Anthony Sabine, Jacobusse Gert W, van der Pal-de Bruin Karin M, Buitendijk Simone, Zeitlin Jennifer
TNO Quality of Life, Department of Reproduction and Perinatology, Leiden, the Netherlands.
Paediatr Perinat Epidemiol. 2009 Jul;23(4):292-300. doi: 10.1111/j.1365-3016.2009.01044.x.
Perinatal mortality rates differ markedly between countries in Europe. If population characteristics, such as maternal age, parity or multiple births, contribute to these differences, standardised rates may be useful for international comparisons of health status and especially quality of care. This analysis used aggregated population-based data on fetal and neonatal mortality stratified by maternal age, parity and multiple birth from 12 countries participating in the EURO-PERISTAT project to explore this question. Adjusted odds ratios were computed for fetal and neonatal mortality and tested for inter-country heterogeneity; standardised mortality rates were calculated using a direct standardisation method. There were wide variations in fetal and neonatal mortality rates, from 3.3 to 7.1 and 2.0 to 6.0 per 1000 total and livebirths, respectively, and in the prevalence of mothers over 35 (7-22%), primiparae (41-50%) and multiple births (2-4%). These population characteristics had a significant association with mortality, although results were less consistent for primiparity. Odds ratios for older mothers and primiparae showed significant inter-country heterogeneity. The association between maternal age and fetal mortality declined as the prevalence of older mothers in the population increased. Standardised rates did not substantially change inter-country rankings and demographic characteristics did not explain the higher mortality observed in some countries. Our results do not support the use of mortality rates standardised for age, parity and multiple births for international comparisons of quality of care. Further research should explore why the negative effects of older maternal age decrease as delayed childbearing becomes more common and, in particular, whether this is due to changes in the social characteristics of older mothers or in health care provision.
欧洲各国的围产期死亡率存在显著差异。如果诸如产妇年龄、胎次或多胞胎等人口特征导致了这些差异，那么标准化率可能有助于进行健康状况尤其是医疗质量的国际比较。本分析使用了参与欧洲围产期统计（EURO-PERISTAT）项目的12个国家基于人群的汇总数据，这些数据按产妇年龄、胎次和多胞胎对胎儿和新生儿死亡率进行了分层，以探讨这一问题。计算了胎儿和新生儿死亡率的调整比值比，并检验了国家间的异质性；使用直接标准化方法计算了标准化死亡率。胎儿和新生儿死亡率差异很大，每1000例总出生和活产中分别为3.3至7.1以及2.0至6.0，35岁以上母亲、初产妇和多胞胎的患病率也存在差异（分别为7%-22%、41%-50%和2%-4%）。这些人口特征与死亡率存在显著关联，尽管初产情况的结果不太一致。高龄母亲和初产妇的比值比显示出显著的国家间异质性。随着人群中高龄母亲患病率的增加，产妇年龄与胎儿死亡率之间的关联减弱。标准化率并没有实质性改变国家间的排名，人口特征也无法解释一些国家观察到的较高死亡率。我们的结果不支持使用按年龄、胎次和多胞胎标准化的死亡率进行医疗质量的国际比较。进一步的研究应探讨为何随着晚育变得更加普遍，高龄产妇的负面影响会减弱，特别是这是否是由于高龄母亲社会特征的变化或医疗保健服务的变化。
