Multistate study of the epidemiology of clubfoot Parker, Samantha E.; Mai, Cara T.; Strickland, Matthew J. ...
Birth defects research. A Clinical and molecular teratology,
November 2009, Letnik:
85, Številka:
11
Journal Article
To examine the trends in the prevalence, epidemiologic correlates, and 1-year survival of omphalocele using 1995-2005 data from the National Birth Defects Prevention Network in the United States.
We ...examined 2,308 cases of omphalocele over 11 years from 12 state population-based birth defects registries. We used Poisson regression to estimate prevalence and risk factors for omphalocele and Kaplan-Meier survival curves and Cox proportional hazards regression to estimate survival patterns and hazard ratios, respectively, to examine isolated compared with nonisolated cases.
Birth prevalence of omphalocele was 1.92 per 10,000 live births with no consistent trend over time. Neonates with omphalocele were more likely to be male (prevalence ratio 1.22, 95% confidence interval CI 1.12-1.34), born to mothers 35 years of age or older (prevalence ratio 1.77, 95% CI 1.54-2.04) and younger than 20 years (prevalence ratio 1.34, 95% CI 1.14-1.56), and of multiple births (prevalence ratio 2.22, 95% CI 1.85-2.66). The highest proportion of neonates with omphalocele had congenital heart defects (32%). The infant mortality rate was 28.7%, with 75% of those occurring in the first 28 days. The best survival was for isolated cases and the worst for neonates with chromosomal defects (hazard ratio 7.75, 95% CI 5.40-11.10) and low-birth-weight neonates (hazard ratio 7.51, 95% CI 5.86-9.63).
Prevalence of omphalocele has remained constant from 1995 to 2005. Maternal age (younger than 20 years and 35 years or older), multiple gestation, and male sex are important correlates of omphalocele, whereas co-occurrence with chromosomal defects and very low birth weight are consistent determinants of 1-year survival among these neonates.
II.
To identify trends in the prevalence and epidemiologic correlates of gastroschisis using a large population-based sample with cases identified by the National Birth Defects Prevention Network over ...the course of an 11-year period.
This study examined 4,713 cases of gastroschisis occurring in 15 states during 1995-2005, using public use natality data sets for denominators. Multivariable Poisson regression was used to identify statistically significant risk factors, and Joinpoint regression analyses were conducted to assess temporal trends in gastroschisis prevalence by maternal age and race and ethnicity.
Results show an increasing temporal trend for gastroschisis (from 2.32 per 10,000 to 4.42 per 10,000 live births). Increasing prevalence of gastroschisis has occurred primarily among younger mothers (11.45 per 10,000 live births among mothers younger than age 20 years compared with 5.35 per 10,000 among women aged 20 to 24 years). In the multivariable analysis, using non-Hispanic whites as the referent group, non-Hispanic black women had the lowest risk of having a gastroschisis-affected pregnancy (prevalence ratio 0.42, 95% confidence interval CI 0.37-0.48), followed by Hispanics (prevalence ratio 0.86, 95% CI 0.81-0.92). Gastroschisis prevalence did not differ by newborn sex.
Our findings demonstrate that the prevalence of gastroschisis has been increasing since 1995 among 15 states in the United States, and that higher rates of gastroschisis are associated with non-Hispanic white maternal race and ethnicity, and maternal age younger than 25 years (particularly younger than 20 years of age).
III.
We investigated the relationship between race/ethnicity and 27 major birth defects.
We pooled data from 12 population-based birth defects surveillance systems in the United States that included 13.5 ...million live births (1 of 3 of US births) from 1999 to 2007. Using Poisson regression, we calculated prevalence estimates for each birth defect and 13 racial/ethnic groupings, along with crude and adjusted prevalence ratios (aPRs). Non-Hispanic Whites served as the referent group.
American Indians/Alaska Natives had a significantly higher and 50% or greater prevalence for 7 conditions (aPR = 3.97; 95% confidence interval CI = 2.89, 5.44 for anotia or microtia); aPRs of 1.5 to 2.1 for cleft lip, trisomy 18, and encephalocele, and lower, upper, and any limb deficiency). Cubans and Asians, especially Chinese and Asian Indians, had either significantly lower or similar prevalences of these defects compared with non-Hispanic Whites, with the exception of anotia or microtia among Chinese (aPR = 2.08; 95% CI = 1.30, 3.33) and Filipinos (aPR = 1.90; 95% CI = 1.10, 3.30) and tetralogy of Fallot among Vietnamese (aPR = 1.60; 95% CI = 1.11, 2.32).
This is the largest population-based study to our knowledge to systematically examine the prevalence of a range of major birth defects across many racial/ethnic groups, including Asian and Hispanic subgroups. The relatively high prevalence of birth defects in American Indians/Alaska Natives warrants further attention.
A Web-based survey focusing on geocoding of birth defects data was developed and administrated to gain an understanding of the capacity of state birth defects programs to geocode maternal residence ...and to identify barriers to geocoding birth defects data. The survey consisted of 21 questions related to geocoding of maternal residence, type of software used, barriers to geocoding, and data linkage. In August 2007, an e-mail with a Web link to the survey was sent to all state birth defects program contacts in the United States, including the District of Columbia, Puerto Rico, and the Centers for Disease Control and Prevention (CDC) requesting they complete the online survey. By October 2007, 39 (74%) out of 53 birth defects program contacts completed the survey. Although nearly all birth defects programs collect maternal residential data, many are not currently geocoding that data. Results indicated that 97% of the programs that completed the survey reported they collected data on maternal residence, 53% of which reported that the birth defects surveillance data were geocoded to the street address level using maternal residential address at delivery. Twenty six percent of the programs that do not currently geocode the data identified "Software and address reference file are not available" as the most significant barrier to geocoding; another 16% chose "Lack of funding" as the most significant barrier to geocoding. Since geocoding is an important component of spatial analyses used to detect potential clusters of birth defects, leveraging resources to overcome the barriers that prevent programs from geocoding is important.
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