National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys.
National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys.
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DOI：
10.1371/journal.pmed.1001356
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发表时间：
2012
期刊：
影响因子：
15.8
通讯作者：
Stevens GA
中科院分区：
文献类型：
--
作者：
Mascarenhas MN;Flaxman SR;Boerma T;Vanderpoel S;Stevens GA
Gretchen Stevens及其同事利用人口生殖健康调查的信息来估计1990年至2010年间全球、地区和国家层面的不孕症模式和趋势。需要对不孕症的患病率和趋势进行全球、区域和国家估计，以确定预防和治疗工作的目标。通过对发达国家和发展中国家的人口和生殖调查应用一致的算法，我们按国家和地区估计1990年至2010年的不孕症患病率和趋势。我们使用一致的算法来计算不孕症，访问并分析了277项人口和生殖健康调查的家庭调查数据。我们采用人口统计学的不孕症测量方法，以活产为结果，并根据结合状况、避孕药具的使用和对孩子的渴望进行5年的暴露期。我们纠正了由于使用关于过去的结合状态和避孕措施使用的不完整信息而产生的偏差。我们使用贝叶斯层次模型来估计190个国家和地区的不孕症患病率和趋势。2010年，在面临怀孕风险的20-44岁妇女中，1.9%（95%不确定区间为1.7%,2.2%）无法活产（原发性不孕症）。在至少有一次活产并有怀孕风险的妇女中，10.5%（9.5%,11.7%）无法生育另一个孩子（继发性不孕）。南亚、撒哈拉以南非洲、北非/中东、中欧/东欧和中亚的不孕症患病率最高。2010年世界大多数地区的不孕症水平与1990年相似，除了撒哈拉以南非洲的原发性和继发性不孕症和南亚的原发性不孕症下降（后验概率[pp]≥0.99）。尽管在大多数地区暴露于怀孕风险的妇女中，不孕症患病率没有统计学上的显著变化，但从1990年到2010年，寻求儿童行为的减少导致所有妇女的原发性不孕症发生率从1.6%降至1.5% (pp = 0.90)，所有妇女的继发性不孕症发生率从3.9%降至3.0% （pp>0.99）。然而，由于人口增长，受不孕症影响的夫妇的绝对数量从1990年的4200万（3960万，4480万）增加到2010年的4850万（4500万，5260万）。该研究的局限性包括一些国家的调查数据存在差距，以及使用代理来确定妊娠暴露。我们分析了人口统计和生殖家庭调查数据，以揭示全球不孕症的模式和趋势。除了在撒哈拉以南非洲和南亚地区，我们发现除了人口增长和世界范围内首选儿童数量的下降之外，几乎没有证据表明20年来不孕症发生了变化。需要进一步研究以确定这些模式和趋势的病因。生殖健康是全球卫生的一个优先领域：千年发展目标5B的具体目标是到2015年普及生殖健康服务。监测实现这一目标进展情况的指标是避孕普及率、青少年生育率、产前保健覆盖率和未满足的计划生育需求。不孕症，即在长时间（不同定义的时间长短不同）无保护性交后无法怀孕，是生殖健康的一个关键但却被忽视的方面。不能生育影响着世界各地的夫妇，并给男性和女性造成情感和心理上的困扰。许多因素——包括生理的、遗传的、环境的和社会的——导致不孕症。据世界卫生组织称，性传播疾病或生殖道感染造成的不孕不育问题在非洲和拉丁美洲尤为严重。研究人员使用了一种统一的不孕症测量方法，将活产作为感兴趣的结果（因为这一信息比怀孕更常见），五年的“暴露期”，也就是说，五年的亲密关系，不使用避孕措施，想要一个孩子（正如研究人员计算的那样，这段时间是必要的，以适应怀孕和生孩子的时间，并考虑到不完整的无保护性交频率的信息）。研究人员使用一种统计模型（贝叶斯分层模型），利用从国家人口和生殖健康调查收集的信息，对1990年至2010年期间190个国家的不孕症水平和趋势进行了估计。南亚和撒哈拉以南非洲的数据最多。研究人员发现，2010年，1.9%的20-44岁想要孩子的女性无法生育第一次活产（原发性不孕症），10.5%之前活产过的女性无法再生育一次（继发性不孕症）。研究人员发现，1990年和2010年的不孕症水平相似，原发性不孕症总体上略有下降（0.1%，但撒哈拉以南非洲和南亚的下降更为明显），继发性不孕症总体上略有增加（0.4%）。年龄影响不孕症发生率：20-24岁妇女的原发性不孕症患病率高于年龄较大的妇女。这种年龄模式是相反的，在继发性不孕症中更为明显。想要孩子的妇女的原发性不孕率也因地区而异，从2010年拉丁美洲和加勒比地区的1.5%到北非和中东的2.6%。除少数例外，全球和国家继发性不孕症的模式与原发性不孕症相似。这些发现表明，2010年，全世界估计有4850万对夫妇在结婚5年后无法生育孩子。然而，这些发现也表明，全球原发性和继发性不孕症的水平在1990年至2010年间几乎没有变化。值得注意的是，基于怀孕能力（而不是活产——本研究中使用的结果）的不孕症测量可能显示出不同程度的不孕症，并且使用比本研究中使用的5年更短的暴露期会产生更高的不孕症率。然而，由于缺乏关于怀孕时间的广泛数据收集，本研究中使用的方法和结果为了解全球、区域和国家的不孕症模式和趋势提供了有用的见解。请通过本摘要的在线版本（http://dx.doi.org/10.1371/journal.pmed.1001356）访问这些网站。世界卫生组织有关于生殖健康的信息，维基百科定义了不孕症，并提供了一些有用的信息（请注意，维基百科是一个免费的在线百科全书，任何人都可以编辑），关于不孕症的患者友好信息可以在PubMed Health和NHS Choices上找到
Gretchen Stevens and colleagues use information from demographic reproductive health surveys to estimate the global, regional, and country levels, patterns, and trends in infertility between 1990 and 2010. Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region. We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20–44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] ≥0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp = 0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy. We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends. Please see later in the article for the Editors' Summary Reproductive health is a priority global health area: the target for Millennium Development Goal 5B is to provide universal access to reproductive health by 2015. The indicators for monitoring progress in reaching this target are contraceptive prevalence rate, adolescent birth rate, antenatal care coverage, and the unmet need for family planning. Infertility, the inability to conceive after a prolonged period (the length of time varies in different definitions) of unprotected intercourse, is a critical but much neglected aspect of reproductive health. The inability to have children affects couples worldwide and causes emotional and psychological distress in both men and women. Many factors—including physiological, genetic, environmental, and social— contribute to infertility. According to the World Health Organization, infertility resulting from sexually transmitted diseases or reproductive tract infections is particularly problematic in Africa and Latin America. The researchers used a uniform measure of infertility that incorporated live birth as the outcome of interest (as this information is more commonly reported than pregnancies), a five-year “exposure period,” that is, a five-year period of being in an intimate relationship, not using contraceptives, and wanting a child (as the researchers calculated that this period was necessary to accommodate the time it takes to become pregnant and have a child, and to allow for incomplete information on frequency of unprotected intercourse). The researchers used a statistical model (Bayesian hierarchical model) to generate estimates for levels and trends of infertility in 190 countries over the time period 1990 to 2010 using information collected from national demographic and reproductive health surveys. The most data was available for South Asia and Sub-Saharan Africa. The researchers found that in 2010, 1.9% of women aged 20–44 years who wanted to have children were unable to have their first live birth (primary infertility), and 10.5% of women with a previous live birth were unable to have an additional live birth (secondary infertility). The researchers found that the levels of infertility were similar in 1990 and 2010, with only a slight overall decrease in primary infertility (0.1%, but with a more pronounced drop in Sub-Saharan Africa and South Asia) and a modest overall increase in secondary infertility (0.4%). Age affected infertility rates: the prevalence of primary infertility was higher among women aged 20–24 years than among older women. The age pattern was reversed and even more pronounced for secondary infertility. And primary infertility rates among women wanting children also varied by region, from 1.5% in Latin America and the Caribbean in 2010, to 2.6% in North Africa and the Middle East. With a few exceptions, global and country patterns of secondary infertility were similar to those of primary infertility. These findings suggest that in 2010, an estimated 48.5 million couples worldwide were unable to have a child after five years. However, these findings also suggest that global levels of primary and secondary infertility hardly changed between 1990 and 2010. It is important to note that an infertility measure based on ability to become pregnant (rather than having a live birth—the outcome used in this study) may show different levels of infertility, and using an exposure period shorter than the five years used in this study would produce higher rates of infertility. However, because of the lack of widespread data collection on time to pregnancy, the methods used and results shown in this study provide useful insights into global, regional, and country patterns and trends in infertility. Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001356. The World Health Organization has information on reproductive health Wikipedia defines infertility and gives some useful information (note that Wikipedia is a free online encyclopedia that anyone can edit) Patient friendly information on infertility can be found at PubMed Health and NHS Choices
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DOI：
10.2471/blt.10.011210
发表时间：
2010-12-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
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作者：
通讯作者：
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影响因子：
168.9
作者：
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影响因子：
2.1
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通讯作者：
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影响因子：
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Ding, Qu Jian;Hesketh, Therese
通讯作者：
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