| PurposeThe prevalence of birth defects is high,the etiology is complex,which not only seriously affect the life,health and quality of life of the children,but also bring heavy burden and economic loss to the family and society.Based on hospital monitoring data,this study studied the current situation and existing problems of birth defects in Chongqing and put forward policy suggestions,so as to provide scientific basis for further development of birth defect prevention,formulation of birth defect prevention policies and intervention measures,and provide technical guidance for improving health promotion measures such as pre-pregnancy eugenics,pregnancy health care and neonatal disease screening in Chongqing.Method1.Based on the hospital monitoring data,descriptive epidemiological research methods were adopted to analyze the monitoring data of birth defects in Chongqing from 2007 to 2020 by means of Chi-square test,Chi-square trend test,and unconditional logistic regression analysis.The incidence,disease spectrum,outcome and influencing factors of birth defects and key diseases were statistically analyzed to grasp the prevalence and occurrence characteristics of birth defects and key diseases in Chongqing.2.Combined with literature research,questionnaire survey,in-depth interview and other methods,domestic and foreign literature retrieval databases,and public information on the official websites of the government and the Health Commission were used to investigate the distribution and service capacity of birth defects resources and the operation of major structural malformations in Chongqing.Combined with the interview results,the current situation of the construction and management of the prevention and control system of birth defects in Chongqing was understood,and the problems in the prevention and control of birth defects in Chongqing were summarized and analyzed.Result1.Current status of birth defects in Chongqing from 2007 to 2020A total of 12,761 cases of perinatal birth defects were monitored in Chongqing from 2007 to 2020,and the incidence of birth defects was 124.82/10,000,142.01/10,000 in urban areas,91.41/10,000 in rural areas,137.28/10,000 in males and109.68 per 10000 in females.The incidence of birth defects in urban areas was significantly higher than that in rural areas(P<0.001).The incidence was higher in males than in females(P<0.001).From 2007 to 2020,the incidence of birth defects in Chongqing showed a decreasing trend(P<0.001).The incidence of pregnant women in different age groups was approximately U-shaped,and the difference was statistically significant(P<0.001).The incidence in metropolitan areas was higher than that in northeast Chongqing and southeast Chongqing city clusters(P<0.001).The incidence of twins or more was higher than that of singletons(P<0.001).In 2020,the top five incidence rates of major birth defects in Chongqing were congenital heart disease33.47/10,000,polydactyly(toes)18.93/10,000,other external ear malformations14.54/10,000,syndactyly(toes)6.67/10,000,microtia(including no ears)4.19/10,000.The incidence of congenital heart disease was the highest.From 2007 to 2020,a total of 1,103 cases of severe and multiple disabling birth defects were monitored in Chongqing,with a total incidence of 1,079 per 10,000,including 11.47/10,000 in urban areas,9.48/10,000 in rural areas,10.47/10,000 in males and 10.97/10,000 in females.The incidence in urban areas was higher than that in rural areas(P=0.004).There was no significant difference between male and female(P=0.436).There was a significant difference in the incidence rate among different maternal age groups(P<0.001).Southeast Chongqing was significantly lower than the metropolitan area and Northeast Chongqing(P<0.001).The trend analysis showed that the incidence of severe multiple disability birth defects in Chongqing decreased from2007 to 2020(P<0.001).Among them,in addition to the severe congenital heart disease is on the rise,neural tube defects,chromosome syndrome,shortening of the limbs,abdominal wall defects are falling(P<0.001).From 2007 to 2020,a total of 2,995 children with congenital heart disease were monitored in Chongqing.The incidence of congenital heart disease was 29.30/10,000,including 38.13/10,000 in urban areas,12.12/10,000 in rural areas,29.97/10,000 in males and 29.54/10,000 in females.The prevalence in urban area was higher than that in rural area(P<0.001).There was no significant difference between males and females(P=0.594).The incidence of parturients in different age groups increased with age(P<0.001).The incidence rate was higher in twins or more than twins than in singletons(P<0.001).Among different regions,the incidence rate was highest in metro area,followed by northeast Chongqing,and lowest in southeast Chongqing(P<0.001).The incidence of congenital heart disease in Chongqing increased firstly and then decreased during 2007-2020,increased during 2007-2015,and decreased during2015-2020(P<0.001).Among the main diseases,atrial septal defect,patent ductus arteriosus and atrioventricular septal defect showed an increasing trend(P<0.001).The average therapeutic induced labor rate of children with birth defects in Chongqing from 2007 to 2020 showed an increasing trend of 43.01%(P<0.001).The average survival rate was 55.42%,which showed a decreasing trend(P=0.020).Factor analysis showed that advanced maternal age,permanent residence in rural area,and high per capita annual family income were risk factors for the death of children with birth defects(P<0.05).Education level,number of fetuses,region,gestational times and birth times were all influencing factors(P<0.05).2.Investigation on the construction status of comprehensive prevention and control system of birth defects in ChongqingIn terms of monitoring of birth defects,Chongqing has continuously optimized the monitoring program for birth defects,upgraded the direct reporting system for monitoring birth defects,and expanded the number of monitoring sites from 17 in 2007 to 80 at present,with more monitoring people and more representative data.In terms of child mortality,the perinatal mortality rate,neonatal mortality rate and infant mortality rate in Chongqing showed a downward trend from 2007 to 2020.In terms of health checks for birth defects,the rate of premarital check-ups and antenatal examination increased in Chongqing from 2018 to 2020.In terms of health checks for birth defects,the rate of premarital medical examination and birth check-ups increased in Chongqing from 2018 to 2020.In terms of the coverage rate of birth defect health care programs,the system management rate of children under 3 years old and the health management rate of children under 7 years old in Chongqing reached more than 90% in 2020,both of which have increased in recent years.In terms of neonatal disease screening,compared with the developed areas in China,Chongqing has fewer screening diseases,and the screening program of congenital heart disease in newborns started late and did not cover the whole city.The investigation on the operation of major structural malformations showed that in 2019,among the 80 medical institutions surveyed in Chongqing,39 hospitals carried out at least one type of surgical treatment for structural malformations,mainly concentrated in Yuzhong district,Shapingba District,Nanan District,Jiulongpo District,Dadukou District,Fuling District and Wanzhou district.Children’s Hospital Affiliated to Chongqing Medical University,Chongqing Three Gorges Central Hospital,and Dianjiang County People’s Hospital were the top three hospitals that carried out the most types of structural deformity surgery.The three hospitals with the largest volume of operations are the Children’s Hospital Affiliated to Chongqing Medical University,the Second Hospital Affiliated to Army Medical University(Xinqiao Hospital),and Chongqing Three Gorges Central Hospital.Different medical institutions that carry out structural deformity have some diseases that they are particularly good at and focus on.Based on the analysis of the interview results,the comprehensive prevention and control of birth defects in Chongqing has some problems,such as unbalanced development among regions,uneven comprehensive prevention and control ability,low level of project support,insufficient supervision,and difficult management.Conclusion1.From 2007 to 2020,the incidence of birth defects in Chongqing was124.82/10,000,showing a decreasing trend,down by 27.78%.The incidence of birth defects is higher in urban areas than in rural areas,and higher in males than females.The incidence of congenital heart disease was the highest.2.From 2007 to 2020,the incidence of severe multiple disabling birth defects in Chongqing showed a decreasing trend,with regional and age differences.Severe congenital heart disease is on the rise.3.From 2007 to 2020,congenital heart disease is on the rise in Chongqing.The incidence of atrial septal defect,patent ductus arteriosus and ventricular septal defect is relatively high,and the prevention and control situation of congenital heart disease in Chongqing is still severe.4.From 2007 to 2020,the average survival rate of children with birth defects in Chongqing was 55.42%.Education level,maternal age,different regions,number of fetuses,region,gestational times and birth times were all influencing factors for the outcome of children with birth defects.5.In recent years,the monitoring capacity of birth defects in Chongqing has been significantly improved.The mortality rate of perinatal infants,newborns and infants showed a downward trend.The comprehensive service capacity of birth defects has been enhanced.However,compared with the developed areas in China,there are still weak links.6.In 2019,among the 80 medical institutions surveyed in Chongqing,39 hospitals performed at least one type of surgical treatment for structural malformations,mainly in Yuzhong District,Shapingba District,Nan ’an District,Jiulongpo District,Dadukou District,Fuling District and Wanzhou District.Different medical institutions that carry out structural deformity have some diseases that they are particularly good at and focus on.7.The comprehensive prevention and control of birth defects in Chongqing has some problems,such as unbalanced development among regions,uneven comprehensive prevention and control ability,low level of project support,insufficient supervision,and difficult management. |
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