2013年与2019年我国育龄夫妇孕前健康风险检出率的对比分析

Comparison of the detection rates of preconception health risks among Chinese couples of reproductive age in 2013 and 2019

目的对比分析2013年与2019年我国育龄夫妇孕前健康风险检出率。方法本研究为横断面研究,连续选取2013年或2019年参加“国家免费孕前优生健康检查项目”的9153916对20~49岁育龄夫妇的孕前健康检查资料,评估育龄女性孕前8类健康风险(遗传风险、生殖风险、慢性病风险、感染风险、营养风险、行为风险、环境风险、社会心理风险)暴露情况,以及育龄男性除生殖风险外的7类孕前健康风险暴露情况。采用t检验和χ^(2)检验比较育龄夫妇人口学特征差异,计算各类孕前健康风险检出率及95%CI,采用χ^(2)检验比较风险检出率差异。结果2019年我国育龄夫妇中年龄≥35岁、高中及以上学历、工人、户籍性质为非农业者比例均显著高于2013年(15.18%比6.22%、52.12%比29.78%、8.33%比7.17%、12.39%比6.64%),农民比例显著低于2013年(60.95%比76.87%)(均P<0.001)。2013年我国育龄女性检出率最高的3类风险是营养风险(37.50%)、感染风险(16.95%)和社会心理风险(11.62%),2019年检出率最高的3类风险是营养风险(38.07%)、感染风险(12.82%)和慢性病风险(11.12%)。2019年育龄女性营养风险检出率显著高于2013年(38.07%比37.50%),感染风险和社会心理风险检出率均显著低于2013年(12.82%比16.95%、7.37%%比11.62%)(均P<0.001)。2013年育龄男性检出率最高的3类风险是行为风险(44.87%)、营养风险(36.81%)和社会心理风险(13.43%),2019年检出率最高的3类风险是营养风险(45.47%)、行为风险(38.76%)和社会心理风险(9.18%)。2019年育龄男性营养风险检出率显著高于2013年(45.47%比36.81%),行为风险和社会心理风险检出率均显著低于2013年(38.76%比44.87%、9.18%比13.43%)(均P<0.001)。结论2019年我国育龄夫妇营养风险及男性遗传风险检出率较2013年有所升高,其他孕前健康风险暴露呈下降趋势;营养风险、感染风险、社会心理风险和慢性病风险为育龄女性当前主要风险,营养风险、行为风险和社会心理风险为育龄男性当前主要风险。

Objective To assess the detection rates of preconception health risks among couples of reproductive age in China and analyze the differences between 2013 and 2019.Methods In this cross-sectional study,the preconception health examination data of 9153916 couples of 20-49 years who participated in the National Free Preconception Health Examination Project in 2013 or 2019 were consecutively selected.The health risks involved eight aspects in women(genetic risk,reproductive risk,chronic disease risk,infectious risk,nutritional risk,behavioral risk,environmental risk and psychosocial risk)and seven aspects in men except for reproductive risks were assessed.The t test and χ^(2) test were used to compare the differences in demographic characteristics between the couples of reproductive age.The detection rates and 95%CI of each preconception health risk were calculated and the χ^(2) test was used to compare the differences in the detection rates of risk factors.Results In 2019,the proportion of couples of reproductive age in China who were 35 years or older,had an education background of high school and above,workers,and held non-agricultural registered residence were all higher than those in 2013(15.18%vs 6.22%,52.12%vs 29.78%,8.33%vs 7.17%,12.39%vs 6.64%),while the proportion of farmers was significantly lower than that in 2013(60.95%vs 76.87%)(all P<0.001).In 2013,the three health risks with the highest detection rate among Chinese women of reproductive age was nutritional risk(37.50%),infectious risk(16.95%)and psychosocial risk(11.62%),respectively;while in 2019,it was nutritional risk(38.07%),infectious risk(12.82%),and chronic disease risk(11.12%),respectively.The detection rate of nutritional risk in Chinese women of reproductive age in 2019 was significantly higher than that in 2013(38.07%vs 37.50%),while the detection rates of infectious risk and psychosocial risk were both lower than those in 2013(12.82%vs 16.95%and 7.37%vs 11.62%)(all P<0.001).In 2013,the top three risks detected in men of reproductive age was behavioral risk(44.87%),nutritional risk(36.81%)and psychosocial risk(13.43%),respectively;and in 2019,it was nutritional risk(45.47%),behavioral risk(38.76%)and psychosocial risk(9.18%),respectively.The detection rates of nutritional risk in men of reproductive age in 2019 was significantly higher than that in 2013(45.47%vs 36.81%),while the detection rates of behavioral risk and psychosocial risk were both lower than those in 2013(38.76%vs 44.87%,9.18%vs 13.43%)(all P<0.001).Conclusions The detection rate of nutritional risk in couples of reproductive age and genetic risk in men in 2019 in China are higher than those in 2013,and the exposure to the other preconception health risks is decreasing.The nutritional risk,infection risk,psychosocial risk and chronic disease risk are the main risk factors for women of reproductive age,while the nutritional risk,behavioral risk and psychosocial risk are the main risk factors for men.