全球 1990 年至 2019 年 204 个国家和地区孕产妇脓毒症和其他感染性疾病的全球负担及趋势。
The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019.
机构信息
Department of Obstetrics and Gynecology, Wuhan No.1 Hospital, Wuhan, China.
Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
BMC Infect Dis. 2021 Oct 18;21(1):1074. doi: 10.1186/s12879-021-06779-0.
BACKGROUND
Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women's and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures.
METHODS
Based on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters.
RESULTS
Although incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions.
CONCLUSION
These findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.
背景
产妇脓毒症和其他产妇感染（MSMI）对妇女和新生儿健康有重大影响，但关于 MSMI 全球负担和趋势的数据有限。全面了解 MSMI 的负担和趋势模式对于分配资源、促进制定有针对性的预防策略以及实施有效的临床治疗措施非常重要。
方法
基于全球疾病负担数据库的数据，我们分析了过去 30 年来 MSMI 的发病率、死亡率、残疾调整生命年（DALY）和产妇死亡率（MMR）的全球负担。然后，通过 MMR 的估计年百分比变化（EAPC）以及发病率、死亡率和 DALY 的年龄标准化率（ASR）评估 MSMI 的趋势。此外，我们确定了社会人口指数（SDI）对 MSMI 流行病学参数的影响。
结果
尽管从 1990 年到 2015 年，发病例数几乎稳定，但从 1990 年到 2019 年，全球发病率、死亡率、DALY 和 MMR 的 ASR 稳步下降。MSMI 的负担在低 SDI 地区最高，下降趋势最快。MSMI 仍然是发达国家产妇死亡的最重要原因之一。不同地区和个别国家的疾病负担和趋势存在很大差异，其中大多数地区的负担和下降趋势都有所减轻。204 个国家/地区和 21 个地区 2019 年 MMR 和 ASR 与相应的 SDI 值呈负相关。
结论
这些发现强调了过去三十年中 MSMI 护理的显著改善，特别是在低和中低收入 SDI 地区。然而，少数国家和地区 MSMI 的负担增加和上升趋势令人担忧，这对产妇健康构成了严重挑战。迫切需要制定更有针对性的预防措施和增加产妇健康资源，以解决这一问题。
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