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. 2020 Mar;34(2):122-129.
doi: 10.1111/ppe.12655.

Multilevel analyses of related public health indicators: The European Surveillance of Congenital Anomalies (EUROCAT) Public Health Indicators

Kate E Best  1 , Judith Rankin  1 , Helen Dolk  2 , Maria Loane  2 , Martin Haeusler  3 , Vera Nelen  4 , Christine Verellen-Dumoulin  5 , Ester Garne  6 , Gerardine Sayers  7 , Carmel Mullaney  8 , Mary T O'Mahony  9 , Miriam Gatt  10 , Hermien De Walle  11 , Kari Klungsoyr  12 , Olatz Mokoroa Carolla  13 , Clara Cavero-Carbonell  14 , Jennifer J Kurinczuk  15 , Elizabeth S Draper  16 , David Tucker  17 , Diana Wellesley  18 , Nataliia Zymak-Zakutnia  19 , Nathalie Lelong  20 , Babak Khoshnood  20
Affiliations

Multilevel analyses of related public health indicators: The European Surveillance of Congenital Anomalies (EUROCAT) Public Health Indicators

Kate E Best et al. Paediatr Perinat Epidemiol. 2020 Mar.

Abstract

Background: Public health organisations use public health indicators to guide health policy. Joint analysis of multiple public health indicators can provide a more comprehensive understanding of what they are intended to evaluate.

Objective: To analyse variaitons in the prevalence of congenital anomaly-related perinatal mortality attributable to termination of pregnancy for foetal anomaly (TOPFA) and prenatal diagnosis of congenital anomaly prevalence.

Methods: We included 55 363 cases of congenital anomalies notified to 18 EUROCAT registers in 10 countries during 2008-12. Incidence rate ratios (IRR) representing the risk of congenital anomaly-related perinatal mortality according to TOPFA and prenatal diagnosis prevalence were estimated using multilevel Poisson regression with country as a random effect. Between-country variation in congenital anomaly-related perinatal mortality was measured using random effects and compared between the null and adjusted models to estimate the percentage of variation in congenital anomaly-related perinatal mortality accounted for by TOPFA and prenatal diagnosis.

Results: The risk of congenital anomaly-related perinatal mortality decreased as TOPFA and prenatal diagnosis prevalence increased (IRR 0.79, 95% confidence interval [CI] 0.72, 0.86; and IRR 0.88, 95% CI 0.79, 0.97). Modelling TOPFA and prenatal diagnosis together, the association between congenital anomaly-related perinatal mortality and TOPFA prevalence became stronger (RR 0.70, 95% CI 0.61, 0.81). The prevalence of TOPFA and prenatal diagnosis accounted for 75.5% and 37.7% of the between-country variation in perinatal mortality, respectively.

Conclusion: We demonstrated an approach for analysing inter-linked public health indicators. In this example, as TOPFA and prenatal diagnosis of congenital anomaly prevalence decreased, the risk of congenital anomaly-related perinatal mortality increased. Much of the between-country variation in congenital anomaly-related perinatal mortality was accounted for by TOPFA, with a smaller proportion accounted for by prenatal diagnosis.

Keywords: perinatal mortality; termination of pregnancy for foetal anomaly.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Actual and modelled association between perinatal mortality and TOPFA prevalence
Figure 2
Figure 2
Actual and modelled association between perinatal mortality and prenatal diagnosis prevalence. ¥Prenatal diagnosis available for Hainaut only, †Prenatal diagnosis available for Cork and Kerry and SE Ireland but not Dublin
See this image and copyright information in PMC

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