Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
BMJ Open. 2023 Jan 30;13(1):e067033. doi: 10.1136/bmjopen-2022-067033.
To examine the potential for bias in the estimate of under-5 mortality due to birth defects recently produced by the WHO and the Maternal and Child Epidemiology Estimation research group.
Systematic analysis.
We examined the estimated number of under-5 deaths due to birth defects, the birth defect specific under-5 mortality rate, and the per cent of under-5 mortality due to birth defects, by geographic region, national income and under-5 mortality rate for three age groups from 2000 to 2019.
The under-5 deaths per 1000 live births from birth defects fell from 3.4 (95% uncertainty interval (UI) 3.1-3.8) in 2000 to 2.9 (UI 2.6-3.3) in 2019. The per cent of all under-5 mortality attributable to birth defects increased from 4.6% (UI 4.1%-5.1%) in 2000 to 7.6% (UI 6.9%-8.6%) in 2019. There is significant variability in mortality due to birth defects by national income level. In 2019, the under-5 mortality rate due to birth defects was less in high-income countries than in low-income and middle-income countries, 1.3 (UI 1.2-1.3) and 3.0 (UI 2.8-3.4) per 1000 live births, respectively. These mortality rates correspond to 27.7% (UI 26.6%-28.8%) of all under-5 mortality in high-income countries being due to birth defects, and 7.4% (UI 6.7%-8.2%) in low-income and middle-income countries.
While the under-5 mortality due to birth defects is declining, the per cent of under-5 mortality attributable to birth defects has increased, with significant variability across regions globally. The estimates in low-income and middle-income countries are likely underestimated due to the nature of the WHO estimates, which are based in part on verbal autopsy studies and should be taken as a minimum estimate. Given these limitations, comprehensive and systematic estimates of the mortality burden due to birth defects are needed to estimate the actual burden.
检查世界卫生组织和母婴流行病学估算研究小组最近对 5 岁以下儿童因出生缺陷导致的死亡率的估计中是否存在偏差。
系统分析。
我们根据地理位置、国民收入和 2000 年至 2019 年三个年龄组的 5 岁以下儿童死亡率，检查了 5 岁以下儿童因出生缺陷导致的死亡人数、特定出生缺陷的 5 岁以下儿童死亡率以及因出生缺陷导致的 5 岁以下儿童死亡率的百分比。
2000 年至 2019 年，每 1000 例活产儿中因出生缺陷导致的死亡人数从 3.4（95%不确定区间[UI]3.1-3.8）下降到 2.9（UI 2.6-3.3）。2000 年，归因于出生缺陷的所有 5 岁以下儿童死亡的百分比为 4.6%（UI 4.1%-5.1%），2019 年增加到 7.6%（UI 6.9%-8.6%）。按国民收入水平划分，出生缺陷导致的死亡率存在显著差异。2019 年，高收入国家因出生缺陷导致的 5 岁以下儿童死亡率低于低收入和中等收入国家，分别为每 1000 例活产儿 1.3（UI 1.2-1.3）和 3.0（UI 2.8-3.4）。这些死亡率分别对应于高收入国家所有 5 岁以下儿童死亡的 27.7%（UI 26.6%-28.8%）归因于出生缺陷，以及低收入和中等收入国家的 7.4%（UI 6.7%-8.2%）。
虽然 5 岁以下儿童因出生缺陷导致的死亡率正在下降，但归因于出生缺陷的 5 岁以下儿童死亡率百分比有所增加，全球各地区差异显著。由于世界卫生组织的估计部分基于口头尸检研究，因此，低收入和中等收入国家的估计值可能被低估，应视为最低估计值。鉴于这些局限性，需要对出生缺陷导致的死亡率进行全面和系统的估计，以估计实际负担。
