Berry Kristen, Pesko Michael F, Hesdorffer Dale C, Shellhaas Renée A, Seirup Joanna K, Grinspan Zachary M
Weill Cornell Medical College, Cornell University, New York, New York, U.S.A.
Division of Health Policy and Economics, Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, U.S.A.
Epilepsia. 2017 Mar;58(3):446-455. doi: 10.1111/epi.13665. Epub 2017 Feb 6.
Seizures are a common manifestation of neurologic dysfunction in neonates and carry a high risk for mortality and adverse long-term outcomes. U.S. birth certificates are a potentially valuable source for studying the epidemiology of neonatal seizures. However, the quality of the data is understudied.
We reviewed all U.S. birth records from 2003 to 2013 to describe the following: (1) rates of missing data, (2) evidence of underreporting, and (3) effect of the 2003 revision of the birth certificate form. We evaluated missingness by state, year, demographic, infant health, and medical care factors using bivariate analyses. To measure potential underreporting, we compared estimates to a published reference (0.95 per 1,000 term births). We developed criteria for data plausibility, and reported which states met these criteria.
Of 22,834,395 live term births (≥36 weeks of gestation) recorded using the revised form from 2005 to 2015, there were 5,875 with neonatal seizures, suggesting an incidence of 0.26 per 1,000 term births, one fourth of the expected incidence. Although the overall degree of missing seizure data was low (0.5%), missingness varied significantly by state, year, demographic, infant health, and medical care factors. After the 2003 birth certificate form revision, missing data and evidence of potential underreporting increased. Nine states met criteria for plausibility.
The value of U.S. birth certificate data for neonatal seizure epidemiology is limited by biased missingness, evidence suggestive of underreporting, and changes in reporting subsequent to the 2003 revision. There are plausible data from nine states, which merit investigation for further research.
癫痫发作是新生儿神经功能障碍的常见表现，且死亡率和长期不良后果风险很高。美国出生证明是研究新生儿癫痫流行病学的潜在宝贵资源。然而，数据质量尚未得到充分研究。
我们回顾了2003年至2013年所有美国出生记录，以描述以下内容：（1）数据缺失率；（2）漏报证据；（3）2003年出生证明表格修订的影响。我们使用双变量分析按州、年份、人口统计学、婴儿健康和医疗因素评估缺失情况。为衡量潜在漏报情况，我们将估计值与已发表的参考值（每1000例足月出生0.95例）进行比较。我们制定了数据合理性标准，并报告了哪些州符合这些标准。
在2005年至2015年使用修订表格记录的22,834,395例足月活产（≥36周妊娠）中，有5875例新生儿癫痫发作，表明每1000例足月出生的发病率为0.26例，为预期发病率的四分之一。尽管癫痫发作数据的总体缺失程度较低（0.5%），但缺失情况因州、年份、人口统计学、婴儿健康和医疗因素而异。2003年出生证明表格修订后，缺失数据和潜在漏报证据增加。九个州符合合理性标准。
美国出生证明数据在新生儿癫痫流行病学方面的价值受到偏倚性缺失、漏报证据以及2003年修订后报告变化的限制。有九个州的数据看似合理，值得进一步研究调查。
