儿科专业技术人力资源对地区婴儿死亡率的影响

Effect of pediatric human resource on regional infantile mortality rate

目的以广州为例，前瞻性评估儿科专业技术人力资源对婴儿死亡率（infantmortalityrate，IMR）的影响，为卫生行政部门制定降低婴儿死亡率的决策提供依据。方法采用《广州市控制和降低孕产妇、婴儿死亡率工作调研》中的2011年初广州市儿科人力资源数据，分析儿科医生的学历、职称及工作年限分布情况及其与2010～2014年广州市婴儿死亡率的相关性；并根据地理位置特征，将广州划分为中心城区、城乡结合部和远郊三类地区进行比较。结果2011年初广州市共有102所医疗机构开设有儿科，从事与儿科相关业务的医生1549人。三类地区儿科医生学历、职称及工作年限分布差异有统计学意义，高学历、高职称及高年资的儿科医生主要集中在中心城区，远郊地区相对缺乏。2010—2014年三个地区的IMR总体呈下降趋势，儿科人力资源相对缺乏的远郊地区婴儿死亡率始终高于其他地区；相关分析显示2014年全市各区的IMR与2011年初区域儿科医生的学历（r=0．844，P〈0．01）、职称（r=-0．707，P=0．02）、工作年限（r=-0．737，P=0．01）之间呈负相关。结论广州地区儿科人力资源配置结构尚不完善、区域之间分布不均。儿科专业技术力量是影响婴儿死亡率的重要因素之一。

Objective To prospectively evaluate the effect of pediatric human resource on regional infantile mortality rate （IMR） in Guangzhou, provide a basis for local health administrative departments to develop strategies to reduce IMR. Methods Based on data from the investigation of controlling and reducing IMR in Guangzhou which was conducted in 2011, the education background, job title, and work experience of pediatricians and the correlation with IMR in Guangzhou were analyzed; according to the characteristics of geographical loca- tion, Guangzhou was divided into central urban area, urban fringe, and suburban area, a comparative study was performed. Results In early 2011,102 medical institutions in Guangzhou set up Department of Pediatrics, 1 549 pediatricians were included. There were statistical- ly significant difference in education background, job title, and distribution of years of working, the pediatricians with high education back- ground, job title, and years of working mainly worked in central urban area, suburban area lacked pediatricians. From 2010 to 2014, IMR in central urban area, urban fringe, and suburban area decreased, IMR in suburban area lacking pediatric human resource was still higher than those in the other areas ; correlation analysis showed that IMR in Guangzhou in 2014 was negatively correlated with education background （ r = -0. 844, P〈0. 01 ）, job title （ r = -0. 707, P = 0. 02）, and years of working （ r = -0. 737, P = 0. 01 ）. Conclusion The allocation and structure of pediatric human resource is imperfect in Guangzhou, the regional distribution is not balanced. Pediatric professional background is one of the important factors that affect IMR.