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

By Kate E Best (8535693), Judith Rankin (481828), Helen Dolk (3169182), Maria Loane (5066558), Martin Haeusler (3605276), Vera Nelen (409807), Christine Verellen-Dumoulin (5066546), Ester Garne (3169191), Gerardine Sayers (8535696), Carmel Mullaney (7760531), Mary T O'Mahony (8535699), Miriam Gatt (5066549), Hermien De Walle (3927668), Kari Klungsoyr (5066555), Olatz Mokoroa Carolla (8535702), Clara Cavero-Carbonell (7769126), Jennifer J Kurinczuk (8535705), Elizabeth S Draper (8535669), David Tucker (3374453), Diana Wellesley (5066564), Nataliia Zymak-Zakutnia (7769141), Nathalie Lelong (323728) and Babak Khoshnood (110800)

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

Topics: Uncategorized, perinatal mortality, termination of pregnancy for foetal anomaly
Year: 2020
OAI identifier: oai:figshare.com:article/11940375
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