2001至2014年我国孕产期保健服务现状及效果分析

Maternal health care service status and effect in China in 2001-2014

目的分析2001至2014年我国孕产期保健服务的现状和效果,探讨各项保健服务指标与孕产妇和围生儿死亡率的相关性。方法分别采用动态数列和多样本秩和检验分析各指标的时间趋势和地区差异,运用秩相关分析探讨各保健服务指标与孕产妇和围生儿死亡率的相关性。结果 2001至2014年,我国各孕产期保健服务指标均呈上升趋势,其中住院分娩率上升最快,平均上升速度达2.10%;2014年,不同地区在住院分娩率和新法接生率的差异仍具有统计学意义(χ~2值分别为22.587、21.357,均P<0.05)。同时,孕产妇和围生儿死亡率呈下降趋势,年平均下降速度分别为6.25%和6.73%;2014年,两指标的地区差异仍具有统计学意义(χ~2值分别为17.856、14.455,均P<0.05)。孕产妇和围生儿死亡率与各保健服务指标之间均存在强的负相关(|rs|值为0.776~0.996,均P≤0.001),其中两项死亡率均与住院分娩率和新法接生率的相关性最大。结论 2014年,我国住院分娩率、新法接生率以及孕产妇和围生儿死亡率仍存在地区差异,尚需进一步改善孕产期保健服务的公平性和可及性,缩小孕产妇和围生儿死亡率的地区差异。

Objective To analyze the status and effect of maternal health care service in China in 2001-2014 and to discuss the correlation between health service index and maternal and prenatal mortality rate. Methods Dynamic series and multiple rank-sum test were respectively used to analyze time trends and regional difference in health service index,and correlation between service index and maternal and prenatal mortality rate was explored. Results Every maternal health service index in China in 2001-2014 presented a uptrend,among which hospital delivery rate increased most quickly with average increase rate of 2. 10%. There was still significant difference in hospital delivery rate and new-method delivery rate among different regions in 2014（ χ-2 value was 22. 587 and 21. 357,respectively,both P〈 0. 05）. At the same time maternal and perinatal mortality rate had a downtrend,with average annual decline rate of 6. 25% and 6. 73%,respectively. In 2014,difference in above two indexes among different regions was still significant（ χ-2 value was 17. 856 and 14. 455,respectively,both P〈 0. 05）. Maternal and perinatal mortality rate had strong negative correlation with health service indexes（ rsvalue ranged from 0. 776 to 0. 996,all P≤0. 001）,and correlation between maternal and perinatal mortality rate and hospital delivery rate and new-method delivery rate was most strong. Conclusion Regional difference is still found in hospital delivery rate,new-method delivery rate,maternal and perinatal mortality rate in China in 2014,indicating needs for improving fairness and availability of maternal health service and narrowing regional difference in maternal and perinatal mortality rate..