Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations.
Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations.
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DOI：
10.1001/jamanetworkopen.2020.32779
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发表时间：
2021-01-04
影响因子：
13.8
通讯作者：
Sandin S
中科院分区：
文献类型：
--
作者：
Risnes K;Bilsteen JF;Brown P;Pulakka A;Andersen AN;Opdahl S;Kajantie E;Sandin S
与足月出生的成年人相比，早产和早产成年人的全因和非传染性疾病 (NCD) 死亡率风险是否更高？这项对来自 4 个北欧出生队列的超过 610 万人进行的队列研究发现，所有程度的早产和早产都与成人过早死亡的风险增加相关。与妊娠期较短相关的超额死亡率在心血管疾病、慢性肺病和糖尿病等非传染性疾病所致死亡中尤为明显。这些研究结果表明，与妊娠期较短相关的早期成人死亡率增加，包括大量早产晚期和早产成年人的风险过高，并且对于非传染性疾病死亡尤为明显。这项队列研究调查了 4 个北欧国家早产和早产的年轻人全因和非传染性疾病死亡的风险。完全妊娠前出生的个体的长期不良后果不仅限于极端胎龄出生的个体。对于接近理想妊娠数周出生的个体的死亡率模式知之甚少，而且确切原因也不清楚；这两者对于公共卫生都至关重要，并且有可能改变风险。旨在检查早产和早产的年轻人全因疾病和非传染性疾病 (NCD) 死亡的风险。这项基于跨国人群的队列研究使用了来自挪威、瑞典、丹麦和芬兰的全国出生队列，针对 1967 年至 2002 年之间出生的个体。对出生时确定的未死亡或移民的个体从 15 岁到 2017 年的死亡率进行了随访。分析从 2019 年 6 月到 2020 年 5 月进行。胎龄类别（即中度早产及早期 [23-33 周]、晚期早产） [34-36 周]、早期 [37-38 周]、足月 [39-41 周] 和后期 [42-44 周]）。非传染性疾病（NCD）的全因死亡率和特定原因死亡率，定义为癌症、糖尿病、慢性肺病和心血管疾病 (CVD)。从 15 岁起，总共对 6 263 286 人的死亡率进行了随访。总体而言，339 403 (5.4%) 人早产，其中 3 049 100 (48.7%) 是女性。与足月出生相比，中度早产及更早早产的全因死亡率调整后风险比 (aHR) 为 1.44 (95% CI，1.34-1.55)；晚期早产为 1.23（95% CI，1.18-1.29）；早产的值为 1.12（95% CI，1.09-1.15）。女性胎龄与全因死亡率之间的相关性强于男性（交互作用 P = .03）。早产与 CVD（aHR，1.89；95% CI，1.45-2.47）、糖尿病（aHR，1.98；95% CI，1.44-2.73）和慢性肺病（aHR，2.28；95% CI，1.36-3.82）死亡风险增加 2 倍相关。主要关联在各国之间重复出现，并且不能用家庭或个人混杂因素来解释。这项研究的结果强化了早产年轻人死于非传染性疾病的风险增加的证据。重要的是，从孕龄到理想足月日期，死亡风险均有所增加，其中包括更多的早产群体。与较短胎龄相关的超额死亡率在心血管疾病、慢性肺病和糖尿病中最为明显。
Are all-cause and noncommunicable disease (NCD) mortality risks higher amomg adults born preterm and early term compared with those born at full term? This cohort study of more than 6.1 million individuals from 4 Nordic birth cohorts provided found all degrees of preterm birth and early-term birth are associated with increased risk of premature adult death. Excess mortality associated with shorter gestation was pronounced for death from NCDs, such as cardiovascular diseases, chronic lung disease, and diabetes. These findings suggest that increased early adult mortality associated with shorter gestation includes excess risk in the large group of adults born late preterm and early term and is pronounced for NCD deaths. This cohort study examines the risk of all-cause and noncommunicable disease deaths among young adults born preterm and early term in 4 Nordic countries. Adverse long-term outcomes in individuals born before full gestation are not confined to individuals born at extreme gestational ages. Little is known regarding mortality patterns among individuals born in the weeks close to ideal gestation, and the exact causes are not well understood; both of these are crucial for public health, with the potential for modification of risk. To examine the risk of all-cause and noncommunicable diseases (NCD) deaths among young adults born preterm and early term. This multinational population-based cohort study used nationwide birth cohorts from Norway, Sweden, Denmark, and Finland for individuals born between 1967 and 2002. Individuals identified at birth who had not died or emigrated were followed up for mortality from age 15 years to 2017. Analyses were performed from June 2019 to May 2020. Categories of gestational age (ie, moderate preterm birth and earlier [23-33 weeks], late preterm [34-36 weeks], early term [37-38 weeks], full term [39-41 weeks] and post term [42-44 weeks]). All-cause mortality and cause-specific mortality from NCD, defined as cancer, diabetes, chronic lung disease, and cardiovascular disease (CVD). A total of 6 263 286 individuals were followed up for mortality from age 15 years. Overall, 339 403 (5.4%) were born preterm, and 3 049 100 (48.7%) were women. Compared with full-term birth, the adjusted hazard ratios (aHRs) for all-cause mortality were 1.44 (95% CI, 1.34-1.55) for moderate preterm birth and earlier; 1.23 (95% CI, 1.18-1.29) for late preterm birth; and 1.12 (95% CI, 1.09-1.15) for early-term birth. The association between gestational age and all-cause mortality were stronger in women than in men (P for interaction = .03). Preterm birth was associated with 2-fold increased risks of death from CVD (aHR, 1.89; 95% CI, 1.45-2.47), diabetes (aHR, 1.98; 95% CI, 1.44-2.73), and chronic lung disease (aHR, 2.28; 95% CI, 1.36-3.82). The main associations were replicated across countries and could not be explained by familial or individual confounding factors. The findings of this study strengthen the evidence of increased risk of death from NCDs in young adults born preterm. Importantly, the increased death risk was found across gestational ages up to the ideal term date and includes the much larger group with early-term birth. Excess mortality associated with shorter gestational age was most pronounced for CVDs, chronic lung disease, and diabetes.
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影响因子：
37.8
作者：
Lawlor, DA;Ronalds, G;Leon, DA
通讯作者：
Leon, DA
影响因子：
37.8
作者：
Kaijser, Magnus;Bonamy, Anna-Karin Edstedt;Ekbom, Anders
通讯作者：
Ekbom, Anders
影响因子：
13.6
作者：
Brooke HL;Talbäck M;Hörnblad J;Johansson LA;Ludvigsson JF;Druid H;Feychting M;Ljung R
通讯作者：
Ljung R
影响因子：
25.8
作者：
D'Onofrio, Brian M.;Class, Quetzal A.;Rickert, Martin E.;Larsson, Henrik;Langstrom, Niklas;Lichtenstein, Paul
通讯作者：
Lichtenstein, Paul
影响因子：
2.2
作者：
Lahti, RA;Penttilä, A
通讯作者：
Penttilä, A