先天性心脏病导致的婴儿死亡率的时间趋势：全国疾病预防控制中心队列分析（1999-2020 年）。
Temporal Trends of Infant Mortality Secondary to Congenital Heart Disease: National CDC Cohort Analysis (1999-2020).
机构信息
Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA.
Department of Medicine, Louisiana State University, Shreveport, Louisiana, USA.
出版信息
Birth Defects Res. 2024 Sep;116(9):e2398. doi: 10.1002/bdr2.2398.
BACKGROUND
Infant mortality continues to be a significant problem for patients with congenital heart disease (CHD). Limited data exist on the recent trends of mortality in infants with CHD.
METHODS
The CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify deaths occurring within the United States with CHD listed as one of the causes of death between 1999 and 2020. Subsequently, trends were calculated using the Joinpoint regression program (version 4.9.1.0; National Cancer Institute).
RESULTS
A total of 47,015 deaths occurred in infants due to CHD at the national level from the year 1999 to 2020. The overall proportional infant mortality (compared to all deaths) declined (47.3% to 37.1%, average annual percent change [AAPC]: -1.1 [95% CI -1.6 to -0.6, p < 0.001]). There was a significant decline in proportional mortality in both Black (45.3% to 34.3%, AAPC: -0.5 [-0.8 to -0.2, p = 0.002]) and White patients (55.6% to 48.6%, AAPC: -1.2 [-1.7 to -0.7, p = 0.001]), with a steeper decline among White than Black patients. A statistically significant decline in the proportional infant mortality in both non-Hispanic (43.3% to 33.0%, AAPC: -1.3% [95% CI -1.9 to -0.7, p < 0.001]) and Hispanic (67.6% to 57.7%, AAPC: -0.7 [95% CI -0.9 to -0.4, p < 0.001]) patients was observed, with a steeper decline among non-Hispanic infant population. The proportional infant mortality decreased in males (47.5% to 53.1%, AAPC: -1.4% [-1.9 to -0.9, p < 0.001]) and females (47.1% to 39.6%, AAPC: -0.9 [-1.9 to 0.0, p = 0.05]). A steady decline in for both females and males was noted.
CONCLUSION
Our study showed a significant decrease in CHD-related mortality rate in infants and age-adjusted mortality rate (AAMR) between 1999 and 2020. However, sex-based, racial/ethnic disparities were noted, with female, Black, and Hispanic patients showing a lesser decline than male, White, and non-Hispanic patients.
背景
婴儿死亡率仍然是先天性心脏病（CHD）患者的一个重大问题。关于 CHD 婴儿死亡率的近期趋势，现有数据有限。
方法
利用疾病预防控制中心的 WONDER（疾病预防控制中心广泛在线数据用于流行病学研究）查询系统，确定了 1999 年至 2020 年期间美国发生的 CHD 列为死因之一的死亡人数。随后，使用 Joinpoint 回归程序（版本 4.9.1.0；国家癌症研究所）计算趋势。
结果
1999 年至 2020 年，全国共有 47015 例婴儿死于 CHD。婴儿总死亡率（与所有死亡人数相比）下降（47.3%降至 37.1%，平均年变化百分比[AAPC]：-1.1[95%CI-1.6 至-0.6，p<0.001]）。黑人和白人患者的死亡率比例均显著下降（黑人从 45.3%降至 34.3%，AAPC：-0.5[-0.8 至-0.2，p=0.002]；白人从 55.6%降至 48.6%，AAPC：-1.2[-1.7 至-0.7，p=0.001]），白人的下降幅度大于黑人。非西班牙裔（从 43.3%降至 33.0%，AAPC：-1.3%[95%CI-1.9 至-0.7，p<0.001]）和西班牙裔（从 67.6%降至 57.7%，AAPC：-0.7[95%CI-0.9 至-0.4，p<0.001]）患者的婴儿死亡率比例也呈显著下降趋势，非西班牙裔婴儿人口的下降幅度更大。男性（从 47.5%降至 53.1%，AAPC：-1.4%[-1.9 至-0.9，p<0.001]）和女性（从 47.1%降至 39.6%，AAPC：-0.9[-1.9 至 0.0，p=0.05]）的婴儿死亡率比例均下降。注意到无论是男性还是女性，其死亡率都呈稳步下降趋势。
结论
本研究表明，1999 年至 2020 年，CHD 相关死亡率和年龄调整死亡率（AAMR）显著下降。然而，我们注意到存在基于性别的、种族/民族差异，女性、黑人以及西班牙裔患者的下降幅度小于男性、白人以及非西班牙裔患者。
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