Loane Maria, Dolk Helen, Kelly Alan, Teljeur Conor, Greenlees Ruth, Densem James
EUROCAT Central Registry, Centre for Maternal, Fetal, and Infant Research, University of Ulster, Newtownabbey, Co Antrim, Northern Ireland, United Kingdom.
Birth Defects Res A Clin Mol Teratol. 2011 Mar;91 Suppl 1:S31-43. doi: 10.1002/bdra.20778. Epub 2011 Mar 4.
As part of EUROCAT's surveillance of congenital anomalies in Europe, a statistical monitoring system has been developed to detect recent clusters or long-term (10 year) time trends. The purpose of this article is to describe the system for the identification and investigation of 10-year time trends, conceived as a "screening" tool ultimately leading to the identification of trends which may be due to changing teratogenic factors.
The EUROCAT database consists of all cases of congenital anomalies including livebirths, fetal deaths from 20 weeks gestational age, and terminations of pregnancy for fetal anomaly. Monitoring of 10-year trends is performed for each registry for each of 96 non-independent EUROCAT congenital anomaly subgroups, while Pan-Europe analysis combines data from all registries. The monitoring results are reviewed, prioritized according to a prioritization strategy, and communicated to registries for investigation. Twenty-one registries covering over 4 million births, from 1999 to 2008, were included in monitoring in 2010.
Significant increasing trends were detected for abdominal wall anomalies, gastroschisis, hypospadias, Trisomy 18 and renal dysplasia in the Pan-Europe analysis while 68 increasing trends were identified in individual registries. A decreasing trend was detected in over one-third of anomaly subgroups in the Pan-Europe analysis, and 16.9% of individual registry tests. Registry preliminary investigations indicated that many trends are due to changes in data quality, ascertainment, screening, or diagnostic methods. Some trends are inevitably chance phenomena related to multiple testing, while others seem to represent real and continuing change needing further investigation and response by regional/national public health authorities.
作为欧洲先天性异常监测（EUROCAT）项目在欧洲开展监测工作的一部分，已开发出一种统计监测系统，用于检测近期的聚集性病例或长期（10年）时间趋势。本文旨在描述该用于识别和调查10年时间趋势的系统，该系统被视为一种“筛查”工具，最终用于识别可能由致畸因素变化导致的趋势。
EUROCAT数据库包含所有先天性异常病例，包括活产儿、孕20周及以后的死胎，以及因胎儿异常而终止妊娠的情况。对96个非独立的EUROCAT先天性异常亚组中的每一个，在每个登记处进行10年趋势监测，而泛欧洲分析则整合了所有登记处的数据。对监测结果进行审查，根据优先排序策略确定优先级，并传达给各登记处进行调查。2010年的监测纳入了21个登记处，涵盖1999年至2008年期间超过400万例出生情况。
在泛欧洲分析中，腹壁异常、腹裂、尿道下裂、18三体综合征和肾发育不良呈现出显著的上升趋势，而在各个登记处共识别出68种上升趋势。在泛欧洲分析中，超过三分之一的异常亚组以及16.9%的各登记处检测呈现下降趋势。登记处的初步调查表明，许多趋势是由于数据质量、确诊、筛查或诊断方法的变化所致。一些趋势不可避免地是与多次检验相关的偶然现象，而其他一些趋势似乎代表着真实且持续的变化，需要区域/国家公共卫生当局进一步调查并做出应对。
