An Algorithm for the Use of Medicare Claims Data to Identify Women with Incident Breast Cancer

Objective. To develop and validate a clinically informed algorithm that uses solely Medicare claims to identify, with a high positive predictive value, incident breast cancer cases.
Data Source. Population-based Surveillance, Epidemiology, and End Results (SEER) Tumor Registry data linked to Medicare claims, and Medicare claims from a 5 percent random sample of beneficiaries in SEER areas.
Study Design. An algorithm was developed using claims from 1995 breast cancer patients from the SEER-Medicare database, as well as 1995 claims from Medicare control subjects. The algorithm was validated on claims from breast cancer subjects and controls from 1994. The algorithm development process used both clinical insight and logistic regression methods.
Data Extraction. Training set: Claims from 7,700 SEER-Medicare breast cancer subjects diagnosed in 1995, and 124,884 controls. Validation set: Claims from 7,607 SEER-Medicare breast cancer subjects diagnosed in 1994, and 120,317 controls.
Principal Findings. A four-step prediction algorithm was developed and validated. It has a positive predictive value of 89 to 93 percent, and a sensitivity of 80 percent for identifying incident breast cancer. The sensitivity is 82–87 percent for stage I or II, and lower for other stages. The sensitivity is 82–83 percent for women who underwent either breast-conserving surgery or mastectomy, and is similar across geographic sites. A cohort identified with this algorithm will have 89–93 percent incident breast cancer cases, 1.5–6 percent cancer-free cases, and 4–5 percent prevalent breast cancer cases.
Conclusions. This algorithm has better performance characteristics than previously proposed algorithms. The ability to examine national patterns of breast cancer care using Medicare claims data would open new avenues for the assessment of quality of care.     

Development and Validation of an Algorithm for Identifying Patients with Hemophilia A in an Administrative Claims Database

Background

The accuracy with which hemophilia A can be identified in claims databases is unknown.

Whole Grain Intakes Are Associated with Healthcare Cost Savings Following Reductions in Risk of Colorectal Cancer and Total Cancer Mortality in Australia: A Cost-of-Illness Model

Whole grain consumption has been associated with the reduced risk of several chronic diseases with significant healthcare monetary burden, including cancer. Colorectal cancer (CRC) is one of the most common cancers globally, with the highest rates reported in Australia. Three servings of whole grains provide a 15% reduction in total cancer and 17% reduction in CRC risk; however, 70% of Australians fall short of this level of intake. The aim of this study was to assess the potential savings in healthcare costs associated with reductions in the relative risk of CRC and total cancer mortality following the whole grain Daily Target Intake (DTI) of 48 g in Australia. A three-step cost-of-illness analysis was conducted using input parameters from: (1) estimates of current and targeted whole grain intakes among proportions (5%, 15%, 50%, and 100%) of the Australian adult (≥20 years) population; (2) estimates of reductions in relative risk (with 95% confidence intervals) of CRC and total cancer mortality associated with specific whole grain intake from meta-analysis studies; and (3) estimates of annual healthcare costs of CRC and all cancers from disease expenditure national databases. A very pessimistic (5% of population) through to universal (100% of population) adoption of the recommended DTI in Australia were shown to potentially yield savings in annual healthcare costs equal to AUD 1.9 (95% CI 1.2–2.4) to AUD 37.2 (95% CI 24.1–48.1) million for CRC and AUD 20.3 (95% CI 12.2–27.0) to AUD 405.1 (95% CI 243.1–540.1) million for total cancers. As treatment costs for CRC and other cancers are increasing, and dietary measures exchanging whole grains for refined grains are not cost preclusive nor does the approach increase energy intake, there is an opportunity to facilitate cost-savings along with reductions in disease for Australia. These results suggest specific benefits of encouraging Australians to swap refined grains for whole grains, with greater overall adherence to suggestions in dietary guidelines.     

A Comparative Analysis of Medicare Home Care Cost Savings for the Terminally Ill

Claims histories of 1,148 Medicare beneficiaries who died of cancer were examined to determine if traditional home care, compared to hospice home care and conventional oncological care, achieved substantial cost savings. Using analysis of variance and the test for the difference between percentages, the study indicated that although traditional home care beneficiaries were about one-third more costly during the last 24 weeks of life than either the hospice home care or conventional care patients, there appeared to be some cost savings during the last 4 weeks of life. The analysis clearly showed that the substitution of home care visits for hospital days occurred much more readily in hospice home care than in traditional home care. As a consequence, the cost savings potential of hospice home care was substantially greater. The study did not show a tendency for daily hospital costs to decline among the hospice or traditional home care patients as death approached. Thus, the hypothesis that home care services achieve cost savings by reducing the daily wst of hospital inpatient care was not supported.     

An Analysis of Injuries Among Home Health Care Workers Using the Washington State Workers' Compensation Claims Database

An examination of the Washington State workers' compensation claims for home health care workers was conducted. Some comparisons were made with nursing homes, acute care hospitals, and all other industries in the state. Between 1998 and 2007, the average claims rate for home health care workers was 1,375 claims/10,000 full-time equivalents (FTEs) compared to 862 claims/10,000 FTEs for all other industries. The proportion of home health care workers' injuries resulting from interactions with another person (89.6%) was comparable to those for nursing homes and hospitals. Although this industry has important economic and social value, risks are poorly characterized. Continued research is necessary.     

Primary Care for Transgender Adolescents and Young Adults in Rhode Island: An Analysis of the all Payers Claims Database

PurposeStructural stigma has shaped disparities across several domains of health for transgender relative to cisgender (nontransgender) adolescents in the United States. Research on transgender health has largely overlooked the role of preventive care, especially for adolescents.MethodsWe used ICD-9 and ICD-10 codes to identify transgender adolescents in the Rhode Island All Payers Claims Database (APCD) from 2011 to 2017 based on a diagnosis for gender identity disorder (GID). We evaluated differences in the use of preventive care services between transgender and cisgender adolescents. We compared the frequency of sexually transmitted infection and HIV screening and the percentage prescribed pre-exposure prophylaxis among transgender and cisgender adolescents using t-tests and chi-square tests. We used logistic regression to evaluate the association between attending regular physical exams and receiving preventive health services.ResultsThere was no significant difference in the proportion of transgender and cisgender adolescents who received regular influenza vaccinations, physical exams, and HPV vaccinations. Transgender adolescents were significantly more likely to receive regular cholesterol and BMI screenings compared to cisgender adolescents. While there was a significant positive association between having regular physical exams and receiving most preventive screenings in the cisgender population, in the transgender population, regular physical exams were only significantly positively associated with STI screening.ConclusionsTransgender adolescents accessing the healthcare system received similar, if not greater, levels of preventive health services compared to their cisgender peers. Because regular physical exams were not associated with receiving most preventive services among transgender adolescents, these services may be delivered outside of primary care settings.     

军队医疗机构实行医保总额预付制的卫生经济学分析

2009年上海市医保局在三级医院开始试行"医保总额预付制"。本文从卫生经济学角度,分析施行总额预付制后医院对卫生服务提供进行的调整,分析军队医疗机构实行总额预付制面临的挑战,提出医院应及时转变观念,从提高医疗质量,加强成本核算,实现医保管理信息化、精细化等方面着手,科学合理控费,主动适应和推进医疗改革的进程。     

Prevalence of Systemic Lupus Erythematosus in South Korea: An Administrative Database Study

Background

Systemic lupus erythematosus (SLE) is a rare autoimmune disease for which a population-based survey on the prevalence of the disease in South Korea has not yet been conducted. Our goal was to estimate the nationwide prevalence of SLE.

Methods

The International Classification of Diseases, Tenth Revision (ICD-10) code for SLE diagnosis—M32—was tentatively given when patients were suspected to have SLE before 2009. As such, the positive predictive value (PPV) of the M32 code shown in medical bills reflecting true SLE was uncertain. We attempted to estimate the prevalence of SLE in South Korea using national administrative database data from 2004–2006. We approximated the actual number of SLE patients by analyzing a list of SLE-coded patients provided by the National Health Insurance (NHI) and Health Insurance Review and Assessment Service. Prevalence was estimated by multiplying the PPV of the M32 diagnostic code by the number of patients receiving the code. The PPV was determined by three methods: direct investigation of the medical records of patients randomly selected from the SLE-coded patients list; assessment of all SLE patients treated at 56 selected hospitals in South Korea; and extrapolation from sub-groups at a single institute to the sub-groups of the national NHI data.

Results

The estimated number of national SLE cases was between 9000 and 11 000, depending on the method of ascertainment, corresponding to a prevalence of 18.8–21.7 per 100 000 people.

Conclusions

This is the first report of a nationwide prevalence survey of SLE in South Korea. National databases may serve as a resource for epidemiologic studies of rare autoimmune diseases like SLE.Key words: systemic lupus erythematosus, prevalence, epidemiology     

全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床疗效分析

目的观察分析全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床效果。方法选取我院2014年2月至2016年2月收治的160例老年股骨颈骨折患者,随机分为两组各80例,观察组患者采用全髋关节置换术治疗,对照组患者采用半髋关节置换术治疗,比较两组的治疗效果。结果观察组患者的优良率97.50%,显著高于对照组的85.00%(P<0.05)。观察组患者的手术时间显著长于对照组(P<0.05)。观察组患者的术后静脉栓塞、髋部疼痛、感染发生率显著低于对照组(P<0.05)。结论针对老年股骨颈骨折患者,全髋关节置换术的治疗效果优于半髋关节置换术,可有效减轻患者疼痛,减少术后并发症,加快康复速度,提高患者生活质量。     

The Economic Burden of Ischemic Stroke and Major Hemorrhage in Medicare Beneficiaries with Nonvalvular Atrial Fibrillation: A Retrospective Claims Analysis

Background

Understanding the economic implications of oral anticoagulation therapy requires careful consideration of the risks and costs of stroke and major hemorrhage. The majority of patients with atrial fibrillation (AF) are aged ≥65 years, so focusing on the Medicare population is reasonable when discussing the risk for stroke.

Objective

To examine the relative economic burden associated with stroke and major hemorrhage among Medicare beneficiaries who are newly diagnosed with nonvalvular atrial fibrillation (NVAF).

Methods

This study was a retrospective analysis of a 5% sample of Medicare claims data for patients with NVAF from 2006 to 2008. Patients with NVAF without any claims of AF during the 12 months before the first (index) claim for AF in 2007 (baseline period) were identified and were classified into 4 cohorts during a 12-month follow-up period after the index date. These cohorts included (1) no claims for ischemic stroke or major hemorrhage (without stroke or hemorrhage); (2) no claims for ischemic stroke and ≥1 claims for major hemorrhage (hemorrhage only); (3) ≥1 claims for ischemic stroke and no major hemorrhage claims (stroke only); and (4) ≥1 claims each for ischemic stroke and for major hemorrhage (stroke and hemorrhage). The 1-year mean postindex total all-cause healthcare costs adjusted by the Centers for Medicare & Medicaid Services Hierarchical Condition Categories (HCC) score were compared among the study cohorts. Results: Of the 9455 eligible patients included in this study, 3% (N = 261) of the patients had ischemic stroke claims only, 3% (N = 276) had hemorrhage claims only, and <1% (N = 13) had both during the follow-up period. The unadjusted follow-up healthcare costs were $63,781 and $64,596 per patient for the ischemic stroke only and the hemorrhage only cohorts, respectively, compared with $35,474 per patient for those without hemorrhage or stroke claims. After adjustment for HCC risk score, the mean incremental costs for patients with stroke claims only and hemorrhage claims only, relative to those without stroke or hemorrhage claims, were $26,776 (95% confidence interval [CI], $20,785-$32,767; P <.001) and $26,168 (95% CI, $20,375-$31,961; P <.001), respectively.

Conclusion

The economic burden of managing patients with NVAF who experience ischemic stroke and hemorrhage were similarly significant during the first year after a diagnosis of NVAF. The burden of major bleeding complications on patients, clinicians, and payers should not be overlooked, and these complications should be considered in conjunction with the cost-savings associated with ischemic stroke risk reduction in future cost-benefit evaluations of oral anticoagulation therapy.Atrial fibrillation (AF) is the most common form of sustained cardiac arrhythmia.1,2 The most recent estimates (published in 2013) of the prevalence of AF in the United States are for 2010 and range from 2.7 million to 6.1 million.3,4 The prevalence of AF doubles with each decade of life after the age of 60 years and occurs in approximately 10% of the US population aged ≥80 years.5–7 A recent study estimates that the number of patients with AF in the United States could potentially reach 12.1 million by 20303; other estimates range from 5.6 million to 12 million patients with AF by 2050.4Patients with AF have an approximate 5-fold increased risk for stroke compared with patients in normal sinus rhythm.4 Furthermore, the percentage of strokes that can be attributed to AF increases steeply with age, with rates of 1.5% in patients aged 50 to 59 years and 23.5% in those aged 80 to 89 years.4 The term “nonvalvular atrial fibrillation” (NVAF) is used to describe cases of AF that occur in the absence of rheumatic mitral valve disease, mitral valve repair, or a prosthetic heart valve.8 NVAF affects approximately 85% of the overall population with AF and is a substantial medical burden for Medicare beneficiaries (aged ≥65 years) in the United States.9,10The current evidence-based clinical guidelines recommend the use of oral anticoagulation in patients with NVAF who are at an intermediate to high risk for stroke.8,11 Although the efficacy of oral anticoagulation therapy to prevent stroke in patients with NVAF is well-established, it is also associated with a risk of bleeding.12–15 Understanding the relative economic burdens of stroke and major hemorrhage is important when considering the costs and benefits of anticoagulation therapy.Several studies have reported the incremental costs associated with stroke alone or with hemorrhage alone using different NVAF payer populations (ie, commercial or Medicare), and a few recent studies have provided incremental cost data for stroke and hemorrhage for the Medicare population, reporting significant incremental costs in the year after the stroke or hemorrhage index dates.7,16–20 Other studies have analyzed the incremental costs associated with stroke alone or with hemorrhage alone, or have analyzed these costs for a commercial population with NVAF.21–24 Most of these studies were done in separate patient populations and different time periods, making assessment of the relative economic burden of stroke versus bleeding difficult. By contrast, our study provides the cost estimates for these 2 conditions simultaneously based on the same patient population, which allows a more appropriate comparison of the economic implication of these 2 major consequences of oral anticoagulation therapy for the prevention of stroke among patients with NVAF.The prespecified objective in our study was to assess the relative economic burden (including Medicare Part D costs) associated with ischemic stroke and with major hemorrhagic events (ie, intracranial and gastrointestinal [GI] bleeding) among Medicare beneficiaries with newly diagnosed NVAF in the 12 months after the NVAF index diagnosis.     

复方倍他米松注射液在全膝关节置换术后的镇痛效果分析

目的探讨复方倍他米松注射液在全膝关节置换术后的镇痛效果及安全性。方法选取我院2014年6月至2016年5月行单侧全膝关节置换术的42例患者,随机分为观察组和对照组,各21例。观察组在关节周围注射吗啡+罗哌卡因+复方倍他米松+肾上腺素镇痛混合剂,对照组注射吗啡+罗哌卡因+肾上腺素镇痛混合剂。患者术后48 h内经静脉应用镇痛泵,比较两组患者术后2 h、6 h、12 h、24 h、48 h、72 h的静息痛VAS评分。结果观察组术后2 h、6 h、12 h、24 h的静息痛VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。两组患者术后48 h、72 h的静息痛VAS评分比较均无统计学差异(P>0.05)。结论全膝关节置换术中采用含有复方倍他米松的鸡尾酒疗法,能够显著减轻患者术后早期疼痛,安全性较高。     

机械通气相关肺炎危险因素分析

目的 探讨机械通气相关肺炎（ＶＡＰ）的危险因素。方法 选取内科ＩＣＵ、外科ＩＣＵ、ＣＣＵ爱气时间在２４小时以上１９４例患者,符合ＶＡＰ诊断标准作为ＢＶＡＰ感染组,ＶＡＰ未感染组作为对照组,采用单因素分析与多因素分析分别得出ＶＡＰ危险因素、独立危险因素。结果 ＶＡＰ的感染发生率为２７．８４％,单因素分析表明慢性肺疾病、先前使用的抗生纱,气管造口术、急诊手术、机械通气患者仰卧位、鼻胃管、肺动脉插管、胃     

Outcomes Associated with 5-HT3-RA Therapy Selection in Patients with Chemotherapy-Induced Nausea and Vomiting: A Retrospective Claims Analysis

Background

Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of chemotherapy, and may present during the administration of chemotherapy (ie, acute CINV) or within 25 to 120 hours of chemotherapy (ie, delayed CINV). Preventing CINV with the initiation of chemotherapy is important, because the risk for CINV in future chemotherapy cycles increases if CINV occurs in the first or previous treatment cycle. Inadequately controlled CINV is associated with increased resource utilization and costs, particularly for patients receiving highly or moderately emetogenic chemotherapy.

Objective

To evaluate the clinical and economic impacts of delayed CINV events in patients who receive initial and maintenance therapy with the newer-generation 5-hydroxytryptamine₃ receptor antagonist (5-HT₃-RA) palonosetron compared with patients who receive initial and maintenance therapy with an older 5-HT₃-RA agent.

Methods

A retrospective database analysis was conducted using the OptumInsight database covering the years 2005–2011 (96% commercially insured members, 4% Medicaid members). Patients with cancer who received initial therapy with an emetogenic single-day chemotherapy regimen and a 5-HT₃-RA agent (ie, dolasetron, granisetron, ondansetron, or palonosetron) were included in the analysis. The outcomes measured included the overall rates of delayed CINV for cycles 1 to 6, by 5-HT₃-RA cohort. For cycles 2 to 6, calculations were based on patients who experienced CINV in the previous cycle, maintained the same 5-HT₃-RA for all cycles, and had chemotherapy with a similar level of emetic potential. The economic outcomes (ie, cost and utilization) were also collected and calculated.

Results

A total of 26,974 patients were included in the analysis. The overall rate for delayed CINV at cycle 1 was 15.6%, and the lowest rate was for palonosetron at 15%. The patients who initiated palonosetron had lower CINV rates throughout all cycles. The regression analysis compared individual agents to palonosetron and demonstrated higher odds of CINV in the second cycle for the older agents (ondansetron: odds ratio [OR], 1.41; 95% confidence interval [CI], 1.14–1.74; P <.002; granisetron: OR, 1.70; 95% CI, 1.39–2.08; P <.001; dolasetron: OR, 1.65; 95% CI, 1.27–2.15; P = .002). This trend continued through cycle 6, and not all ORs were significant. Over 6 cycles, ondansetron cost an additional $126,775 compared with palonosetron; granisetron an additional $169,838 versus palonosetron; and dolasetron an additional $148,960.

Conclusions

Current guidelines support the use of 5-HT₃-RA agents for the prevention of CINV. As shown in this analysis, the selection of a specific 5-HT₃-RA agent has a clinical and subsequent economic impact on patients with cancer experiencing delayed CINV. Specifically, patients receiving therapy with palonosetron had a lower incidence of delayed CINV and incurred lower overall costs.Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of chemotherapy, and may present during or soon after (0–24 hours) chemotherapy administration (ie, acute CINV) or between 25 to 120 hours after chemotherapy administration (ie, delayed CINV).1,2 In the absence of antiemetic prophylaxis, many emetogenic agents will cause emesis in more than 90% of patients within 24 hours of the administration of chemotherapy.1–3 Preventing CINV during the initiation of chemotherapy is important, because the risk for CINV in future chemotherapy cycles increases if CINV occurs in the first or previous treatment cycle.4–8 The 5-hydroxytryptamine₃ receptor antagonists (5-HT₃-RAs) have proved to be very effective in the prevention of CINV, with current guidelines supporting the use of the 5-HT₃-RA agents for CINV prophylaxis.9–11Despite the effectiveness of the 5-HT₃-RAs, uncontrolled CINV still occurs in more than 25% of patients receiving chemotherapy.4 Antiemesis guidelines from the American Society of Clinical Oncology, National Comprehensive Cancer Network (NCCN), and Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) recommend palonosetron as a preferred treatment among the 5-HT₃-RAs for CINV prophylaxis before moderately emetogenic chemotherapy (MEC).9–11 In addition, the NCCN''s antiemesis guidelines have granted palonosetron preferred status for the prevention of CINV with strongly emetogenic chemotherapy (HEC) regimens.10 The MASCC/ESMO guidelines consider palonosetron as the preferred 5-HT₃-RA for anthracycline plus cyclo-phosphamide chemotherapy regimens when a neurokinin 1 receptor antagonist is not available.11The effectiveness of palonosetron has also been supported by studies conducted in solid tumors, as well as in blood cancers, demonstrating that patients receiving palonosetron had significantly lower CINV event rates than patients receiving other 5-HT₃-RAs, and that palonosetron can be safely and effectively administered to patients receiving chemotherapy regimens administered over multiple days per cycle.12–15Although the effectiveness of the older 5-HT₃-RA agents (ie, ondansetron, dolasetron, and granisetron) in preventing emesis in the acute phase (0–24 hours after chemotherapy administration) has been well documented, delayed CINV (2–5 days after chemotherapy administration), particularly nausea, continues to pose clinical (ie, including negative impact on quality of life)16 and economic burdens for patients with cancer.Uncontrolled delayed CINV has been defined as nausea and/or vomiting or a diagnosis of dehydration made during an office visit, emergency department visit, or hospitalization.4,14 The rates of uncontrolled CINV have been estimated to be as high as 28%,4 and uncontrolled CINV has been associated with 25% to 50% of patients delaying or refusing chemotherapy.17 Up to 82% of women receiving MEC or HEC can experience delayed nausea.18 Even if patients do not experience CINV in the first 24 hours of chemotherapy administration, delayed CINV affects activities of daily life in 23% of patients.18–20 Uncontrolled CINV has been shown to be associated with increased resource utilization and costs, particularly for patients receiving MEC or HEC.21,22 In a study assessing CINV costs for the first cycle of a MEC or HEC regimen, 64% of CINV-associated visits included an inpatient visit and 26% included an outpatient visit, with the mean cost of a CINV visit calculated to be $5299 (standard deviation [SD], $6639).21 Another study has estimated the average daily cost of CINV to be approximately $1850.22 These costs further show the need to establish control of CINV at the first chemotherapy cycle.

KEY POINTS

• ▸ Without antiemetic prophylaxis, emesis occurs in more than 90% of patients within 24 hours of receiving emetogenic chemotherapy.
• ▸ Uncontrolled CINV is associated with increased costs and resource utilization, as well as poorer quality of life.
• ▸ The risk for CINV in future chemotherapy cycles increases if it occurs early in the treatment cycle.
• ▸ Based on the current analysis, patients receiving 5-HT₃-RA agents, especially palonosetron, have fewer delayed CINV events and incur lower costs than other agents.
• ▸ Overall, palonosetron was found to reduce all CINV events compared with the older 5-HT₃-RA agents.
• ▸ Delayed CINV was 15% with palonosetron, followed by 16.9% with ondansetron, 17% with granisetron, and 17.3% with dolasetron.
• ▸ Over 6 cycles of chemotherapy, ondansetron cost an additional $126,775 compared with palonosetron, granisetron an additional $169,838, and dolasetron an additional $148,960.
• ▸ In addition, when CINV is not controlled early, palonosetron can still exhibit benefits in subsequent cycles compared with the older 5-HT₃-RA agents.
• ▸ This analysis also shows that choosing the most effective 5-HT₃-RA agent for the first chemotherapy cycle can help to reduce CINV rates in subsequent cycles, and therefore reduce costs.
• ▸ For patients receiving chemotherapy, considering the efficacy and associated costs of the 5-HT₃-RA agent used for CINV prevention can improve the patient''s quality of life and reduce overall costs.

Because CINV in the delayed phase is still a problem for patients receiving chemotherapy, the evidence for the effectiveness of palonosetron, and the increasing pressure to contain healthcare costs, we conducted this study to evaluate the clinical and economic impacts of delayed CINV in patients who initiated therapy with palonosetron and maintained therapy with palonosetron versus patients who initiated therapy with an older 5-HT₃-RA and received maintenance therapy with that older agent throughout their chemotherapy cycles.     

青岛地区出生缺陷发生的相关因素分析

目的：对青岛地区出生缺陷相关因素进行调查分析,为制定出生缺陷干预措施提供参考。方法：2003～2005年青岛市监测的前5位出生缺陷疾病共358例为缺陷组,对照组采用1：2配对,进行回顾性调查,使用统计软件行结果分析。结果：有家族遗传病史和不良孕产史,以及丈夫吸烟、酗酒和孕妇被动吸烟、接触放射线、孕期发热、服药、羊水过多的家庭,出生缺陷的发生风险较高,且两组比较有统计学差异（P0.01）。家庭经济收入和孕期营养与出生缺陷的发生风险成反比。结论：对出生缺陷相关的宣传教育应有针对性地多方位、多渠道进行,最终使每个待孕家庭将出生缺陷预防变成自觉行为。     

孕妇缺铁性贫血影响因素分析

目的探讨孕妇孕期缺铁性贫血的影响因素。方法对进行产前检查的早孕孕妇,按血色素和血清铁蛋白分为缺铁性贫血组35名和对照组104名进行问卷调查。所得资料运用t检验、χ2检验和U检验进行分析。结果两组孕妇在体重、BMI指数、早孕反应、偏食情况、孕期补铁食物摄入频次、生产方式等方面差异有统计学意义(P<0·05,或P<0·01)。结论育龄期饮食结构不合理是导致孕期缺铁性贫血发生的重要因素。