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. 2017 Sep 29;17(1):750.
doi: 10.1186/s12889-017-4765-y.

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Yan Ren  1 , Ping Qian  2 , Zhanqi Duan  3 , Ziling Zhao  2 , Jay Pan  1   4 , Min Yang  5   6   7
Affiliations

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Yan Ren et al. BMC Public Health. .

Abstract

Background: The maternal mortality rate (MMR) markedly decreased in China, but there has been a significant imbalance among different geographic regions (east, central and west regions), and the mortality in the western region remains high. This study aims to examine how much disparity in the health system and MMR between ethnic minority and non-minority counties exists in Sichuan province of western China and measures conceivable commitments of the health system determinants of the disparity in MMR.

Methods: The MMR and health system data of 67 minority and 116 non-minority counties were taken from Sichuan provincial official sources. The 2-level Poisson regression model was used to identify health system determinants. A series of nested models with different health system factors were fitted to decide contribution of each factor to the disparity in MMR.

Results: The MMR decreased over the last decade, with the fastest declining rate from 2006 to 2010. The minority counties experienced higher raw MMR in 2002 than non-minority counties (94.4 VS. 58.2), which still remained higher in 2014 (35.7 VS. 14.3), but the disparity of raw MMR between minority and non-minority counties decreased from 36.2 to 21.4. The better socio-economic condition, more health human resources and higher maternal health care services rate were associated with lower MMR. Hospital delivery rate alone explained 74.5% of the difference in MMR between minority and non-minority counties. All health system indicators together explained 97.6% of the ethnic difference in MMR, 59.8% in the change trend, and 66.3% county level variation respectively.

Conclusions: Hospital delivery rate mainly determined disparity in MMR between minority and non-minority counties in Sichuan province. Increasing hospital birth rates among ethnic minority counties may narrow the disparity in MMR by more than two-thirds of the current level.

Keywords: China; Ethnic disparity; Health system; Maternal mortality rate.

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Conflict of interest statement

Ethics approval and consent to participate

This study involved secondary analysis of county level data, which came from Sichuan province official sources, it was exempt from ethics approval. Our research focused on county level aggregate data rather than individual population, therefore consent to participate is dispensable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The area of Sichuan province in China map
Fig. 2
Fig. 2
Distribution of minority and non-minority counties in Sichuan province by Sichuan Statistical Yearbook 2015
Fig. 3
Fig. 3
Raw maternal mortality rate (1/100,000) by year and ethnic group
See this image and copyright information in PMC

References

    1. Sachs JD, McArthur JW. The millennium project: a plan for meeting the millennium development goals. Lancet. 2005;365(9456):347–353. doi: 10.1016/S0140-6736(05)70201-4. - DOI - PubMed
    1. Trends in maternal mortality. 1990 to 2015. Estimates by WHO UNICEF UNFPA World Bank Group and the United Nations Population Division. Geneva: World Health Organization. 2015. http://www.who.int/reproductivehealth/publications/monitoring/maternal-m....
    1. National Bureau of Statistics of China . China statistical yearbook. 2015.
    1. National Health and Family Planning Commission of the People’s Republic of China. China Health and Family Planning Statistical Yearbook 2015. http://www.nhfpc.gov.cn/zwgkzt/tjnj/list.shtml.
    1. Zhou YY, Zhu J, Wang YP, Dai L, Li XH, Li MR, et al. [trends of maternal mortality ratio during 1996-2010 in China].[J] Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] 2011;45(10):934–939. - PubMed

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