From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Obstet Gynecol. 2010 Mar;115(3):495-502. doi: 10.1097/AOG.0b013e3181d0c328.
To estimate trends in the rates of diagnosis and treatment of ectopic pregnancy in the United States.
We analyzed data from a large administrative claims database of more than 200 U.S. commercial health plans, and estimated time trends in the rate and incidence of ectopic pregnancy among girls and women aged 15-44 years by 5-year age groups and by region from 2002 to 2007. We also estimated time trends in the proportion of cases that were treated surgically, either by laparoscopy or laparotomy, or medically with methotrexate.
We identified 11,989 ectopic pregnancies during the period from 2002 to 2007. The overall rate of ectopic pregnancy among pregnant girls and women aged 15-44 years during the 6-year study period was 0.64%. We did not observe a trend in the rate of ectopic pregnancy by 5-year age group or by geographic region. The ectopic pregnancy rate increased with age; it was 0.3% among girls and women aged 15-19 years and 1.0% among women aged 35-44 years. Methotrexate treatment increased from 11.1% in 2002 to 35.1% in 2007 (P<.001); the methotrexate failure rate was 14.7% over the 6-year study period. Surgical management with laparotomy decreased over the study period from 40.0% to 33.1% (P<.001).
We did not find an increasing or decreasing trend in the rate of ectopic pregnancy among U.S. commercially insured women from 2002 to 2007. The use of administrative claims data are likely the most feasible method for estimating the rate and monitoring trends of ectopic pregnancy in the United States.
评估美国异位妊娠诊断和治疗率的变化趋势。
我们分析了来自美国 200 多家商业健康计划的大型行政索赔数据库中的数据，按年龄组（15-44 岁）和地区（2002 年至 2007 年）估算异位妊娠的发生率和发病率的时间趋势。我们还估算了经腹腔镜或剖腹手术或甲氨蝶呤药物治疗的病例比例的时间趋势。
我们在 2002 年至 2007 年期间确定了 11989 例异位妊娠。在 6 年的研究期间，15-44 岁孕妇中异位妊娠的总发生率为 0.64%。我们未观察到按 5 岁年龄组或地理区域划分的异位妊娠率的趋势。异位妊娠率随年龄增加而增加；15-19 岁女孩和 35-44 岁妇女的异位妊娠率分别为 0.3%和 1.0%。甲氨蝶呤治疗从 2002 年的 11.1%增加到 2007 年的 35.1%（P<.001）；6 年研究期间，甲氨蝶呤失败率为 14.7%。剖腹手术治疗在研究期间从 40.0%下降到 33.1%（P<.001）。
我们未发现 2002 年至 2007 年期间美国商业保险妇女异位妊娠率的上升或下降趋势。使用行政索赔数据可能是评估美国异位妊娠发生率和监测其趋势的最可行方法。
