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

描述(申请人提供)：异位妊娠(EP)，即在子宫体外植入受精卵，是一种严重的急性疾病，也增加了未来大量生殖疾病的风险，包括随后的异位妊娠和不孕不育。美国疾病控制和预防中心(CDC)的记录显示，1970年至1989年间，EP的发生率增加了近4倍，从4.5%上升到16/1000。美国自1992年以来的最新监测数据估计，怀孕率较低(11/1000)，但转向门诊管理病情和依赖住院记录进行国家监测损害了这一估计的准确性。虽然数量不多，但现有证据表明，EP率可能没有下降；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--已经变得越来越普遍。由于美国基于全国代表性来源的EP监测已变得站不住脚，有人建议应尝试其他监测策略，包括使用选定医疗计划中提供的自动数据库。当前的应用程序建议通过分析来自广泛的管理数据源的数据来提供关于美国大型健康维护组织内EP率的长期(IS年)趋势的基于人口的数据。除了随着时间的推移总体和特定年龄的趋势外，分析还将包括对住院患者与门诊患者管理以及内科与外科治疗方式的评估。我们还将记录在同一时间段内潜在重要病因的趋势，包括它们在异位妊娠妇女中的发生。这些分析将提供数据，以：i)更好地评估异位妊娠在美国作为一个公共健康问题的当前状况；2)评估在未来的病因学和预防研究中可能值得更深入调查的潜在风险因素；以及3)通过汇总来自具有类似资源的医疗保健机构的基于人群的数据，为建立对这种情况的更广泛的监测和评估提供病例选择和规划方法。

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.