Differences of maternal mortality rate between Shanghai and New York city from the perspective of regulatory policy

Li Li; Cheng-Yue Li; Qing-Yu Zhou; Chuan Pu; Ling-Zhong Xu; Tian-Qiang Xu; Chao Hao; Zhi Hu; Mo Hao

doi:10.1097/CM9.0000000000000741

Differences of maternal mortality rate between Shanghai and New York city from the perspective of regulatory policy

Chin Med J (Engl). 2020 Apr 5;133(7):792-799. doi: 10.1097/CM9.0000000000000741.

Authors

Li Li^{1

2}, Cheng-Yue Li^{1

2}, Qing-Yu Zhou^{1

2}, Chuan Pu^{2

3}, Ling-Zhong Xu^{2

4}, Tian-Qiang Xu⁵, Chao Hao⁶, Zhi Hu^{2

7}, Mo Hao^{1

2}

Affiliations

¹ Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China.
² Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China.
³ School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
⁴ School of Public Health, Shandong University, Jinan, Shandong 250012, China.
⁵ Institute of Inspection and Supervision, Shanghai Municipal Commission of Health and Family Planning, Shanghai 200031, China.
⁶ Changzhou Center for Disease Control and Prevention, Nanjing, Jiangsu 213003, China.
⁷ Anhui Medical University, Hefei, Anhui 230032, China.

Abstract

Background: Regulatory policy (RP) is known as a major factor to improve health care system performance. A significant difference in maternal mortality rates (MMRs) was observed between New York city (NYC) and Shanghai (SH), both first-class international metropolises. This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities.

Methods: Based on collection of all publicly released policy documents regarding maternal health in the two cities, we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate (RECR), departmental responsibility clarity rate (DRCR), and accountability mechanism clarity rate (AMCR), based on two characteristics of comprehensiveness and effectiveness of RPs. Pearson correlation analysis, principal component analysis, and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC.

Results: By 2017, disparities of maternal health care RP are found between SH and NYC, from the indicators of RECR (100% vs. 77.0%), DRCR (38.9% vs. 45.1%), and AMCR (29.2% vs. 22.5%). From 2006 to 2017, RECR, DRCR, and AMCR in SH have shown a higher growth of 8.7%, 53.2%, and 45.2%, compared with growth of 25.0%, 12.5%, and 2.9% in NYC. The three indicators were found all negatively correlated with MMR in SH (Coefficients = -0.831, -0.833, and -0.909, and P < 0.01), while only RECR and DRCR had negative correlation with MMR in NYC (Coefficients = -0.736 and -0.683, and P < 0.05). Linear regression showed that the principal components of the three indicators were found with significant impact on MMRs both in SH (R = 0.914, R = 0.836, P < 0.001) and NYC (R = 0.854, R = 0.357, P = 0.04).

Conclusion: Compared with NYC, the more comprehensive and effective maternal health care RPs in SH had a stronger impact on MMR control, which contributed to the differences between the two cities' MMRs to some extent. The methods and indicators we adopted for assessment are reasonable and comparable.

MeSH terms

China
Cities
Female
Humans
Linear Models
Maternal Mortality*
New York City
Pregnancy
Regression Analysis