国家政策对中西部地区新生儿遗传代谢病筛查覆盖率的影响  

Impact of national policies related to neonatal inherited metabolic diseases screening on its coverage rate of midwestern regions in China

作　　者：刘檑 朱军[1,2] 万立新 邓奎[1] 阎亚琼[4] 李敏[5] 姚永娜 向良成 袁雪莲 李琪 刘铮[1] 李小洪[1,6] Lei Liu;Jun Zhu;Lixin Wan;Kui Deng;Yaqiong Yan;Min Li;Yongna Yao;Liangcheng Xiang;Xuelian Yuan;Qi Li;Zheng Liu;Xiaohong Li(National Center for Birth Defect Monitoring of China/National Office For Maternal and Child Health Surveillance,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengdu 610041,Sichuan Province,China;Department of Maternal and Child Health,Jilin Women and Children Health Hospital,Changchun 130061,Jilin Province,China;Neonatal Disease Screening Center,Shanxi Women and Children Health Hospital,Taiyuan 030001,Shanxi Province,China;Department of Health Care,Northwest Women and Children′s Hospital,Xi′an 710004,Shaanxi Province,China;Sichuan Birth Defects Clinical Research Center,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院中国出生缺陷监测中心/全国妇幼卫生监测办公室,成都610041 [2]四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]吉林省妇幼保健院妇幼保健部,长春130061 [4]山西省妇幼保健院新生儿疾病筛查中心,太原030001 [5]西北妇女儿童医院保健部,西安710004 [6]四川大学华西第二医院四川省出生缺陷临床医学研究中心,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第4期410-418,共9页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家重点研发计划项目(2018YFC1002200)。

摘　　要：目的探讨国家政策对中西部地区(以下简称为研究地区)新生儿遗传代谢病(NIMD)筛查覆盖率的影响。方法选择2006—2020年国家出台NIMD筛查相关政策背景下的中西部22个省、市、自治区(以下简称为研究地区22个区域)NIMD筛查覆盖率为研究对象。收集影响中西部地区NIMD筛查覆盖率的主要因素,包括研究地区的经济水平[采用人均国内生产总值(GDP)表示],文化教育水平(采用大专及以上文化程度人口比例表示),卫生服务水平(采用住院分娩率表示)、国家相关政策与措施等。根据国家NIMD筛查相关政策特点,将2006—2020年分为第1~4政策阶段,分别为2006—2009年、2010—2012年、2013—2015年、2016—2020年。采用主成分分析法构建反映经济与文化教育水平的综合指标(以下简称为E&C),并采用混合线性模型分析4个政策阶段、E&C及住院分娩率对研究地区NIMD筛查覆盖率的影响。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果①对研究地区E&C的主成分分析结果显示,构建反映E&C:C=0.7071z1+0.7071z2,其中z1和z2分别表示2006—2020年研究地区人均GDP和大专及以上文化程度人口比例。②对研究地区NIMD筛查覆盖率影响因素采用混合线性模型分析结果显示,E&C和住院分娩率均为研究地区NIMD筛查覆盖率的独立影响因素(回归系数=7.89、0.42,Z=3.448、2.477,P=0.001、0.013);与第1政策阶段研究地区NIMD筛查覆盖率相比,至第2、3、4政策阶段,研究地区NIMD筛查覆盖率绝对增加值分别为16.80%(95%CI:11.66%~21.94%,Z=6.407、P<0.001),34.87%(95%CI:27.87%~41.86%,Z=9.770、P<0.001)与38.05%(95%CI:29.05%~47.06%,Z=8.280、P<0.001)。③第1~4政策阶段研究地区NIMD筛查平均覆盖率分别为31.34%、59.60%、85.43%、95.09%,第2~4政策阶段较上一政策阶段绝对增加值分别为28.26%、25.83%、9.66%,可被国家NIMD筛查相关政策解释的绝对增加值分别�Objective To explore influence of national policies related to neonatal inherited metabolic diseases(NIMD)screening on its coverage rate of midwestern regions in China.Methods National policies issues related to NIMD screening in China from 2006 to 2020 on its coverage rate of 22 areas in midwestern regions in China from 2006 to 2020 were selected as subjects for the study.Main influencing factors of coverage rate of NIMD screening of midwestern regions in China,including economic level[per capita gross domestic product(GDP)],cultural and educational level(proportion of population with junior college degree or above),health service(hospital delivery rate)data,and policies related to NIMD screening were collected.According to characteristics of these policies in 2006 to 2020,these policies were divided into phase 1(2006-2009),phase 2(2010-2012),phase 3(2013-2015),and phase 4(2016-2020)policies.Principal component analyzed by constructing a comprehensive index of economic,cultural and educational(E&C)levels,and a mixed linear regression model analyzed the effects of 1-4 phase policies related to NIMD screening,E&C levels,and hospital delivery rate on coverage rate of NIMD screening of midwestern regions in China.The study met the requirements of Helsinki Declaration of World Medical Association newly revised 2013.Results①Principal component analysis of regional E&C levels of midwestern regions in China showed that a comprehensive index C=0.7071z1+0.7071z2 was constructed,in which z1 and z2 denoted the per capita GDP and proportion of population with college or above of midwestern regions in China from 2006 to 2020,respectively.②Mixed linear model analysis on influencing factors of NIMD screening coverage rate of midwestern regions in China showed that E&C levels and hospital delivery rate were independent influencing factors on NIMD screening coverage rate of midwestern regions in China(regression coefficient=7.89,0.42;Z=3.45,2.48,P=0.001,0.013).Compared with phase 1 policies,the absolute increases in NIMD scre

关 键 词：代谢疾病 代谢缺陷 先天性 新生儿筛查 政府政策 卫生政策 社会经济因素 教育程度 卫生服务 混合线性模型 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]