Spatial variability of gastroschisis in Canada, 2006–2011: An exploratory analysis

Abstract

OBJECTIVES: Gastroschisis is a serious birth defect of the abdominal wall that is associated with mortality and significant morbidity. Our understanding of the factors causing this defect is limited. The objective of this paper is to describe the geographic variation in incidence of gastroschisis and characterize the spatial pattern of all gastroschisis cases in Canada between 2006 and 2011. Specifically, we aimed to ascertain the differences in spatial patterns between geographic regions and identify significant clusters and their location. METHODS:The study population included 641 gastroschisis cases from the Canadian Pediatric Surgery Network (CAPSNet) database, a population-based dataset of all gastroschisis cases in Canada. Cases were geocoded based on maternal residence. Using Statistics Canada live-birth data as a denominator, the total prevalence of gastroschisis was calculated at the provincial/territorial levels. Random effects logistic models were used to estimate the rates of gastroschisis in each census division. These rates were then mapped using ArcGIS. Cluster detection was performed using Local Indicators of Spatial Association (LISA). RESULTS:There is significant spatial heterogeneity of the rate of gastroschisis across Canada at both the provincial/territorial and census-division level. The Yukon, Northwest Territories and Prince Edward Island have higher overall rates of gastroschisis relative to other provinces/territories. Several census divisions in Alberta, Manitoba, Saskatchewan, Ontario, Northwest Territories and British Columbia demonstrated case "clusters", i.e., focally higher rates in discrete areas relative to surrounding areas. CONCLUSIONS:There is clear evidence of spatial variation in the rates of gastroschisis across Canada. Future research should explore the role of area-based variables in these patterns to improve our understanding of the etiology of gastroschisis.KEY WORDS: Spatial analysis; gastroschisis; cluster analysis; Canada La traduction du résumé se trouve à la fin de l'article.

Canadian Cannabis Consumption and Patterns of Congenital Anomalies: An Ecological Geospatial Analysis

“…This was observed both in the general rate reported by the CCASS ( Public Health Agency of Canada and Health Canada, 2013 ) and in the age-adjusted and age-unadjusted data reported by ( Bassil et al, 2016 ). This result is consistent both with the uniform findings of all seven studies which have examined this question ( Torfs et al, 1994 ; Werler et al, 2003 ; Forrester and Merz, 2007 ; Draper et al, 2008 ; van Gelder et al, 2009a ; David et al, 2014 ; Skarsgard et al, 2015 ) including several prior reports from the Canadian Surgical Surveillance Group on this subject ( Alshehri et al, 2013 ; Butler et al, 2015 ; Skarsgard et al, 2015 ; Bassil et al, 2016 ; Puligandla et al, 2017 ) presumably reporting on cases which overlap in part with some of the subjects reported herein by CCASS ( Moore et al, 2013 ). This uniformity of the literature in this subject is indeed noteworthy.…”

“…Figure 1 redraws the pediatric epidemiology data from ( Public Health Agency of Canada and Health Canada, 2013 ) and presents data on total congenital anomalies, cardiovascular defects, orofacial defects, Downs Syndrome, gastroschisis, age-unadjusted, age-adjusted gastroschisis data (from Bassil et al, 2016 ) and limb deficiency data. In most cases the incidence data obviously peaks in the northern Territories of Nunavut and / or Northwest Territory.…”

“…It is standardized against all births recorded in the National Register of Births. Gastroschisis incidence data was supplemented with raw data unadjusted for age and age-adjusted data from ( Bassil et al, 2016 ) which covered a similar period. The percent of the population which acknowledged cannabis use in the previous 3 months was taken from ( Statistics Canada, 2018 ).…”

The Canadian Pediatric Surgery Network (CAPSNet): Lessons Learned from a National Registry Devoted to the Study of Congenital Diaphragmatic Hernia and Gastroschisis

“…Several analyses have explored the epidemiology of GS, including maternal, 17,18 sociodemographic, and environmental predictors 19 of GS occurrence. 20 In addition to validating previously established correlations between GS and young maternal age, illicit drug use, and smoking, 17,18,21,22, CAPSNet data have shown a correlation with maternal diabetes, use of medications to treat depression, 17 and low community income. 19 CAPSNet data have also demonstrated evidence of spatial clustering of GS cases within Canada, adding to speculation that environmental factors may contribute to its occurrence.…”

“…19 CAPSNet data have also demonstrated evidence of spatial clustering of GS cases within Canada, adding to speculation that environmental factors may contribute to its occurrence. 20 Although GS is thought of as an isolated structural anomaly, a CAPSNet study revealed a high rate of autopsy-confirmed lethal anomalies among pregnancies ending in termination, stillbirth, or death within 24 hours of birth. 23 Optimal delivery planning has been studied in several recent CAPSNet studies.…”