Lisonkova Sarka, Bartholomew Sharon, Rouleau Jocelyn, Liu Shiliang, Liston Robert M, Joseph K S
Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver BC.
Maternal and Infant Health Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa ON.
J Obstet Gynaecol Can. 2011 Oct;33(10):1011-1019. doi: 10.1016/S1701-2163(16)35050-2.
Vital Statistics and World Health Organization reports show a recent increase in maternal mortality in Canada. We carried out a study of temporal trends, regional variations, and causes of death in Canadian maternal mortality using Vital Statistics data.
We used Vital Statistics death registrations to ascertain maternal deaths between 1981 and 2007. Maternal mortality rates, risk ratios, and 95% confidence intervals were estimated, and the Cochran-Armitage test was used to evaluate temporal trends. We used hospitalization data from the Canadian Institute for Health Information from 1996 to 2007 to confirm maternal mortality trends observed in the Vital Statistics data.
Maternal mortality rates increased significantly from 4.5 (95% CI 3.3 to 5.8) in 1981 to 1983 to 4.7 (95% CI 3.5 to 6.2) in 1996 to 1998 and to 7.2 (95% CI 5.7 to 9.0) per 100 000 live births in 2005 to 2007 (P value for trend < 0.001). The most common causes of maternal death were diseases of the circulatory system, obstetric embolism (venous thromboembolism and amniotic fluid embolism), and hypertension. Deaths due to diseases of the circulatory system and puerperal infection increased significantly from 1981 to 2007. Maternal mortality rates in the hospitalization data were higher and did not show an increase over time. Provincial and territorial maternal mortality rates from Vital Statistics data showed varying degrees of under-ascertainment (12% to 70%) compared with hospitalization data.
Temporal increases in maternal mortality in Canada observed in Vital Statistics data do not correspond with stable temporal trends observed in hospitalization data, and appear to be an artefact of changes in the coding and ascertainment of maternal deaths.
人口动态统计数据和世界卫生组织的报告显示，加拿大近期孕产妇死亡率有所上升。我们利用人口动态统计数据，对加拿大孕产妇死亡的时间趋势、地区差异及死亡原因进行了研究。
我们通过人口动态统计死亡登记来确定1981年至2007年间的孕产妇死亡情况。估计了孕产妇死亡率、风险比及95%置信区间，并采用 Cochr an - Armitage检验评估时间趋势。我们使用了加拿大卫生信息研究所1996年至2007年的住院数据，以确认在人口动态统计数据中观察到的孕产妇死亡趋势。
孕产妇死亡率从1981年至1983年的4.5（95%置信区间3.3至5.8）显著上升至1996年至1998年的4.7（95%置信区间3.5至6.2），并在2005年至2007年达到每10万例活产7.2（95%置信区间5.7至9.0）（趋势P值<0.001）。孕产妇死亡的最常见原因是循环系统疾病、产科栓塞（静脉血栓栓塞和羊水栓塞）以及高血压。从1981年至2007年，循环系统疾病和产褥感染导致的死亡显著增加。住院数据中的孕产妇死亡率更高，且未显示随时间上升。与住院数据相比，人口动态统计数据中的省级和地区孕产妇死亡率存在不同程度的漏报（12%至70%）。
人口动态统计数据中观察到的加拿大孕产妇死亡率随时间上升的情况，与住院数据中观察到的稳定时间趋势不相符，似乎是孕产妇死亡编码和确定方式变化导致的假象。
