Regional Disparities, Economic Development, and Neonatal Mortality and Hospital Delivery in China

作者：Hai Fang, Haijun Zhang, Arturo Vargas Bustamante, Shusheng Luo, Xi Chen, Yanqiu Gao, Jianmeng Liu · 发表于：JAMA Network Open · 年份：2024 · DOI：10.1001/jamanetworkopen.2024.43423 · 被引用次数：8 · 研究领域：Global Maternal and Child Health、Maternal and Neonatal Healthcare、Neonatal Respiratory Health Research

Importance: A negative association between neonatal mortality and hospital delivery has been found in some low- and lower-middle-income countries but not in rural settings characterized by poor quality of maternal and child health care. Objective: To examine the association between neonatal mortality and hospital delivery in China across urban and rural regions, regional disparities, and varying levels of economic development. Design, Setting, and Participants: This retrospective cohort study used county-level data from 2008 to 2020 from the National Maternal & Child Health Statistics across mainland China. Statistical analysis was conducted from March to December 2023. Exposures: Since 2008, China has strategically leveraged hospital deliveries with national subsidies to diminish neonatal mortality, particularly in rural areas. Main Outcomes and Measures: Neonatal mortality and hospital delivery rates were calculated, and their association was estimated using multivariable fixed-effects linear models of county-level cohort data to adjust for time-invariant differences across counties and controls for gross domestic product (GDP) per capita, women's years of education, hospital beds, and health workers. Results: The analysis included data from 2930 counties, with 198.7 million live births across 36 255 county-year records between 2008 and 2020. The mean (SD) neonatal mortality rate per 1000 live births decreased in rural areas from 12.3 (7.5) in 2008 to 3.9 (2.7) in 2020 and ...