Duke Wes, Gilboa Suzanne M
J Registry Manag. 2014 Spring;41(1):13-8.
Fetal death certificates (FDCs) are the main source of stillbirth surveillance data in the United States, yet previous studies suggest FDCs have incomplete ascertainment. In 2005, the Centers for Disease Control and Prevention (CDC) funded 2 pilot programs to determine the feasibility of expanding existing birth defects surveillance systems employing active casefinding methods to conduct surveillance of stillbirths. The objectives of this analysis were to: 1) estimate the completeness of ascertainment of stillbirths identified through one of the pilot programs, the Metropolitan Atlanta Congenital Defects Program (MACDP), and 2) compare the prevalence of stillbirths obtained through active casefinding (MACDP) with data available from FDCs.
Stillbirths in metropolitan Atlanta were independently ascertained by both FDC and MACDP in 2006 and 2008. Capture-recapture methods were used to estimate the total number of stillbirths in the surveillance area. The sensitivities for capturing stillbirths were estimated for FDCs, MACDP, and both sources combined. Prevalence estimates for each data source and for the combined data sources were calculated using a denominator of live births plus FDC-identified stillbirths.
An estimated 1,118 stillbirths occurred in metropolitan Atlanta. MACDP captured 863 and FDCs captured 862. There were 198 stillbirths captured by MACDP and not reported by FDC, and 197 stillbirths identified by FDCs that were not initially captured by MACDP. The estimated sensitivities were 77.1 percent, 77.2 percent, and 94.8 percent for FDCs, MACDP, and both sources combined, respectively. The stillbirth prevalences for 2006 and 2008 using FDC data alone were 8.2 and 7.4 per 1,000 live births plus stillbirths, respectively, and 9.9 and 9.3 per 1,000 live births plus stillbirths, respectively, using both data sources combined.
Leveraging the resources of existing birth defects surveillance programs in combination with FDCs could improve population-based ascertainment of stillbirths.
在美国，胎儿死亡证明（FDC）是死产监测数据的主要来源，但先前的研究表明FDC的信息收集并不完整。2005年，美国疾病控制与预防中心（CDC）资助了两个试点项目，以确定扩大现有出生缺陷监测系统并采用主动病例发现方法进行死产监测的可行性。本分析的目的是：1）估计通过其中一个试点项目——大亚特兰大先天性缺陷项目（MACDP）确定的死产信息收集的完整性，以及2）比较通过主动病例发现（MACDP）获得的死产患病率与FDC提供的数据。
2006年和2008年，大亚特兰大地区的死产情况由FDC和MACDP分别独立确定。采用捕获-再捕获方法估计监测区域内死产的总数。分别估计了FDC、MACDP以及两者结合时捕获死产的敏感性。每个数据源以及合并数据源的患病率估计值是使用活产数加FDC确定的死产数作为分母计算得出的。
据估计，大亚特兰大地区发生了1118例死产。MACDP捕获到863例，FDC捕获到862例。有198例死产被MACDP捕获但未被FDC报告，还有197例死产被FDC识别但最初未被MACDP捕获。FDC、MACDP以及两者结合时的估计敏感性分别为77.1%、77.2%和94.8%。仅使用FDC数据时，2006年和2008年的死产患病率分别为每1000例活产加死产中有8.2例和7.4例，而使用两个数据源结合的数据时，分别为每1000例活产加死产中有9.9例和9.3例。
利用现有出生缺陷监测项目的资源并结合FDC，可以改进基于人群的死产信息收集。
