2010年至2020年我国孕产妇死亡相关性分析及预测

Prediction of maternal mortality ratio in China based on analysis of data from 2010 to 2020

目的分析2010年至2020年我国孕产妇死亡率(maternal mortality ratio,MMR)和孕产妇主要死因别死亡率变化趋势,以及MMR与围产期保健指标相关性,并对2021年至2025年的MMR进行预测分析。方法收集《中国卫生健康统计年鉴》中2010年至2020年我国MMR、孕产妇主要死因别死亡率和围产期保健等相关数据。采用年估计变化百分比(estimated annual percent change,EAPC)分析我国MMR、孕产妇主要死因别死亡率变化趋势;采用平均增长速度描述围产期保健指标变化趋势,Spearman秩相关分析MMR与围产期保健指标相关性;建立GM(1,1)模型并预测2021年至2025年的MMR。结果(1)全国、城市及农村MMR的EAPC分别为-5.16%、-6.24%及-4.28%,提示2010年至2020年我国、城市及农村MMR均有下降趋势(t值分别为-0.98、-12.42及-8.96,P值均<0.001)。(2)2010年至2020年我国孕产妇主要死因中,产科出血、妊娠期高血压疾病、羊水栓塞及肝病均具有下降趋势(t值分别为-12.42、-5.44、-3.98及-3.63,P值均<0.05);除城市的妊娠期高血压疾病死亡率(平均增长速度=0.51%)外,城市和农村孕产妇主要死因别死亡率均有所降低,城市和农村下降幅度最大的疾病均是肝病(平均增长速度分别为-10.40%和-13.96%)。(3)我国MMR与产妇系统管理率(rs=-0.80)、产前检查率(rs=-0.97)、产后访视率(rs=-0.82)及住院分娩率(rs=-0.98)均呈负相关(P值均<0.05);城市MMR(rs=-0.82)、农村MMR(rs=-0.95)分别与住院分娩率呈负相关(P值均<0.05)。(4)我国、城市及农村MMR分别建立了GM(1,1)模型,预测模型为1级,模型预测2021年至2025年MMR呈下降趋势,其中预测2021年和2022年我国MMR分别为15.86/10万和15.13/10万,与国家公布的16.1/10万和15.7/10万相差仅0.24/10万和0.57/10万。结论我国2010年至2020年MMR整体呈下降趋势,其中城市MMR下降快于农村。此外,预测2021年至2025年我国MMR将持续下降,但城乡差距可能将仍然存在。

Objective To analyze the changing trends in maternal mortality ratios(MMRs)and the main cause-specific MMRs in China from 2010 to 2020,evaluate the association between MMRs and pregnancy healthcare and predict the MMRs for the next five years.Methods Data on MMRs,the main cause-specific MMRs,and maternal healthcare in China from 2010 to 2020 were collected from China Health Statistical Yearbook.Estimated annual percent changes(EAPCs)were used to analyze the trends in MMRs and the main cause-specific MMRs in China.Average growth rate was used to describe the trend of perinatal healthcare indicators,and spearman rank correlation was used to analyze the correlation between MMRs and perinatal healthcare indicators.GM(1,1)model was established to predict the MMRs for the following five years.Results(1)From 2010 to 2020,the EAPCs were-5.16%,-6.24%,and-4.28%,respectively,indicating downward trends in MMRs in the whole nation,urban and rural areas(t=-0.98,-12.42 and-8.96,all P<0.001).(2)From 2010 to 2020,the main cause-specific MMRs in China from obstetric hemorrhage,hypertension during pregnancy,amniotic fluid embolism,and liver disease were all in downward trends(t=-12.42,-5.44,-3.98 and-3.63,all P<0.001).Except for the MMR from hypertension during pregnancy in urban areas(average growth rate=0.51%),all main cause-specific MMRs in both urban and rural areas decreased significantly,especially the MMRs from hepatopathy in urban and rural areas(average growth rate=-10.40%and-13.96%).(3)The nation wide MMR was negatively correlated with maternal system management rate(rs=-0.80,P=0.003),prenatal examination rate(rs=-0.97,P<0.001),postpartum visit rate(rs=-0.82,P=0.002)and hospital delivery rate(rs=-0.98,P<0.001).Negative correlations were also found between the MMR and hospital delivery rate in both urban(rs=-0.82,P=0.002)and rural areas(rs=-0.95,P<0.001).(4)The GM(1,1)models for forecasting MMRs in the whole nation,urban and rural areas were established with an accuracy of level 1.The MMR was predicted to show a downward trend in the following five years.The MMRs in China were 15.86/100000 in 2021 and 15.13/100000 in 2022 through prediction,similar to the 16.1/100000 and 15.7/100000 as announced by the government.Conclusions The overall MMR in China shows a downward trend,and it dropped faster in urban areas than the rural areas.In addition,it is predicted that the MMR will continue to decline in the following five years,but the gap between urban and rural areas will remain.