亚洲-白种人在产科肛门括约肌损伤方面的差异：系统评价和荟萃分析方案。
Asian-white disparities in obstetric anal sphincter injury: Protocol for a systematic review and meta-analysis.
机构信息
Faculty of Health Sciences, Department of Global Health, McMaster University, Hamilton, ON, Canada.
Sick Kids Research Institute, Edwin S.H. Leong Centre for Healthy Children, Toronto, ON, Canada.
出版信息
PLoS One. 2023 Sep 8;18(9):e0291174. doi: 10.1371/journal.pone.0291174. eCollection 2023.
BACKGROUND
Obstetric anal sphincter injury (OASI) describes severe injury to the perineum and perineum and perianal muscles following birth and occurs in 4.4% to 6.0% of vaginal births in Canada. Studies from high-income countries have identified an increased risk of OASI in individuals who identify as Asian race versus those who identify as white. This protocol outlines a systematic review and meta-analysis which aims to determine the incidence of OASI in individuals living in high-income countries who identify as Asian versus those of white race/ethnicity. We hypothesize that the pooled incidence of OASI will be higher in Asian versus white birthing individuals.
METHODS
We will search MEDLINE, OVID, Embase, Emcare and Cochrane databases from inception to 2022 for observational studies using keywords and controlled vocabulary terms related to race, ethnicity and OASI. Two reviewers will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and Meta-analysis of Observational Studies (MOOSE) recommendations. Meta-analysis will be performed using RevMan for dichotomous data using the random effects model and the odds ratio (OR) as effect measure with a 95% confidence interval (CI). Subgroup analysis will be performed based on Asian subgroups (e.g., South Asian, Filipino, Chinese, Japanese individuals). Study quality assessment will be performed using The Joanna Briggs Institute Critical Appraisal tools.
DISCUSSION
The systematic review and meta-analysis that this protocol outlines will synthesize the extant literature to better estimate the rates of OASI in Asian and white populations in non-Asian, high-income settings and the relative risk of OASI between these two groups. This systematic summary of the evidence will inform the discrepancy in health outcomes experienced by Asian and white birthing individuals. If these findings suggest a disproportionate burden among Asians, they will be used to advocate for future studies to explore the causal mechanisms underlying this relationship, such as differential care provision, barriers to accessing care, and social and institutional racism. Ultimately, the findings of this review can be used to frame obstetric care guidelines and inform healthcare practices to ensure care that is equitable and accessible to diverse populations.
背景
产科肛门括约肌损伤（OASI）描述了分娩后会阴和会阴及肛门周围肌肉的严重损伤，在加拿大的阴道分娩中发生率为 4.4%至 6.0%。来自高收入国家的研究表明，与白人相比，亚洲人种族的个体发生 OASI 的风险增加。本方案概述了一项系统评价和荟萃分析，旨在确定在高收入国家生活的亚洲人个体与白人种族/民族的个体中 OASI 的发生率。我们假设，与白人分娩个体相比，OASI 的汇总发生率在亚洲人中更高。
方法
我们将使用与种族、民族和 OASI 相关的关键词和受控词汇术语，从开始到 2022 年，在 MEDLINE、OVID、Embase、Emcare 和 Cochrane 数据库中搜索观察性研究。两名审查员将遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南和观察性研究的荟萃分析（MOOSE）建议。使用 RevMan 对二分类数据进行荟萃分析，使用随机效应模型和比值比（OR）作为效应量，置信区间（CI）为 95%。将根据亚洲亚组（例如，南亚、菲律宾、中国、日本个体）进行亚组分析。使用 Joanna Briggs 研究所的批判性评估工具进行研究质量评估。
讨论
本方案概述的系统评价和荟萃分析将综合现有文献，以更好地估计非亚洲高收入环境中亚洲和白人人群中 OASI 的发生率，以及这两组人群中 OASI 的相对风险。对证据的系统总结将为亚洲和白人分娩个体所经历的健康结果差异提供信息。如果这些发现表明亚洲人负担过重，将利用这些发现来倡导未来的研究，以探索这种关系背后的因果机制，例如护理提供的差异、获得护理的障碍，以及社会和制度种族主义。最终，本综述的结果可用于制定产科护理指南，并为医疗保健实践提供信息，以确保为不同人群提供公平和可及的护理。
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