背景:作为儿童死亡的主要原因之一,先天性异常(CA)导致的死亡一直是实现可持续发展目标3.2的主要障碍。
目的:我们进行了这项研究,以了解浙江省5岁以下CA死亡率(CAMR)的死亡负担和趋势,中国东部医疗服务和公共卫生基金会最好的省份之一。
方法:我们使用了从2012年至2021年浙江省5岁以下儿童死亡率监测系统检索的数据。CAMR性别,residence,根据2020年全国人口普查性别和居住地的活产数据,计算并标准化了每年的年龄组。采用泊松回归模型估计CAMR的年平均变化率(AACR),并在调整性别后得到亚组之间的比率,residence,和适当的年龄组。
结果:从2012年到2021年,共有1753名儿童死于CA,标准化CAMR从每100,000例活产的121.2降至62.6,AACR为-9%(95%CI-10.7%至-7.2%;P<.001)。男女儿童也呈下降趋势,城乡儿童,新生儿和大婴儿,AACR为-9.7%,-8.5%,-8.5%,-9.2%,-12%,和-6.3%,分别(所有P<.001)。然而,在1-4岁的儿童中没有观察到显著降低(P=0.22)。一般来说,男女儿童的CAMR比率,农村儿童和城市儿童,年龄较大的婴儿与新生儿,年龄较大的儿童和新生儿为1.18(95%CI1.08-1.30;P<.001),1.20(95%CI1.08-1.32;P=.001),0.66(95%CI0.59-0.73;P<.001),和0.20(95%CI0.17-0.24;P<.001),分别。在所有广泛的CA团体中,循环系统畸形,主要是先天性心脏病导致的死亡,占死亡人数的49.4%(866/1753),在所有年份中排名第一,尽管AACR每年下降,为-9.8%(P<.001)。近年来,由于染色体异常而导致的死亡人数呈上升趋势,尽管AACR不显著(P=.90)。
结论:CAMR每年减少,心血管畸形在浙江历年排名第一,中国。未来的研究和实践应该更加注重预防,早期发现,对CA的长期管理和对有CA儿童的家庭的全面支持,以提高他们的生存机会。
BACKGROUND: As one of the leading causes of child mortality, deaths due to congenital anomalies (CAs) have been a prominent obstacle to meet Sustainable Development Goal 3.2.
OBJECTIVE: We conducted this study to understand the death burden and trend of under-5 CA mortality (CAMR) in Zhejiang, one of the provinces with the best medical services and public health foundations in Eastern China.
METHODS: We used data retrieved from the under-5 mortality surveillance system in Zhejiang from 2012 to 2021. CAMR by sex, residence, and age group for each year was calculated and standardized according to 2020 National Population Census sex- and residence-specific live birth data in China. Poisson regression models were used to estimate the annual average change rate (AACR) of CAMR and to obtain the rate ratio between subgroups after adjusting for sex, residence, and age group when appropriate.
RESULTS: From 2012 to 2021, a total of 1753 children died from CAs, and the standardized CAMR declined from 121.2 to 62.6 per 100,000 live births with an AACR of -9% (95% CI -10.7% to -7.2%; P<.001). The declining trend was also observed in female and male children, urban and rural children, and neonates and older infants, and the AACRs were -9.7%, -8.5%, -8.5%, -9.2%, -12%, and -6.3%, respectively (all P<.001). However, no significant reduction was observed in children aged 1-4 years (P=.22). Generally, the CAMR rate ratios for male versus female children, rural versus urban children, older infants versus neonates, and older children versus neonates were 1.18 (95% CI 1.08-1.30; P<.001), 1.20 (95% CI 1.08-1.32; P=.001), 0.66 (95% CI 0.59-0.73; P<.001), and 0.20 (95% CI 0.17-0.24; P<.001), respectively. Among all broad CA groups, circulatory system malformations, mainly deaths caused by congenital heart diseases, accounted for 49.4% (866/1753) of deaths and ranked first across all years, although it declined yearly with an AACR of -9.8% (P<.001). Deaths due to chromosomal abnormalities tended to grow in recent years, although the AACR was not significant (P=.90).
CONCLUSIONS: CAMR reduced annually, with cardiovascular malformations ranking first across all years in Zhejiang, China. Future research and practices should focus more on the prevention, early detection, long-term management of CAs and comprehensive support for families with children with CAs to improve their survival chances.