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Abstract：
The long-term trends in maternal and child health (MCH) in China and the national-level factors that may be associated with these changes have been poorly explored. This study aimed to assess trends in MCH indicators nationally and separately in urban and rural areas and the impact of public policies over a 30‒year period. An ecological study was conducted using data on neonatal mortality rate (NMR), infant mortality rate (IMR), under-five mortality rate (U5MR), and maternal mortality ratio (MMR) nationally and separately in urban and rural areas in China from 1991 to 2020. Joinpoint regression models were used to estimate the annual percentage changes (APC), average annual percentage changes (AAPC) with 95% confidence intervals (CIs), and mortality differences between urban and rural areas. From 1991 to 2020, maternal and child mortalities in China gradually declined (national AAPC [95% CI]: NMRs - 7.7% [- 8.6%, - 6.8%], IMRs - 7.5% [- 8.4%, - 6.6%], U5MRs - 7.5% [- 8.5%, - 6.5%], MMRs - 5.0% [- 5.7%, - 4.4%]). However, the rate of decline nationally in child mortality slowed after 2005, and in maternal mortality after 2013. For all indicators, the decline in mortality was greater in rural areas than in urban areas. The AAPCs in rate differences between rural and urban areas were - 8.5% for NMRs, - 8.6% for IMRs, - 7.7% for U5MRs, and - 9.6% for MMRs. The AAPCs in rate ratios (rural vs. urban) were - 1.2 for NMRs, - 2.1 for IMRs, - 1.7 for U5MRs, and - 1.9 for MMRs. After 2010, urban‒rural disparity in MMR did not diminish and in NMR, IMR, and U5MR, it gradually narrowed but persisted. MCH indicators have declined at the national level as well as separately in urban and rural areas but may have reached a plateau. Urban‒rural disparities in MCH indicators have narrowed but still exist. Regular analyses of temporal trends in MCH are necessary to assess the effectiveness of measures for timely adjustments.
摘要：
中国母婴健康（MCH）的长期趋势以及可能与这些变化相关的国家级因素尚未得到充分探索。这项研究旨在评估全国和城乡地区的妇幼保健指标趋势，以及30年期间公共政策的影响。使用新生儿死亡率（NMR）的数据进行了生态研究，婴儿死亡率（IMR），五岁以下儿童死亡率（U5MR），从1991年到2020年，中国城市和农村地区的全国和孕产妇死亡率（MMR）。Joinpoint回归模型用于估计年度百分比变化(APC)，具有95%置信区间(CI)的平均年度百分比变化(AAPC)，城乡之间的死亡率差异。从1991年到2020年，中国的母婴死亡率逐渐下降（国家AAPC[95%CI]：NMR-7.7%[-8.6%，-6.8%]，IMR-7.5%[-8.4%，-6.6%]，U5MR-7.5%[-8.5%，-6.5%]，MMR-5.0%[-5.7%，-4.4%]）。然而,2005年后,全国儿童死亡率下降速度有所放缓,2013年后孕产妇死亡率下降速度有所放缓.对于所有指标，农村地区死亡率下降幅度大于城市地区。农村和城市地区的AAPC比率差异为NMR的8.5%，-IMR的8.6%，-U5MR为7.7%，和-9.6%的MMR。AAPC的比率(农村与城市)为NMR-1.2，-2.1对于IMR，-U5MR为1.7，MMR为-1.9。2010年后，MMR的城乡差距没有缩小，核磁共振，IMR,U5MR,它逐渐缩小，但仍然存在。妇幼保健指标在国家一级以及在城市和农村地区分别下降，但可能已经达到平稳状态。妇幼保健指标的城乡差距已经缩小，但仍然存在。有必要对妇幼保健的时间趋势进行定期分析，以评估及时调整措施的有效性。
