Department of Pediatrics (Neonatology), Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA.
Birth Defects Res. 2020 Nov;112(18):1484-1494. doi: 10.1002/bdr2.1772. Epub 2020 Jul 31.
Arkansas (AR) had the highest prevalence of gastroschisis in a recent study including 15 U.S. states. Our objective was to evaluate trends in prevalence and the spatiotemporal distribution of gastroschisis in AR.
Infants with gastroschisis, born 1998-2015, were identified from the Arkansas Reproductive Health Monitoring System. Birth record data were used as denominators for calculations. Maternal residence at delivery was geocoded for spatial analyses. Annual prevalence rates (PRs) were calculated. Joinpoint regression analysis was performed to examine trends in gastroschisis and report the annual percent changes (APCs) in PRs. Spatiotemporal analyses identified counties with unusually high PRs of gastroschisis. Poisson regression, including county, year, and county*year indicators, was fit to evaluate the PRs of gastroschisis, while adjusting for county-level maternal variables.
We identified 401 cases of gastroschisis among 694,459 live births. The overall PR of gastroschisis was 5.8/10,000 live births. The prevalence of gastroschisis had a significant APC of +5.3% (p < .0001) between 1998 and 2012, followed by a nonsignificant yearly average decrease of -17% through 2015 (p = 0.2). The Emerging Hot Spot Analysis and SaTScan identified an overlapping five-county cluster from 2006 to 2013. Poisson regression model, including county (inside vs. outside cluster), time (before vs. after 2006), and county*time indicators, was fit to evaluate the PRs of gastroschisis. The model did not confirm the presence of a spatiotemporal cluster, once it adjusted for county-level maternal characteristics (p = .549).
Close monitoring of rates of gastroschisis is warranted to determine if the PRs of gastroschisis continue to decline in AR.
在最近一项包括美国 15 个州的研究中，阿肯色州（AR）的腹裂患病率最高。我们的目的是评估 AR 腹裂患病率的趋势以及其时空分布。
从阿肯色州生殖健康监测系统中确定了 1998 年至 2015 年出生的患有腹裂的婴儿。出生记录数据被用作计算的分母。分娩时产妇居住地被地理编码用于空间分析。计算了每年的患病率（PR）。采用 Joinpoint 回归分析检查腹裂的趋势，并报告 PR 的年百分比变化（APC）。时空分析确定了腹裂 PR 异常高的县。拟合泊松回归，包括县、年和县*年指标，以评估腹裂的 PR，并调整县级产妇变量。
我们在 694459 例活产儿中确定了 401 例腹裂病例。腹裂的总 PR 为 5.8/10000 活产儿。1998 年至 2012 年间，腹裂的患病率有显著的 APC 增加了 5.3%（p<0.0001），随后到 2015 年每年平均下降 17%（p=0.2）。新兴热点分析和 SaTScan 确定了 2006 年至 2013 年期间一个重叠的五县集群。拟合包含县（集群内与集群外）、时间（2006 年之前与之后）和县*时间指标的泊松回归模型，以评估腹裂的 PR。该模型在调整县级产妇特征后，并未确认存在时空集群（p=0.549）。
需要密切监测 AR 腹裂的发病率，以确定腹裂的 PR 是否继续下降。
