Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis.
Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis.
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DOI：
10.1136/bmj.f6564
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发表时间：
2013-11-07
期刊：
影响因子：
--
通讯作者：
Wapner RJ
中科院分区：
文献类型：
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作者：
Ananth CV;Keyes KM;Wapner RJ
目的评估生物老化、历史趋势和出生队列效应对美国先兆子痫趋势的影响。设计基于人群的回顾性研究。1980-2010年美国国家医院出院调查数据集。1.2亿妇女入院分娩。主要结果测量轻度和重度先兆子痫发生率的时间变化与母亲年龄、分娩年份和出生队列的关系。Poisson回归以及多层次年龄阶段队列模型，调整肥胖和吸烟。结果子痫前期发生率为3.4%。年龄-时期-队列分析显示出强烈的年龄效应，处于母亲年龄的极端女性患先兆子痫的风险最大。与1980年分娩的妇女相比，2003年分娩的妇女患重度先兆子痫的风险增加了6.7倍（95%置信区间为5.6倍至8.0倍）。2003年以后，期间效应下降。严重先兆子痫的趋势也显示出适度的出生队列效应，20世纪70年代出生的妇女风险增加。与1955年出生的女性相比，1970年出生的女性的风险比为1.2（95%置信区间为1.1至1.3）。轻度先兆子痫也有类似的模式，尽管减弱。肥胖和吸烟人群患病率的变化与先兆子痫的时期和队列趋势相关，但不能解释这些趋势。结论：在美国，重度子痫前期的发病率一直在增加，年龄-时期-队列效应都促成了这些趋势。虽然吸烟和肥胖推动了这些趋势，但诊断标准的变化也可能导致年龄-时期-队列效应。美国肥胖率上升的健康后果强调，减少肥胖的努力可能有利于孕产妇和围产期健康。
Objective To estimate the contributions of biological aging, historical trends, and birth cohort effects on trends in pre-eclampsia in the United States. Design Population based retrospective study. Setting National hospital discharge survey datasets, 1980-2010, United States. Participants 120 million women admitted to hospital for delivery. Main outcome measures Temporal changes in rates of mild and severe pre-eclampsia in relation to maternal age, year of delivery, and birth cohorts. Poisson regression as well as multilevel age-period-cohort models with adjustment for obesity and smoking were incorporated. Results The rate of pre-eclampsia was 3.4%. The age-period-cohort analysis showed a strong age effect, with women at the extremes of maternal age having the greatest risk of pre-eclampsia. In comparison with women delivering in 1980, those delivering in 2003 were at 6.7-fold (95% confidence interval 5.6-fold to 8.0-fold) increased risk of severe pre-eclampsia. Period effects declined after 2003. Trends for severe pre-eclampsia also showed a modest birth cohort effect, with women born in the 1970s at increased risk. Compared with women born in 1955, the risk ratio for women born in 1970 was 1.2 (95% confidence interval 1.1 to 1.3). Similar patterns were also evident for mild pre-eclampsia, although attenuated. Changes in the population prevalence of obesity and smoking were associated with period and cohort trends in pre-eclampsia but did not explain the trends. Conclusions Rates of severe pre-eclampsia have been increasing in the United States and age-period-cohort effects all contribute to these trends. Although smoking and obesity have driven these trends, changes in the diagnostic criteria may have also contributed to the age-period-cohort effects. Health consequences of rising obesity rates in the United States underscore that efforts to reduce obesity may be beneficial to maternal and perinatal health.