法国本土未足月临产前胎膜早破的时间趋势与空间分布
本研究利用法国国家健康数据系统2015至2023年行政数据，描述法国本土未足月临产前胎膜早破（PPROM）的时间趋势和省级地理分布。共纳入150 615例PPROM，年粗发病率从2015年2.2%升至2023年2.7%，2020年发病率相对下降。省级平滑标准化发病率比地图显示存在地理不均衡。
要点
- PPROM年发病率在法国本土呈上升趋势，2023年粗发病率达2.7%。
- 2020年PPROM发病率较其他年份下降，发病率比为0.903。
- PPROM在地理分布上存在省级差异，提示需在高风险区域开展针对性预防。
核心结论
- 这是首项描述法国本土PPROM病例的人群研究，为后续探索环境相关假设奠定基础。
- 识别PPROM发病的时间趋势和地理差异对公共卫生政策与实践具有意义，支持在高风险区域制定针对性预防策略。
研究设计与样本
- 基于法国国家健康数据系统行政数据的探索性人群研究，覆盖2015年至2023年法国本土。
- 研究对象为37孕周前诊断PROM的妊娠，年粗发病率以PPROM诊断妊娠数除以同期活产数计算。
- 年趋势采用二项负混合模型估计，平滑标准化发病率比基于BYM2模型估计并考虑省份间空间变异。
主要发现
- 研究期间共纳入150 615例PPROM，每年约16 735例（±596）。
- PPROM发病率随时间呈上升趋势，发病率比为每年1.023（95% CI：1.017–1.030）。
- 年粗发病率从2015年2.2%升至2023年2.7%。
- 2020年PPROM发病率较其他年份下降，发病率比为0.903（95% CI：0.887–0.920）。
- 法国行政大区层面的PPROM平滑标准化发病率比地图显示存在地理不均衡。
关键数值与推荐
- 主要结局为PPROM病例，定义为首次住院诊断PROM时孕周小于37周的妊娠。
- PPROM年发病率上升趋势对应发病率比为每年1.023（95% CI：1.017–1.030）。
- 2020年PPROM发病率较其他年份的发病率比为0.903（95% CI：0.887–0.920）。
临床怎么用
- 临床可将PPROM地理和时间差异作为识别高风险区域、制定针对性预防策略的参考依据。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective To describe the temporal trends in Preterm prelabour rupture of membranes (PPROM) in metropolitan France and the geographical distribution at the administrative division level. Design Exploratory population-based study using administrative data of the French National Health Data System. Setting Metropolitan France, 2015 to 2023. Population Pregnancy with a diagnosis of PROM before 37 SA. Methods Annual crude incidence of PPROM was calculated by dividing the number of pregnancies with PPROM diagnosis by the number of live births recorded during the same period. Annual trend was estimated by a binomial negative mixed model. Smoothed standardised incidence ratios were estimated based on a BYM2 model, which accounts for spatial variability between departments. Main Outcome PPROM cases, defined as pregnancies with first hospitalizations with a diagnosis of PROM before 37 weeks. Results Over the study period, we included 150 615 PPROM cases representing 16 735 (±596) per year. Incidence of PPROM cases showed an ascending trend over time (incidence rate ratio 1.023 per year; 95% CI: 1.017–1.030) with an annual crude incidence ranging from 2.2% in 2015 to 2.7% in 2023. A decrease in the incidence was observed in 2020 relative to other years (incidence rate ratio 0.903, 95% CI: 0.887–0.920). A map of smoothed SIRs of PPROM cases at the French administrative division level revealed geographical inequalities. Conclusions This first population-based study describing PPROM cases in metropolitan France paves the way for further studies to explore environmental hypotheses. Identifying temporal and geographical disparities in PPROM incidence is relevant to public health policy and practice as such disparities argue for the development of targeted prevention strategies in high-risk areas.
引用
- BJOG：Temporal Trends and Spatial Variation in Preterm Prelabour Rupture of Membranes: A Population‐Based Study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。