Investigation of factors influencing congenital heart disease among children in Qinghai Province
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摘要:
目的 分析青海省儿童先天性心脏病(congenital heart disease, CHD)的影响因素。 方法 采用病例对照研究，按性别和年龄相差＜1岁进行1∶2个体匹配，纳入315名＜6岁的儿童(病例组105名，对照组210名)，影响因素采用条件logistic回归分析模型分析。 结果 单因素条件logistic回归分析模型筛选出14个差异均有统计学意义的CHD影响因素(均P<0.001)，包括居住地海拔、民族、出生体重、母亲文化程度、家庭收入、孕期接受宣教、首次妊娠、孕期补充维生素、孕期主要饮用水、孕期食用蔬菜水果、孕期食用油炸腌制品、孕期体育锻炼、孕期饲养动物、孕期定期体检；多因素条件logistic回归分析模型分析筛选出6个有统计学意义的CHD影响因素，包括海拔>2 500 m(OR=4.84, 95% CI: 1.17~20.08, P=0.030)、出生体重≥2.5 kg(OR=0.10, 95% CI: 0.01~0.81, P=0.031)、母亲有大学及以上文化程度(OR=0.23, 95% CI: 0.07~0.76, P=0.016)、家庭人均月收入>1 500元(OR=0.03, 95% CI: 0.01~0.21, P=0.001)、孕期补充维生素(OR=0.06, 95% CI: 0.01~0.40, P=0.004)、孕期饮用纯净水(OR=0.05, 95% CI: 0.01~0.35, P=0.003)。 结论 与低海拔地区相比，居住在高海拔地区发生CHD的危险会高出4.84倍。家庭收入、母亲文化程度、母亲孕期生活方式与CHD的发生可能有关。 Abstract:Objective This study aimed to analyze the factors influencing congenital heart disease (CHD) in children within Qinghai Province. Methods A 1∶2 sex- and age-matched (age difference less than 1 year) case-control study was employed, incorporating 315 children under 6 years (105 in the case group, 210 in the control group). Conditional logistic regression models were utilized to analyze influencing factors. Results Univariate conditional logistic regression model identified 14 significant factors (P<0.001) influencing congenital heart disease, including altitude of residence, ethnicity, birth weight, maternal education, family income, receiving missionary education during pregnancy, first pregnancy, vitamin supplementation during pregnancy, main drinking water during pregnancy, consumption of vegetables and fruits during pregnancy, consumption of fried foods during pregnancy, have physical exercise during pregnancy, keeping animals during pregnancy, and regular medical checkups during pregnancy. Multivariate conditional logistic regression identified six significant factors, including altitude >2500 m (OR=4.84, 95% CI: 1.17-20.08, P=0.030), birth weight ≥2.5 kg (OR=0.10, 95% CI: 0.01-0.81, P=0.031), maternal education level of university or above (OR=0.23, 95% CI: 0.07-0.76, P=0.016), monthly per capita household income >1 500 yuan (OR=0.03, 95% CI: 0.01-0.21, P=0.001), vitamin supplementation during pregnancy (OR=0.06, 95% CI: 0.01-0.40, P=0.004), and consumption of purified water during pregnancy (OR=0.05, 95% CI: 0.01-0.35, P=0.003). Conclusions The risk of CHD was found to be 4.84 times higher in high-altitude residences compared to low-altitude ones. Furthermore, family income, maternal education, and maternal lifestyle during pregnancy may be linked with the occurrence of CHD. -
Key words:
- Congenital heart disease /
- Risk factors /
- Children /
- Epidemiological studies
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表 1 儿童先天性心脏病基线水平的比较
Table 1. Comparison of baseline levels of congenital heart disease in children
变量Variable 病例组①
Case group ①
(n=105)对照组①
Control group ①
(n=210)χ2值
valueP值
value性别Sex 0.001 1.000 男性Male 48(45.71) 96(45.71) 女性Female 57(54.29) 114(54.29) 年龄组/岁Age group/years 1.400 1.920 ＜1 29(27.62) 63(30.00) 1~＜2 10(9.52) 15(7.14) 2~＜3 6(5.71) 15(7.14) 3~＜4 15(14.29) 24(11.43) 4~＜5 13(12.38) 23(10.95) 5~6 33(31.43) 70(33.33) 注：①以[人数(占比/%)]表示。
Note: ① [Number of people (proportion/%)].
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表 2 儿童先天性心脏病影响因素的单因素条件logistic回归分析模型
Table 2. Univariate conditional logistic regression analysis of influencing factors of congenital heart disease in children
变量Variable 病例组⑤
Case group ⑤(n=105)对照组⑤
Control group ⑤(n=210)χ2值
valueOR值value
(95% CI)P值
value居住地海拔/m Altitude of residence /m 2 230~2 500 42(40.00) 181(86.19) 1.00 >2 500 63(60.00) 29(13.81) 43.93 4.86(2.92~8.09) <0.001 民族Nationality 汉族Han 33(31.43) 157(74.76) 1.00 少数民族Minority 72(68.57) 53(25.24) 54.92 6.46(3.8~10.83) <0.001 出生体重/kg ① Birth weight/kg ① <2.5 17(20.98) 9(4.37) 1.00 ≥2.5 64(79.02) 197(95.63) 19.49 0.17(0.07~0.40) <0.001 出生胎龄/周Gestational age/week 早产或过期产Premature or postterm delivery 7(6.67) 13(6.19) 1.00 足月Full-term delivery 98(93.33) 197(93.81) 0.03 0.92(0.36~2.39) 0.870 母亲文化程度Mother′s education 高中及以下High school and below 84(80.00) 46(21.90) 1.00 大学及以上University and above 21(20.00) 164(78.10) 97.47 0.07(0.04~0.13) <0.001 家庭月均收入/元Average monthly household income/yuan <1 500 60(57.14) 43(20.48) 1.00 ≥1 500 45(42.86) 167(79.52) 42.76 0.19(0.12~0.32) <0.001 母亲孕期接受宣教Pregnant mothers receive fertility education during pregnancy 无No 81(77.14) 83(39.52) 1.00 有Yes 24(22.86) 127(60.48) 39.69 0.19(0.11~0.33) <0.001 首次妊娠First pregnancy 否No 65(61.90) 86(40.95) 1.00 是Yes 40(38.10) 124(59.05) 12.31 0.43(0.26~0.69) <0.001 孕期补充维生素Vitamin supplements during pregnancy 否No 34(32.38) 11(5.24) 1.00 是Yes 71(67.62) 199(94.7) 42.12 0.12(0.06~0.24) <0.001 孕期生病Sickness during pregnancy 无No 71(67.62) 154(73.33) 1.00 有Yes 34(32.38) 56(26.67) 1.12 1.32(0.79~2.19) 0.290 孕期服药Taking medication during pregnancy 无No 90(85.71) 186(88.57) 1.00 有Yes 15(14.29) 24(11.43) 0.53 1.25(0.69~2.28) 0.470 孕期居室(办公室)装修Decoration of the living room (office) during pregnancy 无No 100(95.23) 199(94.76) 1.00 有Yes 5(4.77) 11(5.24) 0.03 0.91(0.32~2.55) 0.860 孕期主要饮用水Main drinking water during pregnancy 纯净水Purified water 11(10.48) 112(53.33) 45.81 0.23(0.13~0.40) <0.001 自来水Piped water 79(75.24) 94(44.76) 1.00 湖、井水Lake or well water 15(14.28) 4(1.91) 7.59 3.91(1.35~11.5) 0.006 孕期食用蛋肉鱼水产品、牛奶及豆制品②
Consumption of eggs, meat, fish and fish products, milk and soy products during pregnancy ②偶尔Occasionally 31(29.52) 27(12.86) 5.81 1.61(1.09~2.38) 0.016 间常Occasionally and often 26(24.76) 53(25.24) 1.00 经常Often 48(45.72) 130(61.90) 0.94 0.91(0.75~1.11) 0.330 孕期食用蔬菜、水果② Consumption of vegetables and fruits during pregnancy ② 偶尔Occasionally 18(17.14) 6(2.86) 2.23 1.70(0.80~3.62) 0.140 间常Occasionally and often 19(18.10) 15(7.14) 1.00 经常Often 68(64.76) 189(90.00) 12.40 0.84(0.75~0.95) <0.001 孕期食用油炸、腌制品② Consumption of fried and pickled products during pregnancy ② 偶尔Occasionally 63(60.00) 164(78.10) 14.65 0.81(0.71~0.92) <0.001 间常Occasionally and often 22(20.95) 15(7.14) 1.00 经常Often 20(19.05) 31(14.76) 3.52 0.71(0.49~1.03) 0.061 孕期被动吸烟③ Passive smoking during pregnancy 无No 56(53.33) 104(49.52) 1.00 有Yes 49(46.67) 106(50.48) 0.41 1.08(0.86~1.35) 0.524 孕期适当体育锻炼Appropriate physical activity during pregnancy 无No 77(73.33) 110(52.38) 1.00 有Yes 28(26.67) 100(47.62) 12.74 0.56(0.40~0.79) <0.001 孕期饲养动物Keeping animals during pregnancy 无No 71(67.62) 193(91.90) 1.00 有Yes 34(32.38) 17(8.10) 30.43 4.00(2.35~6.82) <0.001 孕早期情绪Emotions in early pregnancy 愉快Happy 33(31.42) 99(47.14) 6.77 0.68(0.50~0.93) 0.009 一般General 63(60.00) 97(46.19) 1.00 不愉快Unhappy 9(8.58) 14(6.67) 0 0.99(0.4~2.17) 0.982 孕早期性生活Sex during early pregnancy 无No 90(85.71) 177(84.29) 1.00 有Yes 15(14.29) 33(15.71) 0.11 1.02(0.92~1.12) 0.739 孕期定期产检Regular maternity check-ups during pregnancy 无No 38(36.19) 28(13.33) 1.00 有Yes 67(63.81) 182(86.67) 23.27 2.82(1.82~4.35) <0.001 父亲吸烟Father smoking 否No 52(49.52) 125(59.52) 1.00 是Yes 53(50.48) 85(40.48) 2.84 0.83(0.67~1.04) 0.092 父亲饮酒Father Drinking 否No 64(60.95) 144(68.57) 1.00 是Yes 41(39.05) 66(31.43) 1.81 0.89(0.74~1.06) 0.178 母亲性格自我评价Self-assessment of mother′s character 内向Introversion 49(46.67) 92(43.81) 1.00 外向Extraversion 56(53.33) 118(56.19) 0.23 0.95(0.77~1.18) 0.631 母亲孕期情绪Mothers′ moods during pregnancy 稳定Steadiness 79(75.24) 170(80.95) 1.00 不稳定Unsteadiness 26(24.76) 40(19.05) 1.38 1.30(0.84~2.01) 0.240 母亲孕期经历负性事件④ Experiencing negative events during pregnancy ④ 无No 86(81.90) 169(80.48) 1.00 有Yes 19(18.10) 41(19.52) 0.09 1.02(0.91~1.14) 0.761 注：①数据有缺失。②使用频次分为偶尔(0~＜3次/月)，间常(3次/周)，经常(≥4次/周)。③是指被调查者在1周内有≥1 d的时间处于被动吸烟的环境，每天吸入烟雾≥15 min。④孕妇生活事件量表。⑤以[人数(占比/%)]表示。
Note: ①There are data gaps. ②Frequency of use is categorized as occasional (0~<3 times/month), intermittent (3 times/week), frequent (≥4 times/week). ③It was defined as the respondent being in a passive smoking environment for ≥1 d in a 1-week period and inhaling smoke for ≥15 min per day. ④ Maternal Life Events Scale. ⑤[Number of people (proportion/%)].
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表 3 儿童先天性心脏病影响因素的多因素条件logistic回归模型分析
Table 3. Multivariate conditional logistic regression of influencing factors of congenital heart disease in children
变量Variable χ2值
valueOR值value
(95% CI)P值
value居住地海拔/m Altitude of residence /m 2 230~2 500 1.00 >2 500 6.50 6.74(1.55~29.18) 0.011 出生体重/kg Birth weight/kg <2.5 1.00 ≥2.5 4.68 0.10(0.01~0.81) 0.031 母亲文化程度Mother′s education 高中及以下High school and below 1.00 大学及以上University and above 5.80 0.23(0.07~0.76) 0.016 家庭月均收入/元Average monthly household income/yuan <1 500 1.00 ≥1 500 12.07 0.03(0.01~0.21) 0.001 孕期补充维生素Vitamin supplements during pregnancy 否No 1.00 是Yes 8.41 0.06(0.01~0.40) 0.004 孕期主要饮用水Main drinking water during pregnancy 纯净水Purified water 1.00 自来水Piped water 8.70 0.05(0.01~0.35) 0.003
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