Preterm birth and mortality and morbidity: a population-based quasi-experimental study.
Preterm birth and mortality and morbidity: a population-based quasi-experimental study.
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DOI：
10.1001/jamapsychiatry.2013.2107
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发表时间：
2013-11
期刊：
影响因子：
25.8
通讯作者：
Lichtenstein, Paul
中科院分区：
文献类型：
--
作者：
D'Onofrio, Brian M.;Class, Quetzal A.;Rickert, Martin E.;Larsson, Henrik;Langstrom, Niklas;Lichtenstein, Paul
早产与死亡率和发病率的增加有关。然而，以前的研究一直无法严格检查是否混杂因素导致这些协会，而不是早产的有害影响。通过使用准实验设计、同胞比较方法和控制家庭内变化的统计协变量，估计早期胎龄与后代死亡率和发病率之间的关联在多大程度上是由于混淆所致。一项基于人群的队列研究，结合瑞典登记处，以确定1973-2008年在瑞典出生的所有个体（n= 3，300，708名1，736，735名母亲的后代），并将其与多种结果联系起来。到2009年，后代死亡率（婴儿期和整个青年期）和精神病（精神病或躁郁症、自闭症、多动症、自杀企图、药物使用和犯罪）、学术（成绩不及格和教育程度）和社会（伴侣关系、父母身份、低收入、社会福利）结果。在人群中，早期妊娠和结局指标之间存在剂量-反应关系。例如，极端早产（妊娠23-27周）与婴儿死亡率相关（OR=288.1，95%CI =271.7-305.5），孤独症（HR=3.2，CI=2.6-4.0），教育程度低（HR=1.7，CI=1.5-2.0）和社会福利（HR=1.3，CI=1.2-1.5）与足月出生的后代相比。当比较不同暴露的兄弟姐妹并控制统计协变量时，早期妊娠与死亡率和精神病发病率之间的关联通常是稳健的，而与学术和一些社会问题的关联在固定效应模型中大大或完全减弱。早产与死亡率和发病率之间的联系机制是结果特异性的。早产与死亡率和精神病发病率之间的关联在很大程度上独立于共享的家族性混淆和测量的协变量，符合因果推断。然而，一些关联，特别是预测自杀未遂、教育程度和社会福利的关联，是由于混杂因素造成的。
Preterm birth is associated with increased mortality and morbidity. However, previous studies have been unable to rigorously examine whether confounding factors cause these associations rather than the harmful effects of being born preterm. To estimate the extent to which the associations between early gestational age and offspring mortality and morbidity were due to confounds by using a quasi-experimental design, the sibling-comparison approach, and controlling for statistical covariates that varied within families. A population-based cohort study, combining Swedish registries to identify all individuals born in Sweden from 1973–2008 (n=3,300,708 offspring of 1,736,735 mothers) and link them with multiple outcomes. Offspring mortality (during infancy and throughout young adulthood) and psychiatric (psychotic or bipolar disorder, autism, ADHD, suicide attempts, substance use, and criminality), academic (failing grades and educational attainment), and social (partnering, parenthood, low income, social welfare benefits) outcomes through 2009. In the population, there was a dose-response relation between early gestation and the outcome measures. For instance, extreme preterm birth (23–27 weeks of gestation) was associated with infant mortality (OR=288.1, 95% CI=271.7–305.5), autism (HR=3.2, CI=2.6–4.0), low educational attainment (HR=1.7, CI=1.5–2.0), and social welfare benefits (HR=1.3, CI=1.2–1.5) compared to offspring born at term. The associations between early gestation and mortality and psychiatric morbidity generally were robust when comparing differentially exposed siblings and controlling for statistical covariates, whereas the associations with academic and some social problems were greatly or completely attenuated in the fixed effects models. The mechanisms responsible for the associations between preterm birth and mortality and morbidity are outcome-specific. Associations between preterm birth and mortality and psychiatric morbidity were largely independent of shared familial confounds and measured covariates, consistent with a causal inference. Some associations, particularly predicting suicide attempt, educational attainment, and social welfare benefits were due to confounding factors, however.
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影响因子：
--
作者：
D'Onofrio, Brian M.;Singh, Amber L.;Iliadou, Anastasia;Lambe, Mats;Hultman, Christina M.;Grann, Martin;Neiderhiser, Jenae M.;Langstrom, Niklas;Lichtenstein, Paul
通讯作者：
Lichtenstein, Paul
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120.7
作者：
Blennow, Mats;Ewald, Uwe;Stromberg, Bo
通讯作者：
Stromberg, Bo
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5
作者：
Boyd, Heather A.;Poulsen, Gry;Melbye, Mads
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Melbye, Mads
影响因子：
4.6
作者：
D'Onofrio BM;Singh AL;Iliadou A;Lambe M;Hultman CM;Neiderhiser JM;Långström N;Lichtenstein P
通讯作者：
Lichtenstein P
影响因子：
3.7
作者：
Idring S;Rai D;Dal H;Dalman C;Sturm H;Zander E;Lee BK;Serlachius E;Magnusson C
通讯作者：
Magnusson C