兒童死亡率：台灣與經濟合作暨發展組織國家比較

Child mortality: Taiwan compared with OECD countries

目標：瞭解台灣兒童死亡率與經濟合作暨發展組織（Organization for Economic Cooperation and Development, OECD）國家的差異。方法：OECD國家的出生數、人口數與死亡數資料來自世界衛生組織的死因統計資訊系統，台灣資料來自衛生福利部統計處網站。首先計算嬰兒（<1歲），新生兒（<28天），後新生兒（28-364天），1-4歲，5-9歲及10-14歲的死亡率。除了排序各國兒童死亡率外，我們以台灣為基準計算死亡率比與95%信賴區間。最後再比較台灣與日本的死因組成，以及台灣1996-2013年兒童死亡率趨勢。結果：合計2011-2013年資料，台灣嬰兒，新生兒，後新生兒每千活產死亡數分別為3.9、2.4及1.5，1-4歲，5-9歲，10-14歲每十萬人口死亡數分別為 25.8、13.2與14.4，與33個OECD國家比較，排名分別為第23，16，24，27，30與27名。經統計檢定死亡率顯著小於台灣的國家數目分別為19，12，21，24，26與22。在嬰兒死亡個案中，源於周產期的病況比例台灣（46%）較日本（25%）高，先天性疾病比例台灣（22%）較日本（36%）低。在1-4歲死亡個案中，台灣（28%）外因比例高於日本（16%）。關於台灣兒童死亡率趨勢，1996-2013年嬰兒死亡率的年下降率（3.4%）最小，1-4歲死亡率下降率（5.5%）最大。結論：台灣兒童死亡率相較於大多數OECD國家及文化背景相似的日本與韓國都表現不佳，尤其五歲以上兒童的死亡率排名相對較差。1-4歲死亡率雖然下降趨勢顯著，但是外因比例還是高於日本，應該是未來的優先族群。

Objectives: To determine the child mortality rate differences between Taiwan and Organization for Economic Cooperation and Development (OECD) countries. Methods: Data on live births, population, and mortality in OECD countries were derived from the mortality database of the World Health Organization. Taiwan data were derived from the Ministry of Health and Welfare. We first calculated the child mortality rate by age, i.e., infant (<1 year), neonate (<28 days), post-neonate (28-364 days), 1-4 years, 5-9 years, and 10-14 years. We then computed the mortality rate ratio and 95% confidence intervals using the mortality rate of Taiwan as the reference. We also compared the pattern of cause of death between Taiwan and Japan and examined the trends in child mortality of Taiwan between 1996 and 2013. Results: Between 2011 and 2013, the infant, neonate, and post-neonate mortality rate in Taiwan was 3.9, 2.4, and 1.5 deaths per 1,000 live births, respectively. The mortality rates in the 1-4 year, 5-9 year, and 10-14 year age groups in Taiwan were 25.8, 13.2, and 14.4 deaths per 100,000 population, respectively. Compared with 33 OECD countries, the mortality rate in Taiwan ranked 23rd, 16th, 24th, 27th, 30th, and 27th for each age group, respectively. The number of countries with mortality rates significantly lower than Taiwan was 19, 12, 21, 24, 26, and 22 for each age group, respectively. For infant deaths, the proportion attributed to perinatal causes in Taiwan (46%) was greater than Japan (25%); however, the proportion of infant deaths due to congenital causes in Taiwan (22%) was less than Japan (36%). For the 1-4 year age group, the proportion of deaths resulting from external causes in Taiwan (28%) was greater than Japan (16%). The decline in the mortality rate from 1996 through 2013 was greatest amongst children 1-4 years of age (annual reduction of 5.5%) and was less significant for infants (annual reduction of 3.4%). Conclusions: The child mortality rate in Taiwan, especially children ≥ 5 years of age, was higher than most OECD countries, including Japan and Korea, which have a similar cultural background to Taiwan. Despite a drastic reduction in the mortality rate for children 1-4 years of age in Taiwan, the proportion of deaths attributed to external causes was greater than the corresponding children in Japan, which is a prevention priority.