Kudish Bela I, Iglesia Cheryl B, Gutman Robert E, Sokol Andrew I, Rodgers Allison K, Gass Marjery, O'Sullivan Mary Jo, Larson Joseph, Abu-Sitta Moeen, Howard Barbara V
From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Washington Hospital Center, Washington, DC; †Department of Obstetrics and Gynecology, UT Health Science Center, San Antonio, TX; ‡Executive Director Designate, North American Menopause Society, Mayfield Heights, OH; §Department of Obstetrics and Gynecology, University of Miami, FL; ∥Central Controlling Center, Women's Health Initiative, Seattle, WA; ¶Department of Obstetrics and Gynecology, University of Buffalo, NY; and #MedStar Research Institute, Georgetown University, Washington, DC.
Female Pelvic Med Reconstr Surg. 2011 Mar;17(2):80-90. doi: 10.1097/SPV.0b013e31820e5d06.
: This study aimed to examine the risk factors for prevalence and incidence of pelvic organ prolapse (POP) in whites, Hispanics, and blacks.
: This is a secondary analysis of the Women's Health Initiative (WHI) Estrogen plus Progestin Clinical Trial (E + P). Of the original E + P trial population of 16,608, 12,667 women (78.3%; 11,194 whites, 804 blacks, and 669 Hispanics) were included in the final study sample and evaluated during the 5-year period. The outcomes evaluated were any prolapse (WHI prolapse grades 1-3) and WHI prolapse grade 2 or 3. Descriptive analyses, logistic regression, and proportional hazard modeling were performed.
: Increasing parity correlates with increasing WHI prolapse grades (0-3) in whites and blacks but not Hispanics. The incidence of grade 2 or 3 POP increased by 250% in white women with 1 child (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.68-3.71) in comparison to nulliparous women and grew with higher parity. For blacks, a weak association between the parity and grade 2 or 3 POP was noted only in women who had 5 or more kids (HR, 10.41; 95% CI, 1.38-78.77). Blacks were less likely (HR, 0.53; 95% CI, 0.40-0.71) to develop grade 2 or 3 POP compared with whites. For grade 2 or 3 POP, age was found to be a risk factor in whites (odds ratio [OR], 1.03; 95% CI, 1.02-1.04) only and body mass index (≥25 kg/m, <30 kg/m) in whites (OR, 1.64; 95% CI, 1.34-2.02) and Hispanics (OR, 2.87; 95% CI, 1.03-2.02).
: White women are at a much greater risk for developing grade 2 or 3 POP compared with blacks. Parity correlates most strongly with the risk of prolapse development in whites and possibly in grand multiparous blacks.
本研究旨在探讨白人、西班牙裔和黑人盆腔器官脱垂（POP）患病率及发病率的危险因素。
这是对妇女健康倡议（WHI）雌激素加孕激素临床试验（E+P）的二次分析。在最初的16608名E+P试验人群中，12667名女性（78.3%；11194名白人、804名黑人、669名西班牙裔）被纳入最终研究样本，并在5年期间进行评估。评估的结局指标为任何脱垂（WHI脱垂分级1-3级）和WHI脱垂分级2级或3级。进行了描述性分析、逻辑回归分析和比例风险建模。
白人、黑人中，产次增加与WHI脱垂分级（0-3级）增加相关，但西班牙裔并非如此。与未生育女性相比，有1个孩子的白人女性2级或3级POP的发病率增加了250%（风险比[HR]，2.50；95%置信区间[CI]，1.68-3.71），且随着产次增加而上升。对于黑人，仅在生育5个或更多孩子的女性中，产次与2级或3级POP之间存在微弱关联（HR，10.41；95%CI，1.38-78.77）。与白人相比，黑人发生2级或3级POP的可能性较小（HR，0.53；95%CI，0.40-0.71）。对于2级或3级POP，仅在白人中发现年龄是危险因素（优势比[OR]，1.03；95%CI，1.02-1.04），白人（OR，1.64；95%CI，1.34-2.02）和西班牙裔（OR，2.87；95%CI，1.03-2.02）的体重指数（≥25kg/m²，<30kg/m²）是危险因素。
与黑人相比，白人女性发生2级或3级POP的风险要高得多。产次与白人以及可能与多产黑人脱垂发生风险的相关性最强。
