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      Multilevel analyses of related public health indicators: The European Surveillance of Congenital Anomalies (EUROCAT) Public Health Indicators

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          Abstract

          Background

          Public health organisations use public health indicators to guide health policy. Joint analysis of multiple public health indicators can provide a more comprehensive understanding of what they are intended to evaluate.

          Objective

          To analyse variaitons in the prevalence of congenital anomaly‐related perinatal mortality attributable to termination of pregnancy for foetal anomaly (TOPFA) and prenatal diagnosis of congenital anomaly prevalence.

          Methods

          We included 55 363 cases of congenital anomalies notified to 18 EUROCAT registers in 10 countries during 2008‐12. Incidence rate ratios (IRR) representing the risk of congenital anomaly‐related perinatal mortality according to TOPFA and prenatal diagnosis prevalence were estimated using multilevel Poisson regression with country as a random effect. Between‐country variation in congenital anomaly‐related perinatal mortality was measured using random effects and compared between the null and adjusted models to estimate the percentage of variation in congenital anomaly‐related perinatal mortality accounted for by TOPFA and prenatal diagnosis.

          Results

          The risk of congenital anomaly‐related perinatal mortality decreased as TOPFA and prenatal diagnosis prevalence increased (IRR 0.79, 95% confidence interval [CI] 0.72, 0.86; and IRR 0.88, 95% CI 0.79, 0.97). Modelling TOPFA and prenatal diagnosis together, the association between congenital anomaly‐related perinatal mortality and TOPFA prevalence became stronger (RR 0.70, 95% CI 0.61, 0.81). The prevalence of TOPFA and prenatal diagnosis accounted for 75.5% and 37.7% of the between‐country variation in perinatal mortality, respectively.

          Conclusion

          We demonstrated an approach for analysing inter‐linked public health indicators. In this example, as TOPFA and prenatal diagnosis of congenital anomaly prevalence decreased, the risk of congenital anomaly‐related perinatal mortality increased. Much of the between‐country variation in congenital anomaly‐related perinatal mortality was accounted for by TOPFA, with a smaller proportion accounted for by prenatal diagnosis.

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          Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.

          Christopher Murray, Alan Lopez (1997)
          Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons. DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed. Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene. The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.
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            Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis.

            Dagfinn Aune, Ola Saugstad, Tore Henriksen … (2014)
            Evidence suggests that maternal obesity increases the risk of fetal death, stillbirth, and infant death; however, the optimal body mass index (BMI) for prevention is not known. To conduct a systematic review and meta-analysis of cohort studies of maternal BMI and risk of fetal death, stillbirth, and infant death. The PubMed and Embase databases were searched from inception to January 23, 2014. Cohort studies reporting adjusted relative risk (RR) estimates for fetal death, stillbirth, or infant death by at least 3 categories of maternal BMI were included. Data were extracted by 1 reviewer and checked by the remaining reviewers for accuracy. Summary RRs were estimated using a random-effects model. Fetal death, stillbirth, and neonatal, perinatal, and infant death. Thirty eight studies (44 publications) with more than 10,147 fetal deaths, more than 16,274 stillbirths, more than 4311 perinatal deaths, 11,294 neonatal deaths, and 4983 infant deaths were included. The summary RR per 5-unit increase in maternal BMI for fetal death was 1.21 (95% CI, 1.09-1.35; I2 = 77.6%; n = 7 studies); for stillbirth, 1.24 (95% CI, 1.18-1.30; I2 = 80%; n = 18 studies); for perinatal death, 1.16 (95% CI, 1.00-1.35; I2 = 93.7%; n = 11 studies); for neonatal death, 1.15 (95% CI, 1.07-1.23; I2 = 78.5%; n = 12 studies); and for infant death, 1.18 (95% CI, 1.09-1.28; I2 = 79%; n = 4 studies). The test for nonlinearity was significant in all analyses but was most pronounced for fetal death. For women with a BMI of 20 (reference standard for all outcomes), 25, and 30, absolute risks per 10,000 pregnancies for fetal death were 76, 82 (95% CI, 76-88), and 102 (95% CI, 93-112); for stillbirth, 40, 48 (95% CI, 46-51), and 59 (95% CI, 55-63); for perinatal death, 66, 73 (95% CI, 67-81), and 86 (95% CI, 76-98); for neonatal death, 20, 21 (95% CI, 19-23), and 24 (95% CI, 22-27); and for infant death, 33, 37 (95% CI, 34-39), and 43 (95% CI, 40-47), respectively. Even modest increases in maternal BMI were associated with increased risk of fetal death, stillbirth, and neonatal, perinatal, and infant death. Weight management guidelines for women who plan pregnancies should take these findings into consideration to reduce the burden of fetal death, stillbirth, and infant death.
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              Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review.

              Timothy Chico, , J. Harreiter … (2012)
              Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis. The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening. Prevalence is most often reported as 2-6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes. Europe-wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well-designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.
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                Author and article information

                Contributors
                Babak Khoshnood:
                ORCID: https://orcid.org/0000-0002-4031-4915
                babak.khoshnood@inserm.fr
                Journal
                Journal ID (nlm-ta): Paediatr Perinat Epidemiol
                Journal ID (iso-abbrev): Paediatr Perinat Epidemiol
                Journal ID (doi): 10.1111/(ISSN)1365-3016
                Journal ID (publisher-id): PPE
                Title: Paediatric and Perinatal Epidemiology
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0269-5022
                ISSN (Electronic): 1365-3016
                Publication date (Electronic): 26 February 2020
                Publication date (Print): March 2020
                Volume: 34
                Issue: 2 ( doiID: 10.1111/ppe.v34.2 )
                Pages: 122-129
                Affiliations
                [ 1 ] Institute of Health & Society Newcastle University Newcastle upon Tyne UK
                [ 2 ] Centre for Maternal, Fetal and Infant Research Institute of Nursing and Health Research Ulster University Ulster UK
                [ 3 ] Medical University of Graz Graz Austria
                [ 4 ] Provinciaal Instituut voor Hygiëne Antwerp Belgium
                [ 5 ] Eurocat Hainaut –Namur Centre for Human Genetics Institut de Pathologie et de Génétique, IPG Charleroi Belgium
                [ 6 ] Paediatric Department Hospital Lillebaelt Kolding Denmark
                [ 7 ] Health Intelligence Health Service Executive Dublin Ireland
                [ 8 ] Public Health Department HSE Southeast area Lacken Kilkenny Ireland
                [ 9 ] Department of Public Health Health Service Executive South Cork Ireland
                [ 10 ] Department of Health Information and Research Guardamangia Malta
                [ 11 ] Department of Genetics University Medical Center Groningen University of Groningen Groningen The Netherlands
                [ 12 ] Department of Global Public Health and Primary Care University of Bergen Bergen Norway
                [ 13 ] Public Health Division of Gipuzkoa BioDonostia Research Institute San Sebastian Spain
                [ 14 ] Rare Diseases Research Unit Foundation for the Promotion of Health and Biomedical Research of the Valencian Region Valencia Spain
                [ 15 ] National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
                [ 16 ] Department Health Sciences University of Leicester Leicester UK
                [ 17 ] Congenital Anomaly Register and Information Service for Wales Public Health Wales Swansea UK
                [ 18 ] Faculty of Medicine University of Southampton and Wessex Clinical Genetics Service Southampton UK
                [ 19 ] OMNI‐Net Ukraine and Khmelnytsky Children Hospital Khmelnytsky Ukraine
                [ 20 ] INSERM U1153 (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology) Maternité Port Royal Paris France
                Author notes
                [*] [* ] Correspondence

                Babak Khoshnood, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology, Maternité Port Royal, Paris, France.

                Email: babak.khoshnood@ 123456inserm.fr

                Author information
                https://orcid.org/0000-0002-4663-7141
                https://orcid.org/0000-0003-3831-6089
                https://orcid.org/0000-0002-4031-4915
                Article
                Publisher ID: PPE12655
                DOI: 10.1111/ppe.12655
                PMC ID: 7064886
                PubMed ID: 32101337
                SO-VID: 601e93f0-c49a-4a4b-8a51-c2a93d572336
                Copyright © © 2020 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 02 August 2019
                Date revision received : 13 January 2020
                Date accepted : 21 January 2020
                Page count
                Figures: 2, Tables: 2, Pages: 8, Words: 5475
                Funding
                Funded by: Public Health England , open-funder-registry 10.13039/501100002141;
                Funded by: Newcastle University Wellcome Trust Institutional Strategic Support Fund
                Categories
                Subject: Original Article
                Subject: Congenital Anomalies
                Custom metadata
                source-schema-version-number 2.0
                cover-date March 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.7 mode:remove_FC converted:11.03.2020

                ScienceOpen disciplines: Pediatrics
                Keywords: perinatal mortality,termination of pregnancy for foetal anomaly
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: perinatal mortality, termination of pregnancy for foetal anomaly

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