Benavides-Lara Adriana, Barboza-Argüello María de la Paz, Arguedas-Arguedas Olga, Faerron-Angel Jorge Enrique, da Cruz Eduardo M
Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica.
Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense del Seguro Social, San José, Costa Rica.
Birth Defects Res. 2022 Dec 1;114(20):1364-1375. doi: 10.1002/bdr2.2093. Epub 2022 Sep 29.
We aimed to analyze recent infant and neonatal mortality from congenital heart defects (CHD) in Costa Rica, a middle-income country where CHD mortality was above expectations.
A descriptive analysis of infant and neonatal mortality rates from CHD (IMR-CHD and NMR-CHD) during 2000-2019 was performed, according to province, sex, specific CHD, and sub-period, using data from the National Institute of Statistics and Censuses. We used joinpoint regression to identify any calendar-year where a significant change in trend occurred; the average annual percent change (AAPC) was determined. Using Poisson regression, marginal means and mortality ratios (MR) for IMR-CHD and NMR-CHD by sub-period (2000-2006-referent-, 2007-2013, 2014-2019) were estimated and compared using Wald's chi-square tests (α ≤ .05).
During 2000-2019, CHD accounted for 12% of overall infant mortality. IMR-CHD and NMR-CHD decreased linearly over the study period (AAPC = -3.4; p < .01). IMR-CHD decreased by 41%, from 13.6 per 10,000 in 2000-2006 (13.4% of infant mortality) to 8.1 per 10,000 in 2014-2019 (10% of infant mortality) (MR = 0.59; 95% confidence intervals [CI] = 0.52-0.68). NMR-CHD decreased by 38%, from 7.9 per 10,000 in 2000-2006 (11.1% of neonatal mortality) to 4.9 per 10,000 in 2014-2019 (7.9% of infant mortality) (MR = 0.59; 95% CI = 0.52-0.68). Male presented significantly higher NMR-CHD. The main causes of mortality (2014-2019) were total anomalous pulmonary venous connections, hypoplastic left heart syndrome, and double inlet ventricle.
IMR-CHD, NMR-CHD, and their proportional contribution to mortality by all causes and by birth defects decreased significantly, demonstrating that all improvements implemented in the last decades have yielded favorable results.
我们旨在分析哥斯达黎加近期先天性心脏病（CHD）导致的婴儿和新生儿死亡率，该国是一个中等收入国家，其CHD死亡率高于预期。
根据省份、性别、特定CHD及子时期，利用国家统计和普查研究所的数据，对2000 - 2019年期间CHD导致的婴儿和新生儿死亡率（IMR-CHD和NMR-CHD）进行描述性分析。我们使用连接点回归来确定趋势发生显著变化的任何日历年；计算平均年度百分比变化（AAPC）。使用泊松回归，估计IMR-CHD和NMR-CHD在各子时期（2000 - 2006年 - 参照期 - 、2007 - 2013年、2014 - 2019年）的边际均值和死亡率比（MR），并使用Wald卡方检验进行比较（α≤0.05）。
在2000 - 2019年期间，CHD占婴儿总死亡率的12%。在研究期间，IMR-CHD和NMR-CHD呈线性下降（AAPC = -3.4；p < 0.01）。IMR-CHD下降了41%，从2000 - 2006年的每10000例13.6例（占婴儿死亡率的13.4%）降至2014 - 2019年的每10000例8.1例（占婴儿死亡率的10%）（MR = 0.59；95%置信区间[CI] = 0.52 - 0.68）。NMR-CHD下降了38%，从2000 - 2006年的每10000例7.9例（占新生儿死亡率的11.1%）降至2014 - 2019年的每10000例4.9例（占婴儿死亡率的7.9%）（MR = 0.59；95% CI = 0.52 - 0.68）。男性的NMR-CHD显著更高。主要死亡原因（2014 - 2019年）是完全性肺静脉异位连接、左心发育不全综合征和双入口心室。
IMR-CHD、NMR-CHD及其对所有原因和出生缺陷导致的死亡率的比例贡献显著下降，表明过去几十年实施的所有改善措施都取得了良好效果。
