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目的分析2015年北京市婴儿死亡率和5岁以下儿童死亡率、主要死因及医疗保健服务利用情况。方法采用2005-2015年北京市5岁以下儿童死亡监测网数据,分年龄和地区对婴儿和5岁以下儿童死亡率及主要死因进行分析。采用Excel 2007软件和SPSS 15.0软件进行统计学分析。结果 2015年北京市新生儿死亡率(NMR)、婴儿死亡率(IMR)和5岁以下儿童死亡率(U5MR)分别为1.52‰、2.42‰和3.02‰。5岁以下儿童死亡以婴儿为主,占80.16%。2005-2015年北京市NMR、IMR和U5MR总体呈下降趋势,年平均下降率分别为7.43%、5.70%和5.12%,其中NMR下降速度最快。2015年北京市郊区各年龄组儿童死亡率均高于城区。城区NMR、IMR和U5MR年均下降速度快于郊区。2015年北京市5岁以下儿童死亡前5位死因依次为早产或低出生体重、先天性心脏病、出生窒息、肺炎和意外窒息,占全部5岁以下儿童死亡的51.69%。主要死因及顺位具有年龄和地区差异。在新生儿死亡中,城区首位死因为出生窒息,而郊区首位死因为早产或低出生体重,并导致47.14%郊区新生儿死亡。在婴儿死亡中,郊区第5位死因为意外窒息。在1~4岁儿童死亡中,郊区意外死亡儿童所占比例明显高于城区。2015年北京市5岁以下儿童死亡发生在医院、途中和家中的比例分别为69.45%、8.62%和21.93%;死前住院治疗、门诊治疗和未就医比例分别为74.67%、16.97%和8.36%;死前诊断级别在省、区、街级医疗机构和未诊断的比例分别为80.42%、15.93%、1.31%和2.35%。城区5岁以下儿童在医院死亡、死前接收住院治疗、死前诊断医疗机构为省级的比例均高于郊区。结论北京市U5MR处于较低水平,但仍有下降空间,郊区应作为控制5岁以下儿童死亡的重点区域。早产或低出生体重和意外伤害应作为控制郊区U5MR的重点内容。
Objective To analyze the 2015 infant mortality rate in Beijing and the mortality rate of children under 5, the main causes of death and the utilization of health care services. Methods According to the data of the death monitoring network for children under 5 in Beijing during 2005-2015, the mortality rate and the main causes of death of infants and children under 5 were analyzed by age and region. Statistical analysis was performed using Excel 2007 software and SPSS 15.0 software. Results In 2015, the neonatal mortality rate (NMR), infant mortality rate (IMR) and children under 5 years old (U5MR) in Beijing were 1.52 ‰, 2.42 ‰ and 3.02 ‰, respectively. Infants under 5 years of age are predominantly infants, accounting for 80.16%. From 2005 to 2015, the NMR, IMR and U5MR in Beijing showed an overall decreasing trend, with the annual average decreasing rates of 7.43%, 5.70% and 5.12%, respectively, of which the NMR descended the fastest. In 2015, the death rates of children in all age groups in Beijing suburbs were higher than those in urban areas. Urban NMR, IMR and U5MR average annual decline faster than the suburbs. In 2015, the top 5 deaths of children under 5 in Beijing were premature or low birth weight, congenital heart disease, asphyxia, pneumonia and accidental asphyxia, accounting for 51.69% of all deaths of children under five years of age. The main cause of death and the same position with age and regional differences. In the neonatal deaths, the first death in urban areas was due to birth asphyxia, and the first death in the suburbs was due to premature birth or low birth weight and resulted in the death of 47.14% of newborns in the suburbs. In the infant deaths, the fifth death in the suburbs because of accidental suffocation. Among the deaths of children aged 1-4, the proportion of children who died in the suburbs was significantly higher than that in urban areas. In 2015, the deaths of children under the age of 5 in Beijing were 69.45%, 8.62% and 21.93% respectively in the hospitals. The proportion of hospitalized, outpatient and non-hospitalized children before death was 74.67%, 16.97% and 8.36% respectively in 2015, ; The proportions of pre-mortem diagnosis in the provincial, district and street-level medical institutions and undiagnosed were 80.42%, 15.93%, 1.31% and 2.35% respectively. Children under the age of 5 in urban areas died in the hospital and were hospitalized before death. The proportion of pre-mortem medical institutions in the province was higher than that in the suburbs. Conclusion The U5MR in Beijing is at a low level but there is still room for decline. The suburbs should be the key areas to control the death of children under 5 years of age. Preterm birth or low birth weight and accidental injuries should be the focus of control of suburban U5MRs.