調整後台灣新生兒死亡率：國際與國內縣市比較

Adjusted neonatal mortality rates in Taiwan: international and domestic comparisons

目標：由於醫師判定活產行為的差異會影響新生兒死亡率的可比較性，本研究目的是依照世界衛生組織建議，比較去除幾乎不可能存活新生兒前後，台灣與經濟合作發展組織（OECD）國家以及台灣各縣市之間的新生兒死亡率差異。方法：我們連結2018至2021年出生登記檔、出生通報檔與死因統計檔進行死亡率調整。方法一：去除出生體重<500公克或懷孕週數<22週死亡個案；方法二：去除懷孕週數<24週死亡個案。結果：台灣調整前新生兒死亡率（每千活產死亡數）2.52，方法一調整後死亡率降為1.83。與OECD國家比較的百分等級值調整前是60級，屬於中間偏後；調整後是47級，屬於中間偏前，名次改善。方法二調整後新生兒死亡率降為1.49。調整前有四個縣市新生兒死亡率統計檢定顯著高於台灣，方法一調整後，新北市不再顯著高於台灣。方法二調整後，花蓮縣、屏東縣與高雄市都不再顯著高於台灣。結論：幾乎不可能存活新生兒的活產判斷明顯影響新生兒死亡率高低，未來要進行跨國與跨縣市新生兒死亡率比較時，一定要進行調整才能正確解讀數據。

Objectives: To improve the comparability of neonatal mortality rates (NMRs) across regions, the World Health Organization recommends adjusting for potential artifacts stemming from physicians' judgments of live births for previable newborns. This study compared the NMRs of Taiwanese counties and cities before versus after previable newborns were excluded from the total. Methods: We linked birth registration, birth reporting, and mortality data to obtain birth weight (BW) and gestational age (GA) information for adjustment. Subsequently, we conducted a first round of exclusions of neonatal deaths with BW < 500 g or GA < 22 weeks. After conducting the first round of adjustment, we conducted a second round of exclusions of neonatal deaths with GA < 24 weeks. Results: The NMR (deaths per 1,000 live births) for all of Taiwan before adjustment was 2.52. Following the first round of exclusions, the NMR decreased to 1.83. Taiwan’s percentile ranks relative to OECD countries before and after the first round of adjustment was 66 and 47, respectively, improving from the middle low to middle high tier. Taiwan’s NMR fell to 1.49 after the second round of exclusions. Before adjustment, four cities or counties had NMRs that were significantly higher than Taiwan’s national average; they were New Taipei City, Pintung County, Hualien County, and Kaohsiung City. However, after the first round of adjustments, the NMR of New Taipei City was not significantly higher than Taiwan. After the second round of adjustment, the NMRs of Hualien County, Pintung County, and Kaohsiung City were also not significantly higher than Taiwan. Conclusions: Variations in the classification of previable newborns as live births can substantially alter calculations of NMRs, making adjustment for these births critical to accurate NMR calculations between and within countries.