Barboza-Arguello María de la Paz, Benavides-Lara Adriana, Umaña Lila, Vargas-Leitón Bernardo
Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Tres Ríos, Costa Rica,
Universidad Nacional de Costa Rica, Heredia, Costa Rica.
Rev Panam Salud Publica. 2013 Nov;34(5):304-11.
Identify trends for different types of birth defects and their impact on infant (IMR) and neonatal (NMR) mortality rates in Costa Rica from 1981 to 2010.
Infant, neonatal, and postneonatal mortality trends were analyzed, using data from the Central American Population Center, which uses the International Classification of Diseases, versions 9 and 10, to classify causes of death. For each group of birth defects, a Poisson log-linear regression model was constructed. IMR and NMR, relative risk, and 95% confidence intervals (95%CI) were calculated for the three decades (1981-1990, 1991-2000, and 2001-2010). Estimates were compared using Wald chi square.
Comparison of the 1980s and the 2000s found a significant decrease in NMR and IMR from birth defects in these decades, from 2.37 (95%CI: 2.26-2.48) to 2.13 (2.03-2.23) and from 4.13 (3.99-4.27) to 3.18 (3.05-3.31), respectively. Reduction in IMR was significant for birth defect groups for nervous, digestive, and circulatory systems. There was also a significant drop in NMR for nervous and digestive system groups. All other groups experienced a significant increase or no change.
IMR and NMR from birth defects have decreased, although these rates have increased proportionately due to a greater decline in other causes. This reduction is much smaller for neonatal mortality. Primary prevention and neonatal care of birth defects should be strengthened.
确定1981年至2010年哥斯达黎加不同类型出生缺陷的趋势及其对婴儿死亡率（IMR）和新生儿死亡率（NMR）的影响。
利用中美洲人口中心的数据，分析婴儿、新生儿和新生儿后期的死亡率趋势，该中心使用国际疾病分类第9版和第10版对死亡原因进行分类。针对每组出生缺陷，构建泊松对数线性回归模型。计算了三个十年（1981 - 1990年、1991 - 2000年和2001 - 2010年）的IMR、NMR、相对风险和95%置信区间（95%CI）。使用Wald卡方检验比较估计值。
20世纪80年代与21世纪00年代的比较发现，这几十年中出生缺陷导致的NMR和IMR显著下降，分别从2.37（95%CI：2.26 - 2.48）降至2.13（2.03 - 2.23），以及从4.13（3.99 - 4.27）降至3.18（3.05 - 3.31）。神经系统、消化系统和循环系统出生缺陷组的IMR下降显著。神经系统和消化系统组的NMR也显著下降。所有其他组则经历了显著上升或无变化。
出生缺陷导致的IMR和NMR有所下降，尽管由于其他原因下降幅度更大，这些比率相应上升。新生儿死亡率的下降幅度要小得多。应加强出生缺陷的一级预防和新生儿护理。
