Anatomy of provincial level inequality in maternal mortality in China during 2004-2016: a new decomposition analysis.

dc.contributor.author

Zhang, Xinyu

dc.contributor.author

Ye, Yingfeng

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Fu, Chaowei

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Dou, Guanshen

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Ying, Xiaohua

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Qian, Mengcen

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Tang, Shenglan

dc.date.accessioned

2024-07-16T02:21:15Z

dc.date.available

2024-07-16T02:21:15Z

dc.date.issued

2020-05

dc.description.abstract

Background

The maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. Although China has experienced a large decline in MMR, substantial disparities across regions are still apparent. This study aims to explore causes of socioeconomic related inequality in MMR at the province-level in China from 2004 to 2016.

Methods

We collected data from various issues of the China Health Statistics Yearbook, China Statistics Yearbook, and China Population and Employment Statistics Yearbook to construct a longitudinal sample of all provinces in China. We first examined determinants of the MMR using province fixed-effect models, accounted for socioeconomic condition, health resource allocation, and access to health care. We then used the concentration index (CI) to measure MMR inequality and employed the direct decomposition method to estimate the marginal impact of the determinants on the inequality index. Importance of the determinants were compared based on logworth values.

Results

During our study period, economically more deprived provinces experienced higher MMR than better-off ones. There was no evidence of improved socioeconomic related inequality in MMR. Illiteracy proportion was positively associated with the MMR (p < 0.01). In contrast, prenatal check-up rate (p = 0.05), hospital delivery rate (p < 0.01) and rate of delivery attended by professionals (p = 0.02) were negatively associated with the MMR. We also find that higher maternal health profile creation rate (p < 0.01) was associated with a pro-poor change of MMR inequality.

Conclusion

Access to healthcare was the most important factor in explaining the persistent MMR inequality in China, followed by socioeconomic condition. We do not find evidence that health resource allocation was a contributing factor.
dc.identifier

10.1186/s12889-020-08830-2

dc.identifier.issn

1471-2458

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1471-2458

dc.identifier.uri

https://hdl.handle.net/10161/31276

dc.language

eng

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Springer Science and Business Media LLC

dc.relation.ispartof

BMC public health

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10.1186/s12889-020-08830-2

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https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Humans

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Maternal Mortality

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Pregnancy

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Algorithms

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Socioeconomic Factors

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Databases, Factual

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Health Resources

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China

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Female

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Gross Domestic Product

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Maternal Health

dc.title

Anatomy of provincial level inequality in maternal mortality in China during 2004-2016: a new decomposition analysis.

dc.type

Journal article

duke.contributor.orcid

Zhang, Xinyu|0000-0002-5979-244X

duke.contributor.orcid

Tang, Shenglan|0000-0001-6462-753X

pubs.begin-page

758

pubs.issue

1

pubs.organisational-group

Duke

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School of Medicine

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Basic Science Departments

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University Institutes and Centers

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Duke Global Health Institute

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Population Health Sciences

pubs.publication-status

Published

pubs.volume

20

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