Spatial analysis of hypospadias cases in northern France: taking clinical data into account
- PDF / 858,937 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 95 Downloads / 207 Views
RESEARCH ARTICLE
Open Access
Spatial analysis of hypospadias cases in northern France: taking clinical data into account Arthur Lauriot Dit Prevost1,2,3* , Michael Genin3, Florent Occelli4,5, René-Hilaire Priso1,2, Remi Besson1,2, Caroline Lanier4,5 and Dyuti Sharma1,2
Abstract Background: Strong evidence for a causal role of environmental factors in a congenital anomaly is still difficult to produce. The collection of statistical data is crucial for gaining a better understanding of the epidemiology and pathophysiology of these anomalies. We aimed to evaluate spatial variations in hypospadias within our region and it’s association to socioeconomic and ecological factors, taking clinical data into account. Methods: All boys with hypospadias born in northern France and seen in Lille University Medical Center (Lille, France) between 1999 and 2012 were included in the analysis. We retrospectively collected geographic data, clinical data (especially known confounding factors associated with an elevated risk of hypospadias), and demographic, socio-economic and ecological data. We analyzed the entire study population and subsequently the subset of boys lacking confounding factors. Results: The study sample of 975 cases of hypospadias over the 13-year period resulted in an incidence of 25.4/10, 000 male births, and was characterized by significant spatial heterogeneity (p < 0.005) and autocorrelation (p < 0.001). We detected two high-incidence clusters that differed with regard to their land use. After the exclusion of 221 patients with confounding factors, two high-incidence clusters with significant disease risks (1.65 and 1.75, respectively; p < 0.001) and a significant difference in land use (p < 0.001) again appeared. The first cluster contained a higher median [interquartile range] proportion of artificialized land (0.40 [0.22;0.47]) than the remaining “neutral areas” (0.19 [0.08;0.53]) did (p < 0.001). Conversely, the second cluster contained a higher median proportion of rural land (0.90 [0.78;0.96]) than the “neutral areas” (0.81 [0.47;0.92]) did (p < 0.001). The median deprivation index was significantly lower in the urban cluster (0.47 [0.42;0.55]) and significantly higher in the rural cluster (0.69 [0.56;0.73]) (p < 0.001). Conclusions: Our results evidenced the heterogeneous spatial distribution of cases of hypospadias in northern France. We identified two clusters with different environmental and social patterns – even after the exclusion of known confounding factors. Keywords: Birth defect, Congenital malformation, Spatial cluster detection, Geographical analysis, Ecological regression, Endocrine-disrupting chemicals, Deprivation index * Correspondence: [email protected] 1 CHU Lille, Clinique de Chirurgie et Orthopédie de l’Enfant, F-59000 Lille, France 2 CHU Lille, Centre de référence du développement génital DEV-GEN, F-59000 Lille, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creativ
Data Loading...
