2015－2020年甘肃省围产儿出生缺陷时空分布特征分析

李亮亮; 杨兰; 王称; 黄奎奎; 周艳芝

doi:10.3784/jbjc.202209280428

2015－2020年甘肃省围产儿出生缺陷时空分布特征分析

doi: 10.3784/jbjc.202209280428

李亮亮^1,,
杨兰^2, ,,
王称²,
黄奎奎²,
周艳芝²

1.
兰州大学公共卫生学院儿少卫生与妇幼保健研究所, 甘肃兰州 730000
2.
甘肃省妇幼保健院, 甘肃兰州 730000

基金项目: 甘肃省卫生健康行业科研计划项目（No. GSWSYK2021-001）

详细信息

作者简介:
李亮亮，男，甘肃省天水市人，硕士研究生在读，主要从事妇幼保健研究，Email：2451538613@qq.com

通讯作者:
杨兰，Tel：13893205529，Email：yanglan0608@126.com

中图分类号: R211; R181.3+7
计量
- 文章访问数: 141
- HTML全文浏览量: 67
- PDF下载量: 28
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-28
- 网络出版日期: 2023-03-13
- 刊出日期: 2023-04-30

Spatiotemporal distribution of perinatal birth defects in Gansu, 2015−2020

1.
Institute of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou University, Lanzhou 730000, Gansu, China
2.
Gansu Provincial Maternal and Child-care Hospital, Lanzhou 730000, Gansu, China

Funds: This study was supported by Gansu Health Scientific Research Program (No. GSWSYK2021-001)

摘要

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。
- 出生缺陷 /
- 围产儿 /
- 时间趋势 /
- 空间分布
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.
- Birth defect /
- Perinatal infant /
- Temporal trend /
- Spatial distribution

HTML全文

图 1 2015－2020年甘肃省12个市（州）出生缺陷发生率空间分布

注：嘉峪关和甘南藏族自治州尚未建立监测医院

Figure 1. Spatial distribution of incidence of birth defects in 12 prefectures in Gansu, 2015−2020

下载: 全尺寸图片幻灯片

图 2 2015－2020年甘肃省出生缺陷全局空间自相关Moran's I指数

Figure 2. Global spatial autocorrelation Moran's I index of incidence of birth defects in Gansu, 2015−2020

下载: 全尺寸图片幻灯片

图 3 2015－2020年甘肃省出生缺陷发生率局部空间关联指标聚类

Figure 3. Local spatial autocorrelation analysis on incidence of birth defects in Gansu, 2015−2020

下载: 全尺寸图片幻灯片

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

下载: 导出CSV

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
出生缺陷病种	2015	2016	2017	2018	2019	2020	总计	排名	APC（%）	P值
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

下载: 导出CSV

参考文献(27)

[1]	Czeizel AE. Birth defects are preventable[J]. Int J Med Sci, 2005, 2(3): 91–92. DOI: 10.7150/ijms.2.91.
[2]	Xie DH, Yang TB, Liu ZY, et al. Epidemiology of birth defects based on a birth defect surveillance system from 2005 to 2014 in Hunan province, China[J]. PLoS One, 2016, 11(1): e0147280. DOI: 10.1371/journal.pone.0147280.
[3]	Taye M, Afework M, Fantaye W, et al. Magnitude of birth defects in central and northwest Ethiopia from 2010–2014: A descriptive retrospective study[J]. PLoS One, 2016, 11(10): e0161998. DOI: 10.1371/journal.pone.0161998.
[4]	张龙飞. 基于小区域方法的出生缺陷流行病学研究[D]. 济南: 山东大学, 2018. Zhang LF. Epidemiological study of birth defects based on small area study method[D]. Jinan: Shandong University, 2018.
[5]	Kancherla V, Roos N, Walani SR. Relationship between achieving sustainable development goals and promoting optimal care and prevention of birth defects globally[J]. Birth Defects Res, 2022, 114(14): 773–784. DOI: 10.1002/bdr2.2055.
[6]	Perin J, Mulick A, Yeung D, et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the sustainable development goals[J]. Lancet Child Adolesc Health, 2022, 6(2): 106–115. DOI: 10.1016/S2352−4642(21)00311−4.
[7]	中华人民共和国卫生部. 中国出生缺陷防治报告(2012)[EB/OL]. (2012-09-12)[2022-10-28]. http://www.gov.cn/gzdt/att/att/site1/20120912/1c6f6506c7f811bacf9301.pdf. Ministry of Health of the People's Republic of China. China Birth Defect Prevention Report (2012)[EB/OL]. (2012-09-12)[2022-10-28]. http://www.gov.cn/gzdt/att/att/site1/20120912/1c6f6506c7f811bacf9301.pdf.
[8]	Guo C, Du Y, Shen SQ, et al. Spatiotemporal analysis of tuberculosis incidence and its associated factors in mainland China[J]. Epidemiol Infect, 2017, 145(12): 2510–2519. DOI: 10.1017/S0950268817001133.
[9]	国家卫生计生委妇幼健康服务司. 中国妇幼卫生监测工作手册(2013版)[EB/OL]. (2013-08-30)[2022-10-23]. http://www.mchscn.cn/National-22/450.html. Department of Maternal and Child Health Service. National Health and Family Planning Commission. China's maternal and child health surveillance handbook (2013 edition)[EB/OL]. (2013-08-30)[2022-10-23]. http://www.mchscn.cn/National-22/450.html.
[10]	彭振仁, 韦洁, 陈碧艳, 等. 基于地理信息系统的广西壮族自治区出生缺陷空间分析[J]. 疾病监测,2022,37(2):262–268. DOI: 10.3784/jbjc.202104080184. Peng ZR, Wei J, Chen BY, et al. Spatial analysis on birth defects in Guangxi based on geographic information system[J]. Dis. Surveill, 2022, 37(2): 262–268. DOI: 10.3784/jbjc.202104080184.
[11]	张志力, 胡先明, 范惠霞, 等. 2012—2017年山西省围生儿出生缺陷监测结果和流行病学分析[J]. 中国全科医学,2020,23(10):1298–1304. DOI:10.12114/j.issn.1007−9572.2019.00.708. Zhang ZL, Hu XM, Fan HX, et al. Epidemiological analysis of the surveillance data of birth defects among perinatal infants in Shanxi province, 2012–2017[J]. Chin Gen Pract, 2020, 23(10): 1298–1304. DOI: 10.12114/j.issn.1007−9572.2019.00.708.
[12]	梁丽芳, 韦洁, 韦慧, 等. 2013—2019年广西地区围生儿出生缺陷监测结果分析[J]. 中国妇幼保健,2022,37(1):133–136. DOI:10.19829/j.zgfybj.issn.1001−4411.2022.01.039. Liang LF, Wei J, Wei H, et al. Analysis on monitoring results of perinatal birth defects in Guangxi from 2013 to 2019[J]. Matern Child Health Care China, 2022, 37(1): 133–136. DOI: 10.19829/j.zgfybj.issn.1001−4411.2022.01.039.
[13]	周天津, 何琳坤, 赵梓伶, 等. 2010至2018年四川省出生缺陷发生情况分析[J]. 重庆医科大学学报,2021,46(10):1206–1210. DOI: 10.13406/j.cnki.cyxb.002616. Zhou TJ, He LK, Zhao ZL, et al. Incidence of birth defects in Sichuan province from 2010 to 2018[J]. J Chongqing Med Univ, 2021, 46(10): 1206–1210. DOI: 10.13406/j.cnki.cyxb.002616.
[14]	Bhide P, Kar A. A national estimate of the birth prevalence of congenital anomalies in India: systematic review and meta-analysis[J]. BMC Pediatr, 2018, 18(1): 175. DOI: 10.1186/s12887−018−1149−0.
[15]	Silesh M, Lemma T, Fenta B, et al. Prevalence and trends of congenital anomalies among neonates at Jimma Medical Center, Jimma, Ethiopia: A three-year retrospective study[J]. Pediatric Health Med Ther, 2021, 12: 61–67. DOI: 10.2147/PHMT.S293285.
[16]	Lytzen R, Vejlstrup N, Bjerre J, et al. Live-born major congenital heart disease in denmark: Incidence, detection rate, and termination of pregnancy rate from 1996 to 2013[J]. JAMA Cardiol, 2018, 3(9): 829–837. DOI: 10.1001/jamacardio.2018.2009.
[17]	Qu YJ, Liu XQ, Zhuang J, et al. Incidence of congenital heart disease: The 9-year experience of the Guangdong registry of congenital heart disease, China[J]. PLoS One, 2016, 11(7): e0159257. DOI: 10.1371/journal.pone.0159257.
[18]	Kirby RS. The prevalence of selected major birth defects in the United States[J]. Semin Perinatol, 2017, 41(6): 338–344. DOI: 10.1053/j.semperi.2017.07.004.
[19]	朱宝生, 苏洁, 卢晓红, 等. 降低出生缺陷关键技术及干预措施的研究[J]. 中华妇产科杂志,2011,46(9):658–663. DOI:10.3760/cma.J.issn.0529−567x.2011.09.005. Zhu BS, Su J, Lu XH, et al. Study on key techniques and intervention in reducing birth defects[J]. Chin J Obstet Gynecol, 2011, 46(9): 658–663. DOI: 10.3760/cma.J.issn.0529−567x.2011.09.005.
[20]	Sokal R, Tata LJ, Fleming KM. Sex prevalence of major congenital anomalies in the United Kingdom: a national population-based study and international comparison meta-analysis[J]. Birth Defects Res A Clin Mol Teratol, 2014, 100(2): 79–91. DOI: 10.1002/bdra.23218.
[21]	Kalliora C, Mamoulakis C, Vasilopoulos E, et al. Association of pesticide exposure with human congenital abnormalities[J]. Toxicol Appl Pharmacol, 2018, 346: 58–75. DOI: 10.1016/j.taap.2018.03.025.
[22]	Serunjogi R, Barlow-Mosha L, Mumpe-Mwanja D, et al. Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database[J]. Reprod Health, 2021, 18(1): 56. DOI: 10.1186/s12978−021−01115−w.
[23]	岳晓倩, 陈华. 2014—2019年常熟市围产儿出生缺陷与产妇年龄构成关系[J]. 江苏预防医学,2021,32(1):98–99. DOI:10.13668/j.issn.1006−9070.2021.01.034. Yue XQ, Chen H. Relationship between perinatal birth defects and maternal age in Changshu city from 2014 to 2019[J]. Jiangsu J Prev Med, 2021, 32(1): 98–99. DOI: 10.13668/j.issn.1006−9070.2021.01.034.
[24]	Benavides E, Lupo PJ, Langlois PH, et al. A comprehensive assessment of the associations between season of conception and birth defects, texas, 1999-2015[J]. Int J Environ Res Public Health, 2020, 17(19): 7120. DOI: 10.3390/ijerph17197120.
[25]	欧艳秋, 聂志强, 刘小清, 等. 广东省流动和常住人口先天性心脏病危险因素的差异分析[J]. 中华流行病学杂志,2013,34(7):701–705. DOI:10.3760/cma.j.issn.0254−6450.2013.07.009. Ou YQ, Nie ZQ, Liu XQ, et al. Study on the differences of risk factors regarding congenital heart defects between floating population and permanent residents in Guangdong[J]. Chin J Epidemiol, 2013, 34(7): 701–705. DOI: 10.3760/cma.j.issn.0254−6450.2013.07.009.
[26]	夏颖丽, 郑卫红, 陈颖, 等. 北京地区流动人口对出生缺陷发生率及检出率的影响[J]. 中国优生与遗传杂志,2008,16(6):99–100,111. DOI:10.3969/j.issn.1006−9534.2008.06.054. Xia YL, Zheng WH, Chen Y, et al. The effect of floating population on the incidence and detection rate of birth defect[J]. Chin J Birth Health Heredity, 2008, 16(6): 99–100,111. DOI: 10.3969/j.issn.1006−9534.2008.06.054.
[27]	Zhou Y, Mao XQ, Zhou H, et al. Epidemiology of birth defects based on a birth defect surveillance system in Southern Jiangsu, China, 2014-2018[J]. J Matern Fetal Neonatal Med, 2022, 35(4): 745–751. DOI: 10.1080/14767058.2020.1731459.