Division of Neonatology, Department of Pediatrics, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, P. Debyelaan 25. P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Neonatal Intensive Care Unit, Sant'Anna Hospital, Como, Italy.
World J Pediatr. 2024 Apr;20(4):340-352. doi: 10.1007/s12519-023-00775-x. Epub 2023 Nov 27.
Retinopathy of prematurity (ROP) is generally considered to be more frequent in males than in females. However, it is not known whether sex differences in ROP affect all degrees of the condition, are global and have changed as neonatology has developed. We aimed to conduct a systematic review and meta-analysis of studies addressing sex differences in the risk of developing ROP.
PubMed/MEDLINE and Embase databases were searched. The frequentist, random-effects risk ratio (RR) and 95% confidence interval (CI) were calculated. Bayesian model averaged (BMA) meta-analysis was used to calculate the Bayes factors (BFs). The BF is the ratio of the probability of the data under the alternative hypothesis (H) over the probability of the data under the null hypothesis (H).
We included 205 studies (867,252 infants). Frequentist meta-analysis showed a positive association between male sex and severe ROP (113 studies, RR = 1.14, 95% CI = 1.07-1.22) but no association with any ROP (144 studies, RR = 1.00, 95% CI = 0.96-1.03). BMA showed extreme evidence in favor of H for severe ROP (BF = 71,174) and strong evidence in favor of H for any ROP (BF = 0.05). The association between male sex and severe ROP remained stable over time and was present only in cohorts from countries with a high or high-middle sociodemographic index.
Our study confirms the presence of a male disadvantage in severe ROP but not in less severe forms of the disease. There are variations in the sex differences in ROP, depending on geographical location and sociodemographic level of the countries.
早产儿视网膜病变（ROP）通常被认为在男性中比在女性中更为常见。然而，ROP 中性别差异是否影响所有程度的疾病、是否具有全球性以及是否随着新生儿学的发展而发生变化尚不清楚。我们旨在对研究性别差异对 ROP 发病风险的影响进行系统评价和荟萃分析。
检索了 PubMed/MEDLINE 和 Embase 数据库。计算了频率论、随机效应风险比（RR）和 95%置信区间（CI）。使用贝叶斯模型平均（BMA）荟萃分析计算贝叶斯因子（BF）。BF 是替代假设（H）下数据的概率与零假设（H）下数据的概率之比。
我们纳入了 205 项研究（867252 名婴儿）。频率论荟萃分析显示，男性与严重 ROP 之间存在正相关（113 项研究，RR=1.14，95%CI=1.07-1.22），但与任何 ROP 均无相关性（144 项研究，RR=1.00，95%CI=0.96-1.03）。BMA 强烈支持严重 ROP 的 H（BF=71174），并强烈支持任何 ROP 的 H（BF=0.05）。男性与严重 ROP 之间的关联随时间保持稳定，仅存在于高或高-中社会人口指数国家的队列中。
本研究证实了男性在严重 ROP 中存在劣势，但在疾病较轻的形式中则不然。ROP 中的性别差异存在差异，取决于地理位置和所在国家的社会人口水平。
