Ray Joel G, Pirouzmand Neda, Park Alison L, Austin Peter C, Vigod Simone, Grandi Sonia, Berger Howard, Cohen Eyal
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Ontario, Canada.
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Ann Epidemiol. 2025 Aug;108:34-42. doi: 10.1016/j.annepidem.2025.06.002. Epub 2025 Jun 6.
Preterm birth may adversely affect cortical brain development, and subsequent cognition in childhood and adolescence. Such abnormalities in brain development are correlated with suicidal and non-suicidal self-injury and persistent substance use, and to unintentional injury as well.
To evaluate the risk of self-injury, overdose, and all-cause mortality among adolescents and young adults - each in relation to preterm birth.
Population-based cohort study in Ontario, Canada, where there is universal healthcare for all.
All of Ontario, Canada, where there is universal healthcare.
All youths born in Ontario from 1992 to 2012, and alive at age 10 years.
Degree of prematurity in 2-week earlier increments, as well as preterm birth < 37 weeks' gestation.
i) Primary composite of an ED visit or hospitalization for intentional self-injury, poisoning or overdose, or all-cause mortality; and ii) co-primary composite of intentional self-injury, poisoning or overdose - each assessed between ages 10-24 years.
Among 2352,563 youths in the cohort, 151,182 (6.4 %) were born preterm. Adjusted hazard ratios (aHR) for i) self-injury, overdose, or all-cause mortality was 1.03 (95 % CI 1.01-1.05) per 2-week earlier gestational age at birth; and ii) 1.01 (95 % CI 0.99-1.03) for self-injury or overdose. Compared to term births, preterm birth < 37 weeks' gestation was associated with a higher aHR for i) self-injury, overdose or all-cause mortality (1.09, 95 % CI 1.05-1.12); and ii) self-injury or overdose (1.06, 95 % CI 1.02-1.10).
Preterm birth may be associated with a slightly higher risk of all-cause mortality and, possibly, self-injury and overdose among adolescents and young adults. Ongoing efforts might focus on the health of youths who were born prematurely as they enter their adolescent years.
Canadian Institutes of Health Research.
早产可能会对大脑皮质发育以及儿童期和青少年期的后续认知产生不利影响。大脑发育中的此类异常与自杀和非自杀性自伤、持续使用药物以及意外伤害相关。
评估青少年和青年中自伤、药物过量及全因死亡的风险——每种情况均与早产相关。
在加拿大安大略省进行的基于人群的队列研究，该省实行全民医疗保健。
加拿大安大略省全境，实行全民医疗保健。
1992年至2012年在安大略省出生且10岁时仍存活的所有青年。
以提前2周的增量表示的早产程度，以及妊娠<37周的早产。
i）因故意自伤、中毒或药物过量或全因死亡而进行急诊就诊或住院治疗的主要综合指标；ii）故意自伤、中毒或药物过量的共同主要综合指标——均在10至24岁之间进行评估。
在该队列的2352563名青年中，151182名（6.4%）为早产出生。i）自伤、药物过量或全因死亡的校正风险比（aHR）为每出生时孕周提前2周1.03（95%CI 1.01 - 1.05）；ii）自伤或药物过量的校正风险比为1.01（95%CI 0.99 - 1.03）。与足月出生相比，妊娠<37周的早产与以下情况的较高aHR相关：i）自伤、药物过量或全因死亡（1.09，95%CI 1.05 - 1.12）；ii）自伤或药物过量（1.06，95%CI 1.02 - 1.10）。
早产可能与青少年和青年中略高的全因死亡风险相关，也可能与自伤和药物过量相关。持续的努力可能应聚焦于早产青年进入青春期后的健康状况。
加拿大卫生研究院。
