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- Title
Multilevel analyses of related public health indicators: The European Surveillance of Congenital Anomalies (EUROCAT) Public Health Indicators.
- Authors
Best, Kate E.; Rankin, Judith; Dolk, Helen; Loane, Maria; Haeusler, Martin; Nelen, Vera; Verellen‐Dumoulin, Christine; Garne, Ester; Sayers, Gerardine; Mullaney, Carmel; O'Mahony, Mary T.; Gatt, Miriam; De Walle, Hermien; Klungsoyr, Kari; Carolla, Olatz Mokoroa; Cavero‐Carbonell, Clara; Kurinczuk, Jennifer J.; Draper, Elizabeth S.; Tucker, David; Wellesley, Diana
- Abstract
<bold>Background: </bold>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.<bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
PUBLIC health; PERINATAL death; POISSON regression; CONGENITAL disorders; HUMAN abnormalities
- Publication
Paediatric & Perinatal Epidemiology, 2020, Vol 34, Issue 2, p122
- ISSN
0269-5022
- Publication type
journal article
- DOI
10.1111/ppe.12655