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Abstract：
BACKGROUND: Obstructed labor (OL) and uterine rupture (UR) are common obstetric complications. This study explored the burden, risk factors, decomposition, and health inequalities associated with OL and UR to improve global maternal health.
METHODS: This was a cross-sectional analysis study including data on OL and UR from the Global Burden of Diseases, and Risk Factors Study (GBD) 2019. The main outcome measures included the number and age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), prevalence, and deaths.
RESULTS: The global burden of OL and UR has declined, with a decrease in incidence (number in 2019: 9,410,500.87, 95%UI 11,730,030.94 to 7,564,568.91; ASR in 2019: 119.64 per 100,000, 95%UI 149.15 to 96.21; estimated annual percentage change [EAPC] from 1990 to 2019: -1.34, 95% CI -1.41 to -1.27) and prevalence over time. However, DALYs (number in 2019: 999,540.67, 95%UI 1,209,749.35 to 817,352.49; ASR in 2019: 12.92, 95%UI 15.63 to 10.56; EAPC from 1990 to 2019: -0.91, 95% CI -1.26 to -0.57) and deaths remain significant. ASR of DALYs increased for the 10-14 year-old age group (2.01, 95% CI 1.53 to 2.5), the 15-19 year-old age group (0.07, 95% CI -0.47 to 0.61), Andean Latin America (3.47, 95% CI 3.05 to 3.89), and Caribbean (4.16, 95% CI 6 to 4.76). Iron deficiency was identified as a risk factor for OL and UR, and its impact varied across different socio-demographic indices (SDIs). Decomposition analysis showed that population growth primarily contributed to the burden, especially in low SDI regions. Health inequalities were evident, the slope and intercept for DALYs were - 47.95 (95% CI -52.87 to -43.02) and - 29.29 (95% CI -32.95 to -25.63) in 1990, 39.37 (95%CI 36.29 to 42.45) and 24.87 (95%CI 22.56 to 27.18) in 2019. Concentration indices of ASR-DALYs were - 0.2908 in 1990 and - 0.2922 in 2019.
CONCLUSIONS: This study highlights the significant burden of OL and UR and emphasizes the need for continuous efforts to reduce maternal mortality and morbidity. Understanding risk factors and addressing health inequalities are crucial for the development of effective interventions and policies to improve maternal health outcomes globally.
METHODS: This was a cross-sectional analysis study including data on OL and UR from the Global Burden of Diseases, and Risk Factors Study (GBD) 2019. The main outcome measures included the number and age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), prevalence, and deaths.
RESULTS: The global burden of OL and UR has declined, with a decrease in incidence (number in 2019: 9,410,500.87, 95%UI 11,730,030.94 to 7,564,568.91; ASR in 2019: 119.64 per 100,000, 95%UI 149.15 to 96.21; estimated annual percentage change [EAPC] from 1990 to 2019: -1.34, 95% CI -1.41 to -1.27) and prevalence over time. However, DALYs (number in 2019: 999,540.67, 95%UI 1,209,749.35 to 817,352.49; ASR in 2019: 12.92, 95%UI 15.63 to 10.56; EAPC from 1990 to 2019: -0.91, 95% CI -1.26 to -0.57) and deaths remain significant. ASR of DALYs increased for the 10-14 year-old age group (2.01, 95% CI 1.53 to 2.5), the 15-19 year-old age group (0.07, 95% CI -0.47 to 0.61), Andean Latin America (3.47, 95% CI 3.05 to 3.89), and Caribbean (4.16, 95% CI 6 to 4.76). Iron deficiency was identified as a risk factor for OL and UR, and its impact varied across different socio-demographic indices (SDIs). Decomposition analysis showed that population growth primarily contributed to the burden, especially in low SDI regions. Health inequalities were evident, the slope and intercept for DALYs were - 47.95 (95% CI -52.87 to -43.02) and - 29.29 (95% CI -32.95 to -25.63) in 1990, 39.37 (95%CI 36.29 to 42.45) and 24.87 (95%CI 22.56 to 27.18) in 2019. Concentration indices of ASR-DALYs were - 0.2908 in 1990 and - 0.2922 in 2019.
CONCLUSIONS: This study highlights the significant burden of OL and UR and emphasizes the need for continuous efforts to reduce maternal mortality and morbidity. Understanding risk factors and addressing health inequalities are crucial for the development of effective interventions and policies to improve maternal health outcomes globally.
摘要：
背景：产程梗阻（OL）和子宫破裂（UR）是常见的产科并发症。这项研究探讨了负担，危险因素，分解,以及与OL和UR相关的健康不平等，以改善全球孕产妇健康。
方法：这是一项横断面分析研究，包括来自全球疾病负担的OL和UR数据，和风险因素研究（GBD）2019年。主要结果指标包括发病率和年龄标准化率（ASR），残疾调整寿命年(DALYs)，患病率,和死亡。
结果：OL和UR的全球负担有所下降，发病率下降（2019年数字：9,410,500.87，95%UI11,730,030.94至7,564,568.91；2019年ASR：119.64/100,000，95%UI149.15至96.21；1990年至2019年估计年度百分比变化[EAPC]：-1.34，95%CI-1.41至-1.27）和患病率随时间变化。然而,DALYs（2019年数量：999,540.67，95％UI1,209,749.35至817,352.49；2019年ASR：12.92，95％UI15.63至10.56；EAPC从1990年到2019年：-0.91，95％CI-1.26至-0.57），死亡人数仍然很高。10-14岁年龄组的DALYsASR增加（2.01，95%CI1.53至2.5），15-19岁年龄组（0.07，95%CI-0.47至0.61），安第斯拉丁美洲（3.47，95%CI3.05至3.89），和加勒比海（4.16，95%CI6至4.76）。铁缺乏被确定为OL和UR的危险因素，其影响因不同的社会人口指数(SDI)而异。分解分析表明，人口增长主要是造成负担的原因，特别是在低SDI地区。健康不平等是显而易见的，DALYs的斜率和截距在1990年为-47.95(95%CI-52.87至-43.02)和-29.29(95%CI-32.95至-25.63),在2019年为39.37(95CI36.29至42.45)和24.87(95CI22.56至27.18).ASR-DALYs的集中度指数在1990年为-0.2908，在2019年为-0.2922。
结论：这项研究强调了OL和UR的巨大负担，并强调需要不断努力降低孕产妇死亡率和发病率。了解风险因素和解决健康不平等问题对于制定有效的干预措施和政策以改善全球孕产妇健康结果至关重要。
方法：这是一项横断面分析研究，包括来自全球疾病负担的OL和UR数据，和风险因素研究（GBD）2019年。主要结果指标包括发病率和年龄标准化率（ASR），残疾调整寿命年(DALYs)，患病率,和死亡。
结果：OL和UR的全球负担有所下降，发病率下降（2019年数字：9,410,500.87，95%UI11,730,030.94至7,564,568.91；2019年ASR：119.64/100,000，95%UI149.15至96.21；1990年至2019年估计年度百分比变化[EAPC]：-1.34，95%CI-1.41至-1.27）和患病率随时间变化。然而,DALYs（2019年数量：999,540.67，95％UI1,209,749.35至817,352.49；2019年ASR：12.92，95％UI15.63至10.56；EAPC从1990年到2019年：-0.91，95％CI-1.26至-0.57），死亡人数仍然很高。10-14岁年龄组的DALYsASR增加（2.01，95%CI1.53至2.5），15-19岁年龄组（0.07，95%CI-0.47至0.61），安第斯拉丁美洲（3.47，95%CI3.05至3.89），和加勒比海（4.16，95%CI6至4.76）。铁缺乏被确定为OL和UR的危险因素，其影响因不同的社会人口指数(SDI)而异。分解分析表明，人口增长主要是造成负担的原因，特别是在低SDI地区。健康不平等是显而易见的，DALYs的斜率和截距在1990年为-47.95(95%CI-52.87至-43.02)和-29.29(95%CI-32.95至-25.63),在2019年为39.37(95CI36.29至42.45)和24.87(95CI22.56至27.18).ASR-DALYs的集中度指数在1990年为-0.2908，在2019年为-0.2922。
结论：这项研究强调了OL和UR的巨大负担，并强调需要不断努力降低孕产妇死亡率和发病率。了解风险因素和解决健康不平等问题对于制定有效的干预措施和政策以改善全球孕产妇健康结果至关重要。
