Lindström Karolina, Winbladh Birger, Haglund Bengt, Hjern Anders
Karolinska Institute, Department of Clinical Sciences and Education, Sachs Children's Hospital, Stockholm, Sweden.
Pediatrics. 2007 Jul;120(1):70-7. doi: 10.1542/peds.2006-3260.
Increasing numbers of infants born preterm survive into adulthood. In this study, we analyzed the effect of having been born preterm on disability and vocational success in young adults.
A Swedish national cohort of 522,310 infants born in 1973-1979 were followed up for disabilities and income in national registers in 2002 at the age of 23 to 29. Hypotheses were tested in multivariate analysis with logistic regression models on the log scale for dichotomized outcomes and linear regression for continuous variables.
There was a stepwise increase in disability in young adulthood with increasing degree of preterm birth. A total of 13.2% of children born at 24 to 28 weeks' gestation and 5.6% born at 29 to 32 weeks' gestation received economic assistance from society because of handicap or persistent illness, which is equivalent to nearly 4 [corrected] times the risk of those born at term after adjustment for socioeconomic and perinatal confounders. Moderate (33-36 weeks' gestation) and marginal (37-38 weeks' gestation) preterm birth also carried significantly increased risks for disability and were responsible for 74% of the total disability associated with preterm birth. Preterm birth was associated with a lower chance of completing a university education and a lower net salary in a stepwise manner. The total economic gain for Swedish society, in terms of taxes and decreased costs for benefits, if all long-term effects of preterm birth could have been prevented in the birth cohorts in this study, would have amounted to 65 million euros in 2002 alone.
The majority of adults who were born very preterm lived an independent and self-supportive life. Moderately preterm birth carries a considerable risk for long-term impairment. There are strong economic incentives for secondary prevention of disability associated with preterm birth.
越来越多的早产儿存活至成年期。在本研究中，我们分析了早产对年轻成年人残疾和职业成就的影响。
对1973 - 1979年出生的522310名瑞典全国队列婴儿进行随访，通过国家登记系统获取他们在2002年23至29岁时的残疾和收入情况。采用多变量分析，对二分类结局使用对数尺度的逻辑回归模型进行假设检验，对连续变量使用线性回归。
成年期残疾率随早产程度增加而逐步上升。孕24至28周出生的儿童中有13.2%、孕29至32周出生的儿童中有5.6%因残疾或持续性疾病接受社会经济援助，经社会经济和围产期混杂因素调整后，这相当于足月儿风险的近4倍。中度早产（孕33 - 36周）和轻度早产（孕37 - 38周）也显著增加了残疾风险，且占早产相关残疾总数的74%。早产与完成大学教育的可能性降低以及净工资逐步减少相关。就税收和福利成本降低而言，如果本研究中出生队列的早产所有长期影响都能得到预防，仅在2002年瑞典社会的总经济收益就将达到6500万欧元。
大多数极早产儿成年后能够独立生活并自给自足。中度早产有相当大的长期损害风险。对于与早产相关的残疾进行二级预防有很强的经济激励因素。
