Spatiotemporal distribution of perinatal birth defects in Gansu, 2015−2020
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摘要:
目的 评估甘肃省出生缺陷的时空分布特征,为公共卫生资源的合理分配以及出生缺陷的防治提供科学依据。 方法 收集2015—2020年甘肃省42家监测医院出生缺陷数据,采用泊松分布计算各年度以及不同人群的出生缺陷发生率,Joinpoint 回归评估出生缺陷发生率的时间趋势,空间自相关分析判断出生缺陷的空间分布。 结果 2015—2020年甘肃省出生缺陷发生率由2015年的150.96/万[95% 置信区间(CI): 143.95/万~162.39/万]上升至2020年的200.47/万(95%CI:190.26/万~210.68/万),出生缺陷前5顺位病种分别是先天性心脏、多指(趾)、总唇腭裂、神经管缺陷和先天性脑积水。 空间分析显示,兰州市、天水市、武威市为出生缺陷的高风险地区。 结论 2015—2020年甘肃省出生缺陷发生率呈上升趋势,在空间上存在聚集区域,应进一步加强监测水平,加强对主要病种和重点区域的防控。 Abstract:Objective To analyze the spatiotemporal distribution characteristics of birth defects in Gansu province, and provided scientific basis for the prevention and treatment of birth defects in Gansu. Methods The data of perinatal infants with birth defects were collected from 42 surveillance hospitals in Gansu between 2015 and 2020. Poisson distribution was used to calculate the incidences of birth defects in different years and in different populations. Joinpoint regression was used to evaluate the temporal trend of birth defect incidence, and spatial autocorrelation analysis was performed to identify clustering areas of birth defects. Results The incidence of birth defects increased from 150.96/10000 (95%CI: 143.95–162.39) in 2015 to 200.47/10000 (95%CI: 190.26–210.68) in 2020. The five leading birth defects were congenital heart defects, polydactyly, cleft lip and palate, neural tube defects, and congenital hydrocephalus. Spatial analysis showed that Lanzhou, Tianshui, and Wuwei were high-risk areas for birth defects. Conclusion The incidence of birth defects in Gansu showed an upward trend, spatial analysis showed clustering areas of birth defects in Gansu. The prevention and control of major diseases and in key areas should be strengthened. -
Key words:
- Birth defect /
- Perinatal infant /
- Temporal trend /
- Spatial distribution
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表 1 2015-2020年甘肃省出生缺陷发生基本情况
Table 1. Incidence of birth defects in Gansu, 2015−2020
变量 病例数 围产儿数 发生率(/万)(95%CI) χ2值 P值 年份 210.489 < 0.001 2015 1 045 69 225 150.96(143.95~162.39) 2016 1 043 82 047 127.12(119.46~134.79) 2017 1 514 93 793 161.42(153.35~169.48) 2018 1 649 82 851 199.03(189.52~208.54) 2019 1 324 88 429 149.72(141.72~157.73) 2020 1 452 72 429 200.47(190.26~210.68) 性别a 43.712 < 0.001 男性 4 358 254 718 171.48(166.44~176.53) 女性 3 447 233 986 147.79(142.90~152.68) 居住地 25.259 < 0.001 城镇 3 774 243 430 155.03(150.13~159.94) 乡村 4 253 245 344 173.35(168.18~178.51) 分娩季节 17.058 < 0.001 春季 1 925 121 551 158.37(151.35~165.39) 13.168 < 0.001 b 夏季 2 030 114 266 177.66(169.99~185.32) – – 秋季 1 942 120 134 161.65(154.52~168.78) 8.907 0.003 b 冬季 2 130 132 823 160.36(153.60~167.12) 10.991 < 0.001 b 母亲年龄(岁) 189.920 < 0.001 <20 303 9 400 322.34(286.63~358.05) 159.770 < 0.001 b 20~ 1 622 93 472 173.53(165.16~181.90) 11.147 < 0.001 b 25~ 3 352 213 609 156.92(151.65~162.19) – – 30~ 1 823 122 438 148.89(142.11~155.68) 3.258 0.071 35~ 927 49 855 185.94(174.08~197.80) 25.396 < 0.001 b 注:a. 性别不明者未纳入统计分析;b. 经Benjamini & Hochberg法校正后,与参考类别(夏季和 25~29 岁)进行比较而获得的经调整后的P值;CI. 置信区间;–. 参考类别 表 2 2015-2020年甘肃省出生缺陷各病种发生率及趋势
Table 2. Incidence and trend of birth defects in Gansu, 2015−2020
出生缺陷病种 不同年份发生率(/万) 排名 APC(%) P值 2015 2016 2017 2018 2019 2020 总计 先天性心脏病 31.92 35.96 44.67 60.11 67.74 107.83 57.55 1 28.50 0.001 多指(趾) 13.29 13.04 13.43 17.50 17.64 20.43 15.84 2 10.30 0.006 总唇腭裂a 20.37 13.29 22.71 17.50 8.14 9.53 15.32 3 −13.20 0.194 神经管畸形b 14.88 7.43 9.92 10.62 1.13 1.52 7.49 4 −22.70 0.174 先天性脑积水 11.56 3.90 6.61 10.26 3.17 1.66 6.12 5 −17.30 0.284 唐氏综合征 3.03 5.61 6.82 7.85 1.36 0.97 4.40 6 −7.10 0.758 马蹄内翻足 5.06 2.07 4.37 4.71 3.96 3.59 3.95 7 −1.92 0.801 外耳其他畸形 3.03 2.44 4.37 5.55 3.62 4.42 3.93 8 8.53 0.315 并指(趾) 3.03 3.05 2.77 5.07 3.28 3.04 3.38 9 −6.10 0.596 肢体短缩 3.47 2.19 2.77 4.47 1.47 2.07 2.72 10 3.28 0.674 尿道下裂 2.02 1.46 2.56 3.50 3.17 3.45 2.70 11 14.99 0.052 直肠肛门闭锁或狭窄 3.76 1.46 1.60 2.41 2.71 2.21 2.31 12 −4.42 0.626 食道闭锁或狭窄 2.46 0.61 1.17 1.69 1.70 2.62 1.66 13 5.02 0.662 小耳(包括无耳) 1.16 0.49 1.07 1.81 1.47 1.93 1.31 14 16.46 0.123 脐膨出 1.01 0.73 1.49 2.29 0.23 0.69 1.08 15 0.98 0.964 腹裂 2.31 0.98 1.39 1.09 0.34 0.41 1.06 16 27.18 0.028 先天性膈疝 0.43 0.49 2.03 2.53 0.34 0.28 1.06 17 6.53 0.869 联体双胎 0.14 0.37 0.11 0.24 0.00 0.00 0.14 18 – – 膀胱外翻 0.00 0.12 0.00 0.00 0.00 0.00 0.02 19 – – 注:–. 存在数据为0,无法进行趋势分析;a. 总唇腭裂包括唇裂、腭裂以及唇裂合并腭裂;b. 神经管缺陷包括无脑畸形、脑膨出和脊柱裂;APC. 年度变化百分比 -
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