Ectopic Pregnancy: Assessing Long-Term Trends in Rates and Risk Factors

宫外孕：评估发生率和风险因素的长期趋势

• 批准号: 7208541
• 负责人: DELIA SCHOLES
• 金额: $ 8.26万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7208541
• 关键词: Acute; Age; Ambulatory Care; Body of uterus; Canada; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chlamydia trachomatis; Condition; Contraceptive methods; Data; Data Analyses; Data Sources; Databases; Depth; Detection; Diagnosis; Ectopic Pregnancy; Evaluation; First Pregnancy Trimester; Future; Gonorrhea; Health Maintenance Organizations; Healthcare; Hospitalization; Hospitals; Incidence; Infection; Infertility; Inpatients; Intrauterine Devices; Investigation; Length of Stay; Live Birth; Managed Care; Maternal Age; Medical; Medical Surveillance; Methods; Modality; Monitor; Morbidity - disease rate; Numbers; Operative Surgical Procedures; Oral; Outcome; Outpatients; Patients; Patterns of Care; Population; Pregnancy; Pregnancy Rate; Prevention; Public Health; Rate; Records; Relative (related person); Reliance; Reporting; Research; Resources; Risk; Risk Factors; Sampling; Sexually Transmitted Diseases; Source; Sterilization for infection control; Surveys; Sweden; Time; Tubal sterilization; Woman; advanced maternal age; base; computerized; cost; disorder control; fetal; implantation; improved; mortality; national surveillance; programs; reproductive; time interval; trend; zygote

DESCRIPTION (provided by applicant): Ectopic pregnancy (EP), the implantation of a fertilized egg outside the uterine corpus, is a serious acute medical condition that also confers increased risk of substantial future reproductive morbidity, including subsequent ectopic pregnancy and infertility. The U.S. Centers for Disease Control and Prevention (CDC) documented a nearly 4-fold increase in EP occurrence between 1970 and 1989, from 4.5 to 16/1000 reported pregnancies. The most recent U.S. surveillance data, from 1992, estimate lower rates (11/1000 pregnancies), but the shift toward outpatient management of the condition and the reliance on hospitalization records for national surveillance compromise the accuracy of this estimate. Although sparse, available evidence indicates that EP rates may not be declining; and a number of important risk factors-including tubal sterilization, advanced maternal age and Chlamydia trachomatis and other asymptomatic sexually transmitted infections -have become increasingly common. As EP surveillance in the U.S. based on nationally representative sources has become untenable, it has been suggested that other surveillance strategies should be tried, including use of automated databases available at selected healthcare plans. The current application proposes to provide population-based data on long- term (is-year) trends in EP rates within a large U.S. health maintenance organization via analysis of data from an extensive set of administrative data sources. In addition to overall and age-specific trends over time, analyses will include evaluation of inpatient vs. outpatient management and medical vs. surgical treatment modalities. We will also document trends in potentially important etiologic factors during this same interval, including their occurrence among women with ectopic pregnancy. These analyses will provide data to: i) better assess the current status of ectopic pregnancy as a public health problem in the U.S.; 2) evaluate potential risk factors that may merit more in-depth investigation in future etiologic and prevention studies; and 3) provide case selection and programming approaches for establishing more widespread surveillance and evaluation of this condition by aggregating population-based data from healthcare settings with similar resources.

描述（由申请人提供）：异位妊娠（EP），即受精卵在子宫体外着床，是一种严重的急性医学疾病，也会增加未来生殖疾病的风险，包括随后的异位妊娠和不孕症。美国疾病控制和预防中心（CDC）记录了1970年至1989年间EP发生率增加了近4倍，从4.5/1000报告的妊娠增加到16/1000报告的妊娠。最新的美国监测数据，从1992年开始，估计率较低（11/1000怀孕），但转向门诊管理的条件和依赖住院记录的国家监测损害了这一估计的准确性。虽然稀少，现有的证据表明，EP率可能不会下降，和一些重要的风险因素，包括输卵管绝育，高龄产妇和沙眼衣原体和其他无症状性传播感染，已变得越来越普遍。由于在美国，基于全国代表性来源的EP监测已经站不住脚，因此建议尝试其他监测策略，包括使用选定医疗保健计划中可用的自动数据库。本申请提出通过分析来自大量管理数据源的数据，提供关于美国大型健康维护组织内EP率的长期（年）趋势的基于人群的数据。除了随时间推移的总体和特定年龄趋势外，分析还将包括对住院与门诊管理以及内科与外科治疗方式的评价。我们还将记录同一期间潜在重要病因因素的趋势，包括其在异位妊娠女性中的发生率。这些分析将提供数据：i）更好地评估异位妊娠作为美国公共卫生问题的现状; 2)评估潜在的危险因素，可能值得在未来的病因学和预防研究进行更深入的调查;和3）提供病例选择和编程方法，以建立更广泛的监测和评估这种情况下，通过汇总人口为基础的数据，从医疗机构与类似的资源。