挪威科技大学Terje Andreas Eikemo联合美国华盛顿大学Emmanuela Gakidou团队研究了父母受教育程度和儿童死亡率的相关性。该项研究成果发表在2021年6月10日出版的《柳叶刀》杂志上。
父母，特别是母亲的受教育程度与较低的儿童死亡率有关，但在全球范围内，这种相关性的程度尚未达成共识。为了评估5岁以下儿童死亡率的总体下降与不同年龄段母亲和父亲教育增加是否相关，研究组针对父母教育对新生儿、婴儿和5岁以下儿童死亡率的影响，并结合人口与健康调查（DHS）数据的初步分析，进行了一项全面的全球系统性回顾和荟萃分析。
2019年1月23日至2月8日，研究组在Embase、MEDLINE、科学引文索引等7个大型数据库中检索相关文献，由独立评审小组评估每一项记录，以纳入父母教育和儿童死亡率的个人水平数据，并根据研究设计和相关统计数据的可用性逐一筛查排除。
从这些研究中提取的数据与DHS的主要微观数据相结合，对母亲或父亲的教育与其子女6个年龄区间（0-27天、1-11个月、1-4岁、0-4岁、0-11个月和1个月至4年）的死亡率相关性进行荟萃分析。采用了新型混合效应元回归模型，以解决研究中参照和暴露措施的异质性，并调整研究水平协变量（财富或收入、伴侣的受教育年限和儿童性别）。
系统性回顾最终共纳入186项研究。DHS数据来自114项独特调查，共纳入3112474例活产婴儿。研究组将系统综述中提取的数据与原始DHS数据进行综合，对来自92个国家的300项研究进行荟萃分析。母亲和父亲教育程度的提高均显示出与5岁以下儿童死亡率降低相关的剂量-反应关系，母亲教育程度成为更强的预测因素。
该研究团队观察到，与父母均未接受过教育的儿童相比，母亲接受过12年教育（即高中毕业）所生儿童5岁以下死亡率降低了31.0%，父亲接受过12年教育的儿童5岁以下死亡率降低了17.3%。该研究组还发现，平均而言，母亲每多上一年学，5岁以下儿童死亡率降低3.04%，而父亲每多上一年学，5岁以下儿童死亡率降低1.57%。
在所有被研究的年龄段中，父母接受高等教育与儿童死亡率降低之间的相关性都是显著的，且在婴儿出生后第一个月时这种相关性最为显著。荟萃分析框架将与每个个体效应大小相关的不确定性纳入模型拟合过程，以努力减少研究设计和质量带来的偏倚风险。
据研究人员所知，这项研究是第一次在全球层面系统地量化儿童生存教育的跨代重要性。结果显示，即使在控制了其他家庭社会经济地位的指标后，母亲和父亲受教育程度较低仍是儿童死亡率的危险因素。这项研究为普及素质教育作为实现降低新生儿和儿童死亡率的可持续发展目标提供了有力证据。
附：英文原文
Title: Parental education and inequalities in child mortality: a global systematic review and meta-analysis
Author: Mirza Balaj, Hunter Wade York, Kam Sripada, Elodie Besnier, Hanne Dahl Vonen, Aleksandr Aravkin, Joseph Friedman, Max Griswold, Magnus Rom Jensen, Talal Mohammad, Erin C Mullany, Solvor Solhaug, Reed Sorensen, Donata Stonkute, Andreas Tallaksen, Joanna Whisnant, Peng Zheng, Emmanuela Gakidou, Terje Andreas Eikemo
Issue&Volume: 2021-06-10
Abstract:
Background
The educational attainment of parents, particularly mothers, has been associated with lower levels of child mortality, yet there is no consensus on the magnitude of this relationship globally. We aimed to estimate the total reductions in under-5 mortality that are associated with increased maternal and paternal education, during distinct age intervals.
Methods
This study is a comprehensive global systematic review and meta-analysis of all existing studies of the effects of parental education on neonatal, infant, and under-5 child mortality, combined with primary analyses of Demographic and Health Survey (DHS) data. The literature search of seven databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Scopus, and Web of Science) was done between Jan 23 and Feb 8, 2019, and updated on Jan 7, 2021, with no language or publication date restrictions. Teams of independent reviewers assessed each record for its inclusion of individual-level data on parental education and child mortality and excluded articles on the basis of study design and availability of relevant statistics. Full-text screening was done in 15 languages. Data extracted from these studies were combined with primary microdata from the DHS for meta-analyses relating maternal or paternal education with mortality at six age intervals: 0–27 days, 1–11 months, 1–4 years, 0–4 years, 0–11 months, and 1 month to 4 years. Novel mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among the studies and to adjust for study-level covariates (wealth or income, partner's years of schooling, and sex of the child). This study was registered with PROSPERO (CRD42020141731).
Findings
The systematic review returned 5339 unique records, yielding 186 included studies after exclusions. DHS data were compiled from 114 unique surveys, capturing 3 112 474 livebirths. Data extracted from the systematic review were synthesized together with primary DHS data, for meta-analysis on a total of 300 studies from 92 countries. Both increased maternal and paternal education showed a dose–response relationship linked to reduced under-5 mortality, with maternal education emerging as a stronger predictor. We observed a reduction in under-5 mortality of 31·0% (95% CI 29·0–32·6) for children born to mothers with 12 years of education (ie, completed secondary education) and 17·3% (15·0–18·8) for children born to fathers with 12 years of education, compared with those born to a parent with no education. We also showed that a single additional year of schooling was, on average, associated with a reduction in under-5 mortality of 3·04% (2·82–3·23) for maternal education and 1·57% (1·35–1·72) for paternal education. The association between higher parental education and lower child mortality was significant for both parents at all ages studied and was largest after the first month of life. The meta-analysis framework incorporated uncertainty associated with each individual effect size into the model fitting process, in an effort to decrease the risk of bias introduced by study design and quality.
Interpretation
To our knowledge, this study is the first effort to systematically quantify the transgenerational importance of education for child survival at the global level. The results showed that lower maternal and paternal education are both risk factors for child mortality, even after controlling for other markers of family socioeconomic status. This study provides robust evidence for universal quality education as a mechanism to achieve the Sustainable Development Goal target 3.2 of reducing neonatal and child mortality.
DOI: 10.1016/S0140-6736(21)00534-1
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00534-1/fulltext
LANCET：《柳叶刀》，创刊于1823年。隶属于爱思唯尔出版社，最新IF：202.731
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本期文章：《柳叶刀》：Online/在线发表
