2000-2016年中国孕产妇死亡率变化趋势及影响因素分析

Changing trend and influencing factors of maternal mortality in China, 2000-2016

目的研究2000-2016年我国孕产妇死亡率变化趋势及影响因素,为政府开展妇幼保健工作提供决策支持。方法收集2000-2016年全国孕产妇死亡率、系统管理高危产妇比重、建卡率、系统管理率、产前检查率、产后访视率、住院分娩率、新法接生率等数据。采用Cochran-Armitage趋势检验分析各指标的变化趋势,Spearman秩相关分析孕产期保健指标与孕产妇死亡率的相关关系,多元逐步回归探究影响孕产妇死亡率的主要因素。结果 2000-2016年间我国孕产妇死亡率呈下降趋势(Z=-7.75,P<0.01),农村地区孕产妇死亡率年均下降速度为7.50%,城市地区为2.51%;孕产妇保健指标呈上升趋势,且与孕产妇死亡率为负相关(P<0.01);多元逐步回归分析显示,系统管理高危产妇比重和新法接生率是影响孕产妇死亡率的主要因素。结论 2000-2016年,我国孕产妇死亡率显著下降,农村孕产妇死亡率年均下降速度高于城市,城乡差距缩小;孕产妇保健工作对孕产妇健康有重大意义,尤其要确保各地区的系统管理高危产妇及新法接生的实施及推广。

Objective To analyze the changing trend and influencing factors of maternal mortality in China during 2000-2016 so as to provide decision-making supports for the government to conduct maternal and child health management. Methods We collected the data regarding the maternal mortality, proportion of systematically-managed high-risk puerperae, rate of registering in hospitals, systematic management rate, prenatal check rate, postpartum follow-up rate, hospital delivery rate and new midwifery rate in China during 2000-2016. The Cochran-Armitage trend test was employed to analyze the changing trend of each indicator. Spearman rank correlation analysis was applied to analyzing the relation between maternal health care indicators and maternal mortality. Multiple stepwise regression analysis was used to explore the main factors influencing maternal mortality. Results The maternal mortality in China during 2000-2016 showed a declining trend(Z=-7.75, P<0.01). The average annual declining rates of maternal mortality in rural and urban areas were 7.50% and 2.51% respectively. The maternal health care indicators presented increasing trends, and were negatively correlated with maternal mortality(all P<0.01). Multiple stepwise regression analysis indicated that proportion of systematically-managed high-risk puerperae and new midwifery rate were the major influential factors for maternal mortality. Conclusions The maternal mortality in China during 2000-2016 remarkably declined. The average annual decreasing rate of the maternal mortality was higher in rural areas than in urban areas, but the gap between rural and urban areas had been narrowed. Maternal health care, especially popularizing systematic management among high-risk puerperae and new midwifery is of great importance for improving maternal health.