Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010-2013: A Bayesian modelling analysis

doi:10.1371/journal.pmed.1003114

	Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010-2013: A Bayesian modelling analysis
	Li, Junming 1; Liang, Juan 2; Wang, Jinfeng 3,4; Ren, Zhoupeng 3; Yang, Dian 3; Wang, Yanping 2; Mu, Yi 2; Li, Xiaohong 2; Li, Mingrong 2; Guo, Yuming 5
刊名	PLOS MEDICINE
	2020-05-01
卷号	17 期号:5 页码:19
ISSN号	1549-1277
DOI	10.1371/journal.pmed.1003114
通讯作者	Wang, Jinfeng(wangjf@lreis.ac.cn) ; Zhu, Jun(zhujun1@163.com)
英文摘要	Background As one of its Millennium Development Goals (MDGs), China has achieved a dramatic reduction in the maternal mortality ratio (MMR), although a distinct spatial heterogeneity still persists. Evidence of the quantitative effects of determinants on MMR in China is limited. A better understanding of the spatiotemporal heterogeneity and quantifying determinants of the MMR would support evidence-based policymaking to sustainably reduce the MMR in China and other developing areas worldwide. Methods and findings We used data on MMR collected by the National Maternal and Child Health Surveillance System (NMCHSS) at the county level in China from 2010 to 2013. We employed a Bayesian space-time model to investigate the spatiotemporal trends in the MMR from 2010 to 2013. We used Bayesian multivariable regression and GeoDetector models to address 3 main ecological determinants of the MMR, including per capita income (PCI), the proportion of pregnant women who delivered in hospitals (PPWDH), and the proportion of pregnant women who had at least 5 check-ups (PPWFC). Among the 2,205 counties, there were 925 (42.0%) hotspot counties, located mostly in China's western and southwestern regions, with a higher MMR, and 764 (34.6%) coldspot counties with a lower MMR than the national level. China's westernmost regions, including Tibet and western Xinjiang, experienced a weak downward trend over the study period. Nationwide, medical intervention was the major determinant of the change in MMR. The MMR decreased by 1.787 (95% confidence interval [CI]: 1.424-2.142, p < 0.001) per 100,000 live births when PPWDH increased by 1% and decreased by 0.623 (95% CI 0.436-0.798, p < 0.001) per 100,000 live births when PPWFC increased by 1%. The major determinants for the MMR in China's western and southwestern regions were PCI and PPWFC, while that in China's eastern and southern coastlands was PCI. The MMR in western and southwestern regions decreased nonsignificantly by 1.111 (95% CI - 1.485-3.655, p = 0.20) per 100,000 live births when PCI in these regions increased by 1,000 Chinese Yuan and decreased by 1.686 (95% CI 1.275-2.090, p < 0.001) when PPWFC increased by 1%. Additionally, the western and southwestern regions showed the strongest interactive effects between different factors, in which the corresponding explanatory power of any 2 interacting factors reached up to greater than 80.0% (p < 0.001) for the MMR. Limitations of this study include a relatively short study period and lack of full coverage of eastern coastlands with especially low MMR. Conclusions Although China has accomplished a 75% reduction in the MMR, spatial heterogeneity still exists. In this study, we have identified 925 (hotspot) high-risk counties, mostly located in western and southwestern regions, and among which 332 counties are experiencing a slower pace of decrease than the national downward trend. Nationally, medical intervention is the major determinant. The major determinants for the MMR in western and southwestern regions, which are developing areas, are PCI and PPWFC, while that in China's developed areas is PCI. The interactive influence of any two of the three factors, PCI, PPWDH, and PPWFC, in western and southwestern regions was up to and in excess of 80% (p < 0.001).
资助项目	National Natural Science Foundation of China[41531179] ; National Natural Science Foundation of China[41701460] ; Ministry of Science and Technology of the People's Republic of China[2016YFC1302504] ; China Medical Board[11-065] ; United Nations International Children's Emergency Fund[2016EJH011] ; Australian National Health and Medical Research Council[APP1107107] ; Australian National Health and Medical Research Council[APP1163693]
WOS关键词	ZERO-INFLATED POISSON ; RISK ; BANGLADESH ; COUNTDOWN ; DISEASE ; HEALTH ; DEATH
WOS研究方向	General & Internal Medicine
语种	英语
出版者	PUBLIC LIBRARY SCIENCE
WOS记录号	WOS:000558077100014
资助机构	National Natural Science Foundation of China ; Ministry of Science and Technology of the People's Republic of China ; China Medical Board ; United Nations International Children's Emergency Fund ; Australian National Health and Medical Research Council
内容类型	期刊论文
源URL	[http://ir.igsnrr.ac.cn/handle/311030/158176]
专题	中国科学院地理科学与资源研究所
通讯作者	Wang, Jinfeng; Zhu, Jun
作者单位	1.Shanxi Univ Finance & Econ, Sch Stat, Taiyuan, Shanxi, Peoples R China 2.Sichuan Univ, West China Univ Hosp 2, Dept Obstet, Natl Off Maternal & Child Hlth Surveillance China, Chengdu, Sichuan, Peoples R China 3.Chinese Acad Sci, Inst Geog Sci & Nat Resources Res, State Key Lab Resources & Environm Informat Syst, Beijing, Peoples R China 4.Univ Chinese Acad Sci, Beijing, Peoples R China 5.Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia
推荐引用方式 GB/T 7714	Li, Junming,Liang, Juan,Wang, Jinfeng,et al. Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010-2013: A Bayesian modelling analysis[J]. PLOS MEDICINE,2020,17(5):19.
APA	Li, Junming.,Liang, Juan.,Wang, Jinfeng.,Ren, Zhoupeng.,Yang, Dian.,...&Zhu, Jun.(2020).Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010-2013: A Bayesian modelling analysis.PLOS MEDICINE,17(5),19.
MLA	Li, Junming,et al."Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010-2013: A Bayesian modelling analysis".PLOS MEDICINE 17.5(2020):19.