| BackgroundAs the world’s high attention to the survival conditions of the maternal, also the development of our economy and the increasing investment in health care at the same time, we have increased the attention to the research of maternal and child health, such as trend, cause and influence factors. Due to the reasonable prediction and research on influencing factors of maternal mortality rate play a vital role in the implementation of the public interventions, in this article, we investigate the death causes and influence factors, also the accurate prediction of two following years.There is clear regional, urban and rural differences in maternal mortality. Studies have shown that the maternal mortality rate of Eastern region was far lower than that of Western region. Maternal mortality in rural areas was several times the rate of the city. At the same time, the cause, including the direct and indirect cause of the death has changed. However, the discussion about this situation was confined to a certain province, or previous study, which did not keep track of the latest data. Therefore, this article chooses the data of national maternal mortality rate in China from1991to2012, and the data of31provinces and cities in2012as the research data. The long-term trend of maternal mortality rate and regional differences are shown first, and then the influence factors of maternal mortality rate are comprehensively analyzed. At last we explore a kind of forecasting model, to accurately predict the future development of maternal mortality rate and provide reasonable scientific basis for controlling maternal mortality rate.Objectives1. To explore the long-term change trend of maternal deaths, according to the data of the maternal mortality rate in China from1991to2012and data about the cause of death.2. To discuss the maternal mortality rate in geographical distribution, according to maternal mortality data of31provinces and cities of2012in China. And explore the influence factors of maternal mortality rate through principal component regression analysis, to find out the main influence factors.3. To predict maternal mortality rate through reasonable model, to further allocate health resources, and provide reasonable suggestions to a targeted control measure.Methods1. Data:Including maternal mortality rate and indicators of31provinces and cities, such as economy and population, each of which is collected respectively from "China health statistics yearbook2013" and "Chinese statistics yearbook2013".(1) Maternal mortality rate data:maternal mortality rate data of this study is divided into two parts:maternal mortality rate and cause of death from1991to2012and maternal mortality data of31provinces and cities in2012, both of which are derived from "China health statistics yearbook2013". These data is collected under the monitoring point, one point of maternal death monitoring network established by the ministry of health in31(excluding Hong Kong, Macao and Taiwan) provinces, autonomous regions and municipalities directly..(2) Data of health, population and economic from31provinces and cities:these data is derived from "Chinese statistics yearbook2013". The data from31provinces (except Hong Kong, Macao and Taiwan), is edited by the Chinese bureau of statistics.2. Analysis methods:descriptive analysis is adopted to analyze the changes of maternal death during different periods and in various places, also the change of the cause of death. Principal component regression analysis is adopted to analyze the main factors influencing maternal mortality rate, time series model to predict the change of maternal mortality rate in the future.Results1. The distribution of maternal mortality rateThe national maternal mortality rate showed a trend of drop. In the city, the rate dropped from46.3/100000in1991to22.2/100000in2012, and the average speed of dropping each year was3.4%. It was obvious that rural maternal mortality declined more sharply than city, dropping from100/100000in1991to25.6/100000in2012, and the average annual dropping rate is6.3%. In the coastal cities, such as Beijing, Shanghai, Jiangsu, Zhejiang and Shandong and other regions, the maternal mortality rate was below10/100000. In western regions such as Tibet, the maternal mortality rate could be as high as180.7/100000. In the central region, such as Xinjiang, Qinghai, Yunnan and Gansu, the rate fluctuated between30-40/100000. In the rest cities, the maternal mortality rate fluctuated10-30/100000.2. The change of death causeThe death rates caused by obstetric hemorrhage dropped by31.4/100000in2000to7.0/100000in2012. The death caused by pregnancy hypertension, heart disease and amniotic fluid embolism also reduced, respectively from the10.9/100000,5.3/100000and6.2/100000in2000to2.1/100000,3.1/100000and2.9/100000in2012. And constituent ratios of the four types of disease are changing, too. The constituent ratios of obstetric hemorrhage and pregnancy hypertension dropped from46.7%and16.2%in2000to27.5%and8.4%in2012, however, the mortality rate caused by heart disease and amniotic fluid embolism increased, respectively from7.9%and9.2%in2000to12.2%and11.5%in2012. In cities, in addition to obstetric hemorrhage, mortality rates caused by other diseases dropped slightly. The constituent ratios of obstetric hemorrhage and amniotic fluid embolism accounted increased slightly, while other major disease accounted for the proportion dropped.3. The main factors influencing maternal mortality rateThrough principal component regression, We could get standardized principal component regression equation:y=-0.31x1-0.49x2-0.40x3-0.80x4-0.79x5-0.87x6-0.39x7-0.62x8-0.66x9-0.40x10-0.33x11-0.15x12+0.87x13. All the included factors, such as the economy, population, health care, nutrition, level of education, were statistically significant. However, the proportion of illiterate population, hospital births, antenatal examination rate and the rate of postpartum visit had the greatest influence on maternal mortality.4. Maternal mortality predictionThrough the forecast, the maternal mortality may be23.9/100000in2014in the city, while the maternal mortality rate would be25.6/100000in2014in rural communities.Conclusions1. This article confirms that the maternal mortality rate is much lower. In general, the gap in rural and urban maternal mortality is smaller.2. In urban and rural areas, the mortality and constituent ratio of main disease have changed slightly. In the aspect of prevention and control of maternal mortality, the focus of the urban and rural areas is different3. The influence factors of maternal mortality are interlinked, what have the greatest influence on maternal mortality is the proportion of illiterate population, hospital births rate, antenatal examination rate and the rate of postpartum visit. So, the government of a region should focus on improving the level of their education and health care services to improve maternal health.4. What the model predicts is that the maternal mortality rate in the city will rebound slightly, while rural areas appears to stagnate, so we should take effective measures to control the cause of maternal death in the city. |
PDF Full Text Request