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浙江大学学报(医学版)  2022, Vol. 51 Issue (1): 10-18    DOI: 10.3724/zdxbyxb-2021-0120
专题报道     
2008—2020年江苏省淮安市围产儿出生缺陷变化趋势及影响因素分析
王慧1,张悦2,丁伟洁1,朱怡2,3,卢红梅1,岳虹霓1,戴晓晨4,李端辉2,朱晓琴1,*(),徐小林2,5,*()
1.淮安市妇幼保健院群体保健科,江苏 淮安 223001
2.浙江大学医学院公共卫生学院,浙江 杭州 310058
3.华中科技大学同济医学院公共卫生学院,湖北 武汉 430030
4.美国华盛顿大学公共卫生学院,美国 西雅图 98195
5.浙江大学医学院附属第二医院临床大数据与统计中心,浙江 杭州 310009
Trends and influencing factors of perinatal birth defects in Huai’an from 2008 to 2020
WANG Hui1,ZHANG Yue2,DING Weijie1,ZHU Yi2,3,LU Hongmei1,YUE Hongni1,DAI Xiaochen4,LI Duanhui2,ZHU Xiaoqin1,*(),XU Xiaolin2,5,*()
1. Department of Preventive Health Care, Huai’an Maternity and Child Health Care Hospital, Huai’an 223001, Jiangsu Province, China;
2. School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China;
3. School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
4. School of Public Health, University of Washington, Seattle 98195, USA;
5. Center for Clinical Big Data and Statistics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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摘要:

目的:分析2008—2020年淮安市围产儿出生缺陷的发生情况、变化趋势及其影响因素。方法:数据来源于江苏省淮安市妇幼卫生信息系统中2008—2020年的监测数据以及淮安市统计年鉴。以年度变化百分比和平均年度变化百分比(AAPC)为主要指标,采用JoinPoint回归描述十三年间淮安市出生缺陷发生的变化趋势。采用Spearman相关性分析探讨出生缺陷发生率与人口出生率、结婚登记率及高龄产妇分娩占比的相关性。结果:2008—2020年,淮安市共发生围产儿出生缺陷3414例,出生缺陷发生率为4.6‰(3414/736 608),且表现为明显的上升趋势(AAPC=8.8%,t=3.2,P<0.01),2016年为变化转折点。在24类出生缺陷中,先天性心脏病发病率急剧上升,已成为顺位第一疾病,而无脑畸形、脑膨出、脊柱裂等神经管缺陷发病率下降明显。出生缺陷率与人口出生率呈负相关(r=–0.751,P<0.01),与结婚登记率无明显相关性(r=–0.516,P>0.05),与高龄产妇分娩占比呈正相关(r=0.726,P<0.01)。结论:2008—2020年,淮安市出生缺陷发生率整体呈上升趋势,先天性心脏病已成为第一顺位的出生缺陷,高龄产妇分娩占比与出生缺陷之间关系密切。

关键词: 围产儿出生缺陷发生率流行趋势影响因素    
Abstract:

Objective: To analyze the incidence, trends and related factors of birth defects in Huai’an from 2008 to 2020. Methods: The surveillance data from maternal and child health system of Huai’an from 2008 to 2020 and Huai’an Statistical Yearbook were used for analysis. Taking the annual change percentage and average annual change percentage (AAPC) as the main outcome indicators, the JoinPoint regression analysis was performed to estimate the changing trend of birth defects from 2008 to 2020. Spearman correlation analysis was used to examine the association between birth defects and birth rate, marriage rate, proportion of women with advanced maternal age. Results: During 2008 to 2020, a total of 3414 cases of neonatal birth defects occurred in Huai’an, with an incidence of 4.6‰ (3414/736 608). The rate of perinatal birth defects in Huai’an showed an increasing trend (AAPC=8.8%, t=3.2, P<0.01), and the year of 2016 was a significant changing point. Among 24 types of birth defects, the incidence of congenital heart disease rose and became the most prevalent defect, while the incidence of neural tube malformations such as anencephaly, encephalocele and spina bifida was declined. The incidence of birth defect was negatively correlated with the birth rate (r=–0.751, P<0.01), not correlated with marriage rate (r=–0.516, P>0.05), and positively correlated with the proportion of women with advanced maternal age (r=0.726, P<0.01).Conclusion: The incidence of birth defects in Huai’an shows an increasing trend from 2008 to 2020 with congenital heart disease as the most common type of birth defect, and the increase of birth defects incidence is closely related with the increase of the proportion of women with advanced maternal age.

Key words: Perinatal infants    Birth defects    Incidence    Changing trends    Influencing factors
收稿日期: 2021-10-11 出版日期: 2022-05-17
CLC:  R722  
基金资助: 江苏省妇幼健康科研项目(F201402,F201932);淮安市科技项目(HAB202043);江苏省医院管理创新研究课题(JSYGY-3-2020-442);淮安市卫生健康科研项目(HAWJ202020,HAWJ202118);美国中华医学基金会公开竞争项目(21-416);浙江大学百人计划启动经费
通讯作者: 朱晓琴,徐小林     E-mail: xiaolin.xu@zju.edu.cn
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引用本文:

王慧,张悦,丁伟洁,朱怡,卢红梅,岳虹霓,戴晓晨,李端辉,朱晓琴,徐小林. 2008—2020年江苏省淮安市围产儿出生缺陷变化趋势及影响因素分析[J]. 浙江大学学报(医学版), 2022, 51(1): 10-18.

WANG Hui,ZHANG Yue,DING Weijie,ZHU Yi,LU Hongmei,YUE Hongni,DAI Xiaochen,LI Duanhui,ZHU Xiaoqin,XU Xiaolin. Trends and influencing factors of perinatal birth defects in Huai’an from 2008 to 2020. J Zhejiang Univ (Med Sci), 2022, 51(1): 10-18.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0120        https://www.zjujournals.com/med/CN/Y2022/V51/I1/10

年份

第一位

第二位

第三位

第四位

第五位

2008

其他畸形(94.53)

唇裂(59.52)

唇裂合并腭裂(56.02)

先天性心脏病(54.27)

多指(35.01)

2009

其他畸形(123.29)

多指(59.24)

唇裂合并腭裂(54.44)

先天性心脏病(52.84)

并指(32.02)

2010

其他畸形(102.38)

唇裂合并腭裂(55.25)

唇裂(55.25)

多指(42.25)

先天性心脏病(42.25)

2011

其他畸形(73.67)

唇裂(48.59)

唇裂合并腭裂(42.32)

多指(39.18)

先天性脑积水(26.65)

2012

其他畸形(84.01)

唇裂合并腭裂(49.51)

先天性心脏病(45.01)

多指(43.51)

唇裂(22.50)

2013

多指(55.00)

其他畸形(45.83)

唇裂合并腭裂(29.03)

先天性心脏病(18.33)

唇裂(15.28)

2014

其他畸形(63.52)

多指(49.22)

先天性心脏病(36.52)

唇裂合并腭裂(30.17)

直肠肛门闭塞或狭窄(包括无肛)(23.82)

2015

多指(66.10)

其他畸形(45.14)

唇裂合并腭裂(45.14)

唇裂(33.86)

先天性心脏病(27.41)

2016

多指(70.99)

其他畸形(70.99)

先天性心脏病(28.73)

唇裂合并腭裂(27.04)

唇裂(27.04)

2017

多指(117.84)

先天性心脏病(87.94)

其他畸形(84.42)

并指(49.25)

外耳其他畸形(38.69)

2018

多指(136.40)

其他畸形(121.00)

先天性心脏病(114.40)

唇裂合并腭裂(11.00)

唇裂(17.60)

2019

先天性心脏病(636.82)

其他畸形(118.94)

多指(94.16)

外耳其他畸形(39.65)

小耳(包括无耳)(37.17)

2020

先天性心脏病(491.62)

其他畸形(265.66)

多指(198.48)

外耳其他畸形(73.28)

小耳(包括无耳)(61.07)

合计

先天性心脏病(98.29)

其他畸形(70.46)

多指(35.84)

唇裂合并腭裂(30.41)

唇裂(23.89)

表 1  2008—2020年江苏省淮安市前五位出生缺陷类型及发生率
图 1  2008年与2020年江苏省淮安市围产儿出生缺陷顺位变化颜色代表出生缺陷分类:蓝色(眼、耳、面和颈部先天性畸形),橙色(神经系统畸形),紫色(肌肉、骨骼系统先天性畸形),绿色(消化系统先天性畸形),红色(先天性心脏病),灰色(其他先天性畸形),墨绿色(染色体畸形),亮绿色(泌尿系统畸形). 实线表示发生率上升,虚线表示发生率下降. 在2008年和2020年,膀胱外翻和联体双胎发生率均为0,未纳入比较.
图 2  2008—2020年江苏省淮安市围产儿出生缺陷发生率变化趋势图出生缺陷发生率=某年某地出生缺陷数/当年该地围产儿数.图中虚线代表节点年份.
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