Objective To explore the relationship between macro-economic indicators and incidences of adverse events linked to intrauterine devices (IUDs). Methods Data on IUD-associated adverse events were collected from a cohort study conducted between September 2005 and December 2006. Regional economic data were from the 2006 National Economic and Social Development Statistical Bulletins and Statistical Yearbooks of various regions. A total of 20,220 IUD users in 236 towns in Jiangsu, Shanghai, Guangdong, Anhui, Sichuan, and Chongqing provinces in China were included in this study. Linear correlation and regression analyses were used to analyze the relationships between regional income and total incidences of adverse events, incidences of mild adverse events, and incidences of severe adverse events. Results Incidences of total adverse events and mild adverse events were positively correlated with regional economic level (rs=0.336, Plt;0.05; rs=0.272, Plt;0.05), while incidences of severe adverse events were not correlated with regional economic level. Conclusions The positive relationship between regional economic level and reported IUD-associated mild adverse events likely reflects income-related disparities in women seeking care and receiving treatment for mild adverse events. This points to a need to improve both public health education and the quality of health services, particularly in poorer areas.
Objective To establish a risk evaluation indicator system for intrauterine device (IUD), to determine the weight of indicators, to comprehensively evaluate the risk of IUDs by using a variety of comprehensive evaluation methods according to the data of IUDs, so as to provide references for the government purchasing decision-making. Methods The literature review, long-term monitoring of IUD adverse events, large sample randomized controlled trials (RCTs) and Delphi methods were applied to establish the risk evaluation indicator system for IUD. The weight of each indicator was determined by jointly using the subjective scoring method and CRITIC method. Based on the established indicator system, primary research (RCT) data and secondary research data (literature data), the analytic hierarchy process (AHP), technique for order preference by similarity to ideal solution (TOPSIS) and synthetical scored method were used to assess the risk of IUDs respectively, and then the assessment results of three methods were integrated to obtain a comprehensive rank of various IUDs. Results A two-level risk evaluation indicator system for IUD was established and the seven 1st level indicators included unwanted pregnancy, expulsion, menstruation problems, pain, IUD ectopia, position and shape changes as well as total health problems, which were divided into 26 2nd level indicators. Through the subjective and objective weighting method, the weights of each 1st level indicator were 0.147 5, 0.144 3, 0.140 7, 0.174 8, 0.163 2, 0.132 8, and 0.096 6, respectively. The risk evaluation of the above three methods showed that among the three kinds of IUD in a multicenter RCT, yuangong365 was with the lowest risk, followed by TCu380A and MLCu375. The risk evaluation showed that among the 14 kinds of IUD from literatures, medicated γ IUD was with the lowest risk, followed by HCu280, yuangong365, and Gyne IUD, while the medicated stainless steel ring 165 was with the highest risk. Conclusion The established indicator system has a good representation and credibility, and the ways to identify the weight of indicators are scientific, comprehensive and accurate. Meanwhile, the findings which were demonstrated by various assessing methods are consistent to a large extent. Now that medicated γ IUD and HCu280 have been already included in the National Coverage Plan, it is suggested that if the prices of yuangong365 and Gyne IUD are reasonable, the two IUDs could be considered to be listed in the National Coverage Plan and freely chosen by women of child-bearing age.
ObjectiveTo systematically review the efficacy of 10 commonly used intrauterine devices (IUD) by network meta-analysis.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, POPLINE, CNKI, WanFang Data, SinoMed, CMCI, ChiCTR databases and websites were electronically searched to collect randomized clinical trials (RCTs) on efficacy of 10 IUDs from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, network meta-analysis was performed by using WinBUGS 1.4.3 software and Stata 13.0 software.ResultsA total of 67 RCTs involving 59 991 IUD users were included. The results of network meta-analysis indicated that after 1 year of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165 and MLCu375, and its effectiveness ranked second out of ten IUDs (SUCRA=77.1%). YCu200 had a lower pregnancy rate than that of TCu220C, which ranked third (SUCRA=71.5%). After 2 years of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A and OCu165, which had the highest probability to be the most effective intervention (SUCRA=92.1%). YCu200 had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165, GCu200, GammaCu and MLCu375, and its effectiveness ranked second (SUCRA=81.2%).ConclusionsCurrent evidence shows that the risk of pregnancy of GyneFix and YCu200 are lower at 1 and 2 years of use, which suggests they possess superior short-term effectiveness. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.