点。     

What targets for international development policies are appropriate for improving health in Russia?

BACKGROUND: The OECD countries and the United Nations have agreed to co-ordinate their work around a series of International Development Targets. The targets for health are based on improvements in infant, child and maternal mortality. Progress towards these goals will be used to assess the effectiveness of development policies. OBJECTIVES: To assess the potential impact of achievement of the International Development Targets on health in Russia, and to identify possible alternatives that may be more relevant to transition countries. DESIGN: The study covered the population of the Russian Federation from 1995-99.The effects of reducing infant, child and maternal mortality on Russian life expectancy at birth were modelled using construction of life tables. Three scenarios were modelled, reducing rates to those of the best performing regions in Russia, those required to achieve the International Development Targets and current UK rates. The results were compared with the effect on life expectancy at birth of policies to reduce adult mortality in different ways. RESULTS: Achieving the International Development Targets for infant, child and maternal mortality (66.7 and 75% reductions) will contribute very little to improving life expectancy in Russia (0.96 years). In contrast, even a 20% reduction in adult mortality would give rise to an increase in male life expectancy at birth of 1.86 years. CONCLUSION: Targets for health improvement in transition countries such as Russia should take account of adult mortality as well as the indicators contained in the International Development Targets.     

Maternal health during pregnancy and perinatal mortality in Bangladesh: evidence from a large-scale community-based clinical trial

Perinatal mortality is very high in Bangladesh. In this setting, few community-level studies have assessed the influence of underlying maternal health factors on perinatal outcomes. We used the data from a community-based clinical controlled trial conducted between 1994 and 1997 in the catchment areas of a large MCH/FP hospital located in Mirpur, a suburban area of Dhaka in Bangladesh, to investigate the levels of perinatal mortality and its associated maternal health factors during pregnancy. A total of 2007 women were followed after recruitment up to delivery, maternal death, or until they dropped out of the study. Of these, 1584 who gave birth formed our study subjects. The stillbirth rate was 39.1 per 1000 births [95% confidence interval (CI) 39.0, 39.3] and the perinatal mortality rate (up to 3 days) was 54.3 per 1000 births [95% CI 54.0, 54.6] among the study population. In the fully adjusted logistic regression model, the risk of perinatal mortality was as high as 2.7 times [95% CI 1.5, 4.9] more likely for women with hypertensive disorders, 5.0 times [95% CI 2.3, 10.8] as high for women who had antepartum haemorrhage and 2.6 times [95% CI 1.2, 5.8] as high for women who had higher haemoglobin levels in pregnancy when compared with their counterparts. The inclusion of potential confounding variables such as poor obstetric history, sociodemographic characteristics and preterm delivery influenced only marginally the net effect of important maternal health factors associated with perinatal mortality. Perinatal mortality in the study setting was significantly associated with poor maternal health conditions during pregnancy. The results of this study point towards the urgent need for monitoring complications in high-risk pregnancies, calling for the specific components of the safe motherhood programme interventions that are designed to manage these complications of pregnancy.     

2018年河南省妇幼保健机构服务能力初步分析

目的 初步分析2018年河南省妇幼保健机构服务能力现状,为妇幼保健机构服务能力的建设提供参考。方法 对河南省各级妇幼保健机构相关数据进行统计学对比分析,主要包括开展诊疗服务的机构情况、开展住院服务机构床位分布情况、卫生技术人员学历及数量变化情况、孕产妇和新生儿危重症救治中心建设情况、妇幼健康核心指标变化情况。结果 河南省172所妇幼保健机构中床位数占比最多的是产科,其次是儿科,分别为34.35%、21.37%。2010—2018年全省妇幼保健机构床位数呈现逐年上升的趋势,婴儿死亡率（2010年为7.1‰,2018年为3.8‰）、5岁以下儿童死亡率（2010年为8.7‰,2018年为5.3‰）、孕产妇死亡率（2010年为15.2/10万,2018年为10.9/10万）指标整体呈下降趋势,优于全国指标。在县区级妇幼保健机构中,卫生技术人员主要以大专及以下学历为主,占63.66%,孕产妇危重症救治中心和新生儿危重症救治中心建设占比分别为50.65%、40.91%。结论 河南省各级妇幼保健机构发展良好,服务能力稳步提升,但是各机构之间服务能力存在差异。县区级妇幼保健机构受卫生技术人才限制,服务能力需要进一步提升。     

Maternal age as a risk factor for wheezing lower respiratory illnesses in the first year of life.

Postneonatal mortality due to respiratory illnesses is known to be inversely related to maternal age, but the possible role of young motherhood as a risk factor for respiratory morbidity in infants has not been thoroughly explored. The authors studied the incidence of lower respiratory tract illnesses during the first year of life, as ascertained by health plan pediatricians, in over 1,200 infants enrolled at birth between 1980 and 1984 in Tucson, Arizona. The incidence of wheezing lower respiratory tract illnesses increased significantly (p = 0.005) with decreasing maternal age, whereas the incidence of nonwheezing lower respiratory tract illness was independent of maternal age. A logistic regression was used to control for the effects of several known confounding factors. When compared with infants of mothers aged more than 30 years, adjusted odds ratios were 2.4 (95% confidence interval 1.8-3.1) for infants whose mothers were less than age 21 years (p < 0.0001), 1.8 (95% confidence interval 1.4-2.3) for infants whose mothers were aged 21-25 (p < 0.0001); and 1.4 (95% confidence interval 1.1-1.6) for infants whose mothers were aged 26-30 (p < 0.001). These results suggest that young motherhood is an important risk factor for wheezing lower respiratory tract illnesses during the first year of life. Both biological and social factors related to maternal age may explain these findings.     

Interpregnancy Interval and Severe Maternal Morbidity in Iowa, 2009 to 2014

IntroductionMaternal mortality and morbidity rates have risen significantly, yet little research has focused on how severe maternal morbidity (SMM) is associated with future reproductive health, such as birth spacing or the likelihood of subsequent SMM. This study focuses on the risk of SMM recurrence and the association of interpregnancy intervals with SMM.MethodsThis population-based, retrospective cohort study used Iowa hospital discharge data longitudinally linked to birth certificate data between 2009 and 2014. To examine recurrence of SMM, crude and adjusted multivariable logistic regression models were generated. The associations between varying interpregnancy intervals and subsequent SMM were examined. Crude, stratified, and adjusted risk ratios and their associated 95% confidence intervals were estimated.ResultsA total of 36,190 women were included in this study. Women with SMM in the index delivery had significantly higher odds of SMM in the subsequent delivery (adjusted odds ratio, 8.16; 95% confidence interval, 5.45–12.24) compared with women without SMM. Women with an interpregnancy interval of less than 6 months compared with 18 months or longer were more likely to experience SMM during their subsequent delivery, although the difference was not statistically significant (adjusted odds ratio, 1.41; 95% confidence interval, 0.99, 2.03).ConclusionsThis study demonstrates that women who experience SMM are at markedly increased risk of subsequent SMM. Further investigation is necessary to inform optimal interpregnancy interval recommendations based on prior maternal health outcomes.