Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries.

IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Josephine Funck Bilsteen, Signe Opdahl, Anna Pulakka, Per Ivar Finseth, Weiyao Yin, Kristine Pape, Jorun Schei, Johanna Metsälä, Anne-Marie Nybo Andersen, Sven Sandin, Eero Kajantie, Kari Risnes
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引用次数: 0

Abstract

Background: External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood.

Methods: Individual level data from national health registries in Denmark (1978-2001), Finland (1987-2003), Norway (1967-2002), and Sweden (1974-2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016-2018. Gestational age was categorized as "very/moderately preterm" (23-33 weeks), "late preterm" (34-36 weeks), "early term" (37-38 weeks), "full term" (39-41 weeks), and "post term" (42-44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country's estimates in meta-analyses.

Results: Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99-1.24) for males and 1.55 (95% CI 1.28-1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04-1.18) and 1.15 (95% CI 1.02-1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34-2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99-1.53] and 1.29 [95% CI 1.16-1.45], respectively) and females (HRs 1.53 [95% CI 0.97-2.41] and 1.35 [95% CI 1.07-1.71], respectively, with some heterogeneity across countries).

Conclusions: Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males.

按孕龄和性别分列的青少年晚期和成年早期外因死亡率:北欧四国基于人口的队列研究。
背景:意外事故、药物使用和自杀等外部死因在很大程度上导致了青少年和成年早期的死亡率,并表现出明显的性别差异。早产儿罹患精神障碍、认知和执行功能受损的风险更高,这可能会增加他们因外部原因死亡的可能性。我们研究了胎龄与青少年晚期和成年早期外因死亡率之间的性别差异:我们将丹麦(1978-2001 年)、芬兰(1987-2003 年)、挪威(1967-2002 年)和瑞典(1974-2001 年)国家健康登记处的个人数据连接起来,形成了全国性的队列。在2016-2018年期间,共有6,924,697名参与者接受了从15岁到最长50岁的随访。胎龄分为 "极早产/中度早产"(23-33 周)、"晚期早产"(34-36 周)、"早期早产"(37-38 周)、"足月"(39-41 周)和 "足月后"(42-44 周)。研究结果包括外部原因导致的总体死亡率,以及运输事故、自杀、毒品或酒精导致的最大亚组死亡率。我们以足月婴儿为参照,估算了不同性别的危险比(HRs),并将每个国家的估算结果汇总到荟萃分析中:结果:在所有妊娠年龄段,男性死亡率均高于女性。极早产/中度早产儿的外因死亡率较高,男性为 1.11(95% 置信区间 [CI]0.99-1.24),女性为 1.55(95% 置信区间 [CI]1.28-1.88)。晚期早产儿的相应估计值分别为 1.11(95% CI 1.04-1.18)和 1.15(95% CI 1.02-1.29)。极度/中度早产儿因交通事故造成的死亡率较高,但精确度较低。就女性而言,极度/中度早产儿的自杀死亡率较高(HR 1.76,95% CI 1.34-2.32),而男性则不然。药物或酒精导致的死亡率在极度/中度早产和晚期早产男性(HRs 分别为 1.23 [95% CI 0.99-1.53] 和 1.29 [95% CI 1.16-1.45])和女性(HRs 分别为 1.53 [95% CI 0.97-2.41] 和 1.35 [95% CI 1.07-1.71],各国之间存在一定的异质性)中较高:总体而言,早产儿的外因死亡率高于足月出生的男性和女性。在自杀方面存在明显的性别差异,早产是女性的一个风险因素,但不是男性的一个风险因素。
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来源期刊
BMC Medicine
BMC Medicine 医学-医学:内科
CiteScore
13.10
自引率
1.10%
发文量
435
审稿时长
4-8 weeks
期刊介绍: BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.
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