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An international contrast of rates of placental abruption: an age-period-cohort analysis.

Ananth CV, Keyes KM, Hamilton A, Gissler M, Wu C, Liu S, Luque-Fernandez MA, Skjærven R, Williams MA, Tikkanen M, Cnattingius S - PLoS ONE (2015)

Bottom Line: No birth cohort effects were evident.There is a strong maternal age effect on abruption.These findings suggest considerable variation in abruption frequencies across countries; differences in the distribution of risk factors, especially smoking, may help guide policy to reduce abruption rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America.

ABSTRACT

Background: Although rare, placental abruption is implicated in disproportionately high rates of perinatal morbidity and mortality. Understanding geographic and temporal variations may provide insights into possible amenable factors of abruption. We examined abruption frequencies by maternal age, delivery year, and maternal birth cohorts over three decades across seven countries.

Methods: Women that delivered in the US (n = 863,879; 1979-10), Canada (4 provinces, n = 5,407,463; 1982-11), Sweden (n = 3,266,742; 1978-10), Denmark (n = 1,773,895; 1978-08), Norway (n = 1,780,271, 1978-09), Finland (n = 1,411,867; 1987-10), and Spain (n = 6,151,508; 1999-12) were analyzed. Abruption diagnosis was based on ICD coding. Rates were modeled using Poisson regression within the framework of an age-period-cohort analysis, and multi-level models to examine the contribution of smoking in four countries.

Results: Abruption rates varied across the seven countries (3-10 per 1000), Maternal age showed a consistent J-shaped pattern with increased rates at the extremes of the age distribution. In comparison to births in 2000, births after 2000 in European countries had lower abruption rates; in the US there was an increase in rate up to 2000 and a plateau thereafter. No birth cohort effects were evident. Changes in smoking prevalence partially explained the period effect in the US (P = 0.01) and Sweden (P<0.01).

Conclusions: There is a strong maternal age effect on abruption. While the abruption rate has plateaued since 2000 in the US, all other countries show declining rates. These findings suggest considerable variation in abruption frequencies across countries; differences in the distribution of risk factors, especially smoking, may help guide policy to reduce abruption rates.

No MeSH data available.


Related in: MedlinePlus

Age-period-cohort effects of placental abruption in the United States, Canada, Sweden, Norway, Denmark, Finland, and Spain.Abruption rates (per 1000) based on maternal age are shown on the left axis, and the rate ratio with 95% confidence interval for placental abruption in relation to maternal birth cohort (year 1975 as the reference) and period (year 2000 as the reference) are shown on the right axis.
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pone.0125246.g003: Age-period-cohort effects of placental abruption in the United States, Canada, Sweden, Norway, Denmark, Finland, and Spain.Abruption rates (per 1000) based on maternal age are shown on the left axis, and the rate ratio with 95% confidence interval for placental abruption in relation to maternal birth cohort (year 1975 as the reference) and period (year 2000 as the reference) are shown on the right axis.

Mentions: Fig 3 shows the estimates of age, period, and cohort effects on abruption. The age-specific rates are plotted on the left axis, and period and cohort estimates are plotted on the rate ratio scale (right axis), with 2000 as the reference group for period and 1975 as the reference for birth cohort.


An international contrast of rates of placental abruption: an age-period-cohort analysis.

Ananth CV, Keyes KM, Hamilton A, Gissler M, Wu C, Liu S, Luque-Fernandez MA, Skjærven R, Williams MA, Tikkanen M, Cnattingius S - PLoS ONE (2015)

Age-period-cohort effects of placental abruption in the United States, Canada, Sweden, Norway, Denmark, Finland, and Spain.Abruption rates (per 1000) based on maternal age are shown on the left axis, and the rate ratio with 95% confidence interval for placental abruption in relation to maternal birth cohort (year 1975 as the reference) and period (year 2000 as the reference) are shown on the right axis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4446321&req=5

pone.0125246.g003: Age-period-cohort effects of placental abruption in the United States, Canada, Sweden, Norway, Denmark, Finland, and Spain.Abruption rates (per 1000) based on maternal age are shown on the left axis, and the rate ratio with 95% confidence interval for placental abruption in relation to maternal birth cohort (year 1975 as the reference) and period (year 2000 as the reference) are shown on the right axis.
Mentions: Fig 3 shows the estimates of age, period, and cohort effects on abruption. The age-specific rates are plotted on the left axis, and period and cohort estimates are plotted on the rate ratio scale (right axis), with 2000 as the reference group for period and 1975 as the reference for birth cohort.

Bottom Line: No birth cohort effects were evident.There is a strong maternal age effect on abruption.These findings suggest considerable variation in abruption frequencies across countries; differences in the distribution of risk factors, especially smoking, may help guide policy to reduce abruption rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America.

ABSTRACT

Background: Although rare, placental abruption is implicated in disproportionately high rates of perinatal morbidity and mortality. Understanding geographic and temporal variations may provide insights into possible amenable factors of abruption. We examined abruption frequencies by maternal age, delivery year, and maternal birth cohorts over three decades across seven countries.

Methods: Women that delivered in the US (n = 863,879; 1979-10), Canada (4 provinces, n = 5,407,463; 1982-11), Sweden (n = 3,266,742; 1978-10), Denmark (n = 1,773,895; 1978-08), Norway (n = 1,780,271, 1978-09), Finland (n = 1,411,867; 1987-10), and Spain (n = 6,151,508; 1999-12) were analyzed. Abruption diagnosis was based on ICD coding. Rates were modeled using Poisson regression within the framework of an age-period-cohort analysis, and multi-level models to examine the contribution of smoking in four countries.

Results: Abruption rates varied across the seven countries (3-10 per 1000), Maternal age showed a consistent J-shaped pattern with increased rates at the extremes of the age distribution. In comparison to births in 2000, births after 2000 in European countries had lower abruption rates; in the US there was an increase in rate up to 2000 and a plateau thereafter. No birth cohort effects were evident. Changes in smoking prevalence partially explained the period effect in the US (P = 0.01) and Sweden (P<0.01).

Conclusions: There is a strong maternal age effect on abruption. While the abruption rate has plateaued since 2000 in the US, all other countries show declining rates. These findings suggest considerable variation in abruption frequencies across countries; differences in the distribution of risk factors, especially smoking, may help guide policy to reduce abruption rates.

No MeSH data available.


Related in: MedlinePlus