Determinants of survival in children with congenital abnormalities: A long-term population-based cohort study
Determinants of survival in children with congenital abnormalities: A long-term population-based cohort study
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DOI：
10.1002/bdra.20218
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发表时间：
2006-01-01
影响因子：
--
通讯作者：
Dodds, L
中科院分区：
文献类型：
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作者：
Agha, MM;Williams, JI;Dodds, L
背景：今天，由于医疗保健的改善，更多的先天缺陷儿童在幼儿期存活下来；然而，关于这一人群的长期死亡率和生存率的信息很少。特别是，目前尚不清楚除了出生缺陷外，其他出生特征是否对他们的死亡率有任何影响。方法：对两组有或无出生缺陷的儿童进行了长达17年的随访。对1979年至1986年间在安大略省出生的4.5万多名有先天缺陷的儿童和4.5万名没有先天缺陷的儿童进行了跟踪调查。在整个研究期间，比较两个队列的长期生存率和死亡风险。研究人员还检查了出生特征，以确定其对死亡风险的影响。结果：研究期间分别记录有出生缺陷儿童和无出生缺陷儿童的死亡病例3620例和301例，有出生缺陷儿童的死亡率高出13倍（相对危险度[RR]， 12.9, 95%可信区间[CI]， 12.1-13.7）。出生缺陷组的死亡率即使在10-15年后仍然较高。在两组中，低胎龄和低出生体重的儿童死亡风险更高。缺陷数量与死亡风险之间存在很强的剂量-反应关系。结论：先天畸形儿童在其一生中面临许多挑战。即使他们在出生后第一年的高死亡率风险中幸存下来，他们在今后几年仍将面临相当高的死亡风险。除了出生缺陷外，其他出生特征在他们的死亡率中也起着独立的作用。这些指标可用于识别高危儿童。
BACKGROUND: Today more children with birth defects survive early childhood because of improved medical care; however, little information is available about patterns of long-term mortality and survival in this population. In particular, it is not clear whether other birth characteristics, apart from birth defects, have any role in their mortality. METHODS: Two large cohorts of children with and without birth defects were followed for up to 17 years. More than 45,000 children with birth defects, and 45,000 matched children without birth defects born in Ontario between 1979 and 1986 were followed. Throughout the study period long-term survival rates and the risk of death were compared between the 2 cohorts. Birth characteristics were also examined to determine their effect on the risk of death. RESULTS: During the study the deaths of 3620 and 301 children with and without birth defects, respectively, were recorded, indicating that those with birth defects had a 13 times higher rate of mortality (relative risk [RR], 12.9, 95% confidence interval [CI], 12.1-13.7). Mortality rates in the birth-defects cohort remained higher even after 10-15 years. In both groups children of low gestational age and low birth weight had a higher risk of death. There was a strong dose-response relationship between the number of defects and the risk of death. CONCLUSIONS: Children born with abnormalities face many challenges throughout their lifetimes. If they survive the high mortality risk of the first year of life, they still have to face the considerably higher risk of death in the years to come. In addition to birth defects, other birth characteristics play an independent role in their mortality. These indicators could be used to identify high-risk children.