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

https://arctichealth.org/en/permalink/ahliterature272271
Source
PLoS One. 2015;10(5):e0125246
Publication Type
Article
Date
2015
Author
Cande V Ananth
Katherine M Keyes
Ava Hamilton
Mika Gissler
Chunsen Wu
Shiliang Liu
Miguel Angel Luque-Fernandez
Rolv Skjærven
Michelle A Williams
Minna Tikkanen
Sven Cnattingius
Source
PLoS One. 2015;10(5):e0125246
Date
2015
Language
English
Publication Type
Article
Keywords
Abruptio Placentae - epidemiology
Age Distribution
Canada - epidemiology
Cohort Studies
Denmark - epidemiology
Female
Finland - epidemiology
Humans
Maternal Age
Norway - epidemiology
Pregnancy
Prevalence
Risk factors
Smoking
Spain - epidemiology
Sweden
United States - epidemiology
Abstract
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.
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.
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
Notes
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PubMed ID
26018653 View in PubMed
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Association between maternal chronic conditions and congenital heart defects: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature112613
Source
Circulation. 2013 Aug 6;128(6):583-9
Publication Type
Article
Date
Aug-6-2013
Author
Shiliang Liu
K S Joseph
Sarka Lisonkova
Jocelyn Rouleau
Michiel Van den Hof
Reg Sauve
Michael S Kramer
Author Affiliation
Centre for Chronic Disease Prevention, Public Health Agency of Canada, Room 405A2, AL 8604A, 785 Carling Ave, Ottawa, ON, Canada K1A 0K9. sliu@uottawa.ca
Source
Circulation. 2013 Aug 6;128(6):583-9
Date
Aug-6-2013
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Chronic Disease - epidemiology
Cohort Studies
Connective Tissue Diseases - epidemiology
Diabetes Mellitus, Type 1 - epidemiology
Diabetes Mellitus, Type 2 - epidemiology
Down Syndrome - epidemiology
Epilepsy - epidemiology
Female
Heart Defects, Congenital - epidemiology
Humans
Hypertension - epidemiology
Infant, Newborn
Male
Mood Disorders - epidemiology
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy, Multiple - statistics & numerical data
Risk factors
Thyroid Diseases - epidemiology
Young Adult
Abstract
This study quantifies the association between maternal medical conditions/illnesses and congenital heart defects (CHDs) among infants.
We carried out a population-based study of all mother-infant pairs (n=2,278,838) in Canada (excluding Quebec) from 2002 to 2010 using data from the Canadian Institute for Health Information. CHDs among infants were classified phenotypically through a hierarchical grouping of International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada codes. Maternal conditions such as multifetal pregnancy, diabetes mellitus, hypertension, and congenital heart disease were defined by use of diagnosis codes. The association between maternal conditions and CHDs and its subtypes was modeled using logistic regression with adjustment for maternal age, parity, residence, and other factors. There were 26 488 infants diagnosed with CHDs at birth or at rehospitalization in infancy; the overall CHD prevalence was 116.2 per 10,000 live births, of which the severe CHD rate was 22.3 per 10,000. Risk factors for CHD included maternal age =40 years (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.39-1.58), multifetal pregnancy (aOR, 4.53; 95% CI, 4.28-4.80), diabetes mellitus (type 1: aOR, 4.65; 95% CI, 4.13-5.24; type 2: aOR, 4.12; 95% CI, 3.69-4.60), hypertension (aOR, 1.81; 95% CI, 1.61-2.03), thyroid disorders (aOR, 1.45; 95% CI, 1.26-1.67), congenital heart disease (aOR, 9.92; 95% CI, 8.36-11.8), systemic connective tissue disorders (aOR, 3.01; 95% CI, 2.23-4.06), and epilepsy and mood disorders (aOR, 1.41; 95% CI, 1.16-1.72). Specific CHD subtypes were associated with different maternal risk factors.
Several chronic maternal medical conditions, including diabetes mellitus, hypertension, connective tissue disorders, and congenital heart disease, confer an increased risk of CHD in the offspring.
Notes
Comment In: Evid Based Med. 2014 Apr;19(2):e824282172
PubMed ID
23812182 View in PubMed
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Cause-specific mortality during and after pregnancy and the definition of maternal death.

https://arctichealth.org/en/permalink/ahliterature191183
Source
Chronic Dis Can. 2002;23(1):31-6
Publication Type
Article
Date
2002
Author
Linda A Turner
Michael S Kramer
Shiliang Liu
Author Affiliation
Bureau of Reproductive and Child Health, Health Canada, Ottawa, Ontario.
Source
Chronic Dis Can. 2002;23(1):31-6
Date
2002
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cause of Death
Confidence Intervals
Female
Humans
Maternal mortality
Pregnancy
Abstract
As part of a study to determine whether maternal mortality in Canada is under- reported, we explored the validity of including deaths not directly related to pregnancy. We linked live birth and stillbirth registrations to death registrations of women of reproductive age from 1988 through 1992. We calculated standardized mortality ratios, by cause, from deaths in women known to have been pregnant and deaths in same-aged women not known to have been pregnant within the same time period. Women known to have been pregnant were approximately half as likely to die as would be expected in each of two six-month time periods: from 20 weeks gestation to 42 days postpartum (SMR 0.4, 95% CI 0.3-0.5), and from 42 days to 225 days postpartum (SMR 0.5, 95% CI 0.5-0.6). Furthermore, pregnant and recently pregnant women were not more likely to die from specific causes, with the exception of diseases of the arteries, arterioles, and capillaries (SMR 3.5, 95% CI 1.3-7.7) during pregnancy or within 42 days of pregnancy termination. The only other SMR that was > 1 was for death from cerebrovascular disorders during pregnancy and up to 42 days postpartum, although not significantly so (SMR 1.4, 95% CI 0.8-2.2). No other cause-specific SMRs were > 1. Moreover, recently pregnant women were found to be much less likely to commit suicide or to be the victims of homicide. We found no empirical justification for including deaths not directly related to pregnancy in reported counts of maternal deaths for most of the causal categories we considered.
PubMed ID
11876834 View in PubMed
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A comparison of foetal and infant mortality in the United States and Canada.

https://arctichealth.org/en/permalink/ahliterature155090
Source
Int J Epidemiol. 2009 Apr;38(2):480-9
Publication Type
Article
Date
Apr-2009
Author
Cande V Ananth
Shiliang Liu
K S Joseph
Michael S Kramer
Author Affiliation
Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901-1977, USA. cande.ananth@umdnj.edu
Source
Int J Epidemiol. 2009 Apr;38(2):480-9
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Age Distribution
Birth weight
Canada - epidemiology
Cause of Death
Cohort Studies
Female
Fetal Mortality
Gestational Age
Humans
Infant
Infant mortality
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Maternal Age
Stillbirth - epidemiology
United States - epidemiology
Abstract
Infant mortality rates are higher in the United States than in Canada. We explored this difference by comparing gestational age distributions and gestational age-specific mortality rates in the two countries.
Stillbirth and infant mortality rates were compared for singleton births at >or=22 weeks and newborns weighing>or=500 g in the United States and Canada (1996-2000). Since menstrual-based gestational age appears to misclassify gestational duration and overestimate both preterm and postterm birth rates, and because a clinical estimate of gestation is the only available measure of gestational age in Canada, all comparisons were based on the clinical estimate. Data for California were excluded because they lacked a clinical estimate. Gestational age-specific comparisons were based on the foetuses-at-risk approach.
The overall stillbirth rate in the United States (37.9 per 10,000 births) was similar to that in Canada (38.2 per 10,000 births), while the overall infant mortality rate was 23% (95% CI 19-26%) higher (50.8 vs 41.4 per 10,000 births, respectively). The gestational age distribution was left-shifted in the United States relative to Canada; consequently, preterm birth rates were 8.0 and 6.0%, respectively. Stillbirth and early neonatal mortality rates in the United States were lower at term gestation only. However, gestational age-specific late neonatal, post-neonatal and infant mortality rates were higher in the United States at virtually every gestation. The overall stillbirth rates (per 10,000 foetuses at risk) among Blacks and Whites in the United States, and in Canada were 59.6, 35.0 and 38.3, respectively, whereas the corresponding infant mortality rates were 85.6, 49.7 and 42.2, respectively.
Differences in gestational age distributions and in gestational age-specific stillbirth and infant mortality in the United States and Canada underscore substantial differences in healthcare services, population health status and health policy between the two neighbouring countries.
PubMed ID
18806278 View in PubMed
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Epidemiology of pregnancy-associated venous thromboembolism: a population-based study in Canada.

https://arctichealth.org/en/permalink/ahliterature148495
Source
J Obstet Gynaecol Can. 2009 Jul;31(7):611-20
Publication Type
Article
Date
Jul-2009
Author
Shiliang Liu
Jocelyn Rouleau
K S Joseph
Reg Sauve
Robert M Liston
David Young
Michael S Kramer
Author Affiliation
Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Ottawa, ON, Canada.
Source
J Obstet Gynaecol Can. 2009 Jul;31(7):611-20
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Cohort Studies
Female
Humans
Incidence
Pregnancy
Pregnancy Complications, Hematologic - epidemiology
Risk factors
Thromboembolism - epidemiology
Abstract
To estimate the frequency of, and to identify risk factors for, pregnancy-associated venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) requiring hospitalization.
We conducted a population-based cohort study (N = 3 852 569) using the Discharge Abstract Database of the Canadian Institute for Health Information (CIHI), for the fiscal years 1991-1992 to 2005-2006. All women with pregnancy-related hospitalizations in Canada (excluding Quebec and Manitoba) were identified. DVT and PE rates were calculated using the number of hospital deliveries (i.e., cohort of women at risk) as the denominator for the antepartum and peripartum (labour and delivery) hospitalizations and for postpartum readmissions. Risk factors for DVT/PE were identified using logistic regression.
During the antepartum, peripartum, and postpartum periods, 5.4, 7.2, and 4.3 VTE cases per 10,000 pregnancies, respectively were observed. The total incidence of DVT was 12.1 per 10,000 pregnancies (0.26 deaths per 100,000), and the rate for PE was 5.4 per 10,000 (0.96 deaths per 100,000). The strongest risk factors for DVT occurrence during the peripartum period were thrombophilia (adjusted odds ratio [aOR] 15.4; 95% CI 10.8-22.0), a past history of circulatory disease, and major puerperal infection, whereas those for PE were previous DVT (aOR 56.9; 95% CI 40.9-79.1), heart disease (aOR 43.4, 95% CI 35.0-53.9), antiphospholipid syndrome, past history of circulatory disease, transfusion, and major puerperal infection.
Cases of VTE and associated deaths occur most frequently during the peripartum period. Although mortality from pregnancy-associated VTE is low, maternal characteristics and other factors can be used to identify women at risk for VTE.
PubMed ID
19761634 View in PubMed
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Incidence, risk factors, and associated complications of eclampsia.

https://arctichealth.org/en/permalink/ahliterature130297
Source
Obstet Gynecol. 2011 Nov;118(5):987-94
Publication Type
Article
Date
Nov-2011
Author
Shiliang Liu
K S Joseph
Robert M Liston
Sharon Bartholomew
Mark Walker
Juan Andrés León
Russell S Kirby
Reg Sauve
Michael S Kramer
Author Affiliation
Health Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada. Shiliang.Liu@phac-aspc.gc.ca
Source
Obstet Gynecol. 2011 Nov;118(5):987-94
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Eclampsia - epidemiology
Female
Humans
Incidence
Infant mortality
Infant, Newborn
Maternal mortality
Pregnancy
Retrospective Studies
Risk factors
Young Adult
Abstract
To estimate trends in incidence and identify risk factors and maternal and neonatal consequences of eclampsia in Canada.
We conducted a population-based cohort study of all women and their newborns (N=1,910,729) delivered in the hospital in Canada (excluding Quebec) from 2003 to 2009. The data were obtained from the Canadian Institute for Health Information. Logistic models were used to examine the association with potential determinants and consequences of eclampsia.
The incidence of eclampsia declined dramatically from 12.4 per 10,000 deliveries in 2003 to 5.9 in 2009. Among singleton deliveries, nulliparity (adjusted odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0-2.6), anemia (adjusted OR 2.4; 95% CI 2.0-3.0), and existing heart disease (adjusted OR 4.8; 95% CI 2.9-7.3) increased the risk of eclampsia. The declining trend in eclampsia remained unchanged after accounting for changes in potential determinants and risk factors during the study period. Eclampsia was associated with increased risks of maternal death (adjusted OR 26.8; 95% CI 9.7-73.8), assisted ventilation (adjusted OR 102.3; 95% CI 78.2-133.8), respiratory distress syndrome (adjusted OR 36.2; 95% CI 15.3-85.3), acute renal failure (adjusted OR 20.9; 95% CI 11.4-38.3), obstetric embolism (adjusted OR 9.1; 95% CI 4.1-19.9), and other complications. Adverse neonatal outcomes associated with eclampsia included neonatal death (adjusted OR 2.9; 95% CI 1.6-5.5), respiratory distress syndrome (adjusted OR 5.1; 95% CI 4.1-6.3), and small-for-gestational age birth (adjusted OR 2.6; 95% CI 2.3-3.0).
Despite declining incidence and improved care of women with eclampsia, the condition remains strongly associated with serious adverse consequences.
Notes
Comment In: Obstet Gynecol. 2011 Nov;118(5):976-722015863
PubMed ID
22015865 View in PubMed
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Increasing incidence of non-Hodgkin's lymphoma in Canada, 1970-1996: age-period-cohort analysis.

https://arctichealth.org/en/permalink/ahliterature184988
Source
Hematol Oncol. 2003 Jun;21(2):57-66
Publication Type
Article
Date
Jun-2003
Author
Shiliang Liu
Robert Semenciw
Yang Mao
Author Affiliation
McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Canada.
Source
Hematol Oncol. 2003 Jun;21(2):57-66
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Canada - epidemiology
Child
Child, Preschool
Cohort Effect
Female
Humans
Incidence
Infant
Infant, Newborn
Lymphoma, Non-Hodgkin - diagnosis - epidemiology
Male
Middle Aged
Registries
Sex Factors
Time Factors
Abstract
Previous studies have shown that the incidence of non-Hodgkin's lymphoma (NHL) has increased in many parts of the world in recent decades. Using data obtained from the Canadian Cancer Registry, the present study examined time trends in NHL incidence in Canada between 1970 and 1996 and the effects of age, period of diagnosis and birth cohort on incidence patterns for each sex separately. Results showed that overall age-adjusted incidence rates increased substantially, from 7.3 and 5.2 per 100,000 in 1970-1971 to 14.0 and 10.0 per 100,000 in 1995-1996 in males and females, respectively. Diffuse lymphoma was the major histological subtype, accounting for approximately 76% of NHL cases over the 27-year period. The data suggest that period effects have played a major role, although birth cohort effects may also have been involved. Sex-specific patterns of the incidence were similar over the time period of diagnosis but were distinct among recent birth cohorts. In conclusion, there is in fact a marked increase in NHL in Canada which cannot be explained in terms of improvements in diagnosis, changes in NHL classification and the increase in AIDS-associated NHL alone. The birth cohort effect in NHL suggests that changes in risk factors may have contributed to the observed increase.
PubMed ID
12802810 View in PubMed
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Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.

https://arctichealth.org/en/permalink/ahliterature165194
Source
CMAJ. 2007 Feb 13;176(4):455-60
Publication Type
Article
Date
Feb-13-2007
Author
Shiliang Liu
Robert M Liston
K S Joseph
Maureen Heaman
Reg Sauve
Michael S Kramer
Author Affiliation
Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Ont. Shiliang_Liu@phac-aspc.gc.ca
Source
CMAJ. 2007 Feb 13;176(4):455-60
Date
Feb-13-2007
Language
English
Publication Type
Article
Keywords
Adult
Breech Presentation
Canada - epidemiology
Case-Control Studies
Cesarean Section - mortality - utilization
Delivery, Obstetric - standards - trends
Female
Health Services Research
Humans
Incidence
Infant, Newborn
Maternal Age
Maternal Mortality - trends
Morbidity
Natural Childbirth
Obstetric Labor Complications - mortality
Patient Care Planning - standards - trends
Pregnancy
Probability
Reference Values
Risk assessment
Surgical Procedures, Elective - standards - trends
Survival Analysis
Term Birth
Abstract
The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women.
Using the Canadian Institute for Health Information's Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada (excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate "planned cesarean group" considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally.
The planned cesarean group comprised 46,766 women v. 2,292,420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 4.1-6.3), wound hematoma (OR 5.1, 95% CI 4.6-5.5), hysterectomy (OR 3.2, 95% CI 2.2-4.8), major puerperal infection (OR 3.0, 95% CI 2.7-3.4), anesthetic complications (OR 2.3, 95% CI 2.0-2.6), venous thromboembolism (OR 2.2, 95% CI 1.5-3.2) and hemorrhage requiring hysterectomy (OR 2.1, 95% CI 1.2-3.8), and stayed in hospital longer (adjusted mean difference 1.47 d, 95% CI 1.46-1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion (OR 0.4, 95% CI 0.2-0.8). Absolute risk increases in severe maternal morbidity rates were low (e.g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2-2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87).
Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians.
Notes
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Comment In: CMAJ. 2007 Oct 9;177(8):89917923661
Comment In: CMAJ. 2007 Feb 13;176(4):475-617296960
PubMed ID
17296957 View in PubMed
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The occurrence of abruptio placentae in Canada: 1990 to 1997.

https://arctichealth.org/en/permalink/ahliterature177314
Source
Chronic Dis Can. 2004;25(2):16-20
Publication Type
Article
Date
2004
Author
Teresa Broers
Will D King
Tye E Arbuckle
Shiliang Liu
Author Affiliation
Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada.
Source
Chronic Dis Can. 2004;25(2):16-20
Date
2004
Language
English
Publication Type
Article
Keywords
Abruptio Placentae - epidemiology - mortality
Adolescent
Adult
Canada - epidemiology
Cohort Studies
Female
Humans
Middle Aged
Mortality - trends
Pregnancy
Pregnancy Outcome - epidemiology
Prevalence
Abstract
Abruptio placentae is a serious obstetric condition associated with an increased incidence of perinatal mortality and morbidity. Despite this, there is little information on the occurrence of abruptio placentae in Canada. The Discharge Abstract Database from the Canadian Institute for Health Information was used to identify a cohort of women who had singleton live or stillbirth deliveries in Canada between 1990 and 1997 (n = 2,162,815). Rates of abruptio placentae and abruptio placentae ending in stillbirth were examined by calendar year, province, maternal age and urban/rural status. There is a trend towards an increasing rate of abruptio placentae by year, from 10.9 (95 % confidence interval [CI] 10.5-11.3) cases/1000 deliveries in 1990 to a high of 12.1 (95% CI 11.6-12.5) cases/1000 deliveries in 1996, while the rate ending in stillbirth remained relatively constant. The abruptio placentae rate was highest in mothers over 40 years of age and the case-fatality rate highest in those under 20. These results provide a baseline reference for rates of abruptio placentae in Canada.
PubMed ID
15554607 View in PubMed
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