Spatial patterns of the congenital heart disease prevalence among 0- to 14-year-old children in Sichuan Basin, P. R China, from 2004 to 2009

Comparison of Blood Lead Concentrations in Mothers of Children with Congenital Heart Disease and Mothers of Healthy Children

Congenital heart disease (CHD) is the most prevalent congenital defect that causes several problems for patients and their families and medical specialists. It is important to investigate CHD risk factors due to their significantly destructive load on society. This study aims to determine the association between maternal lead exposure and conceiving a child with CHD. This case-control study was performed on a total of 246 mothers in the pediatric clinic of Vali-e-Asr Hospital in Birjand, Iran. One hundred forty-six mothers with CHD children were defined as the case group, and 100 age-matched mothers with healthy children were considered the control group. All the mothers were between 20 and 40 years old, and their children were under the age of 6 months. Demographic data was collected from mothers using a well-designed questionnaire. In addition, all mothers were referred to the laboratory for measuring blood lead concentrations. The mean blood lead concentration (BLC) of mothers in the group of children with heart problems was 4.11 ± 10.02 with a median of 2.50 μg/dL and in the control group was 2.66 ± 2.06 with a median of 2.30 μg/dL. The Mann-Whitney test results showed that mothers' lead concentration in the group of children with heart problems was significantly higher than the control group (z = 2.13, p = 0.03). The chi-square test results showed that lead concentrations in the two groups were significantly different from each other (χ² = 9.11, p = 0.01). The results of our study showed that mothers of children with CHD had higher blood concentrations than mothers of healthy children.

Spatial-temporal analysis of cause-specific cardiovascular hospital admission in Beijing, China

BACKGROUND

The main aim of this study was to explore the spatial-temporal patterns of cause-specific CVD admission in Beijing using retrospective SaTScan analysis.

METHODS

A spatial-temporal analysis was conducted at the district level based on the rates of total and cause-specific CVD admissions, including coronary heart disease (CHD), atrial fibrillation (AF), and heart failure (HF) from 2013 to 2017. We used joint point regression, Global Moran's I and Anselin's local Moran's I, together with Kulldorff's scan statistic.

RESULTS

Hospital admission trend decreased during the study period. Admission rates followed a spatially clustered pattern with differences occurring between cause-specific CVDs. Clusters were mainly identified in ecological preservation areas, with a more likely cluster found in Daxing, Fangshan, Xicheng district for total CVD, CHD, AF and HF, respectively.

CONCLUSIONS

Hospital admission of cause-specific CVD showed spatial clustered pattern, especially in ecological preservation areas.

A spatial analysis of birth defects in Texas, 1999-2011

BACKGROUND

The etiologies of major birth defects are still unclear and few spatial analyses have been conducted in the United States. Spatial analyses of individual-level data can help elucidate environmental and social risk factors.

METHODS

We used generalized additive models to analyze 52,955 cases of neural tube defects, congenital heart defects (CHDs), gastroschisis, and orofacial cleft defects, and sampled from 642,399 controls born between 1999 and 2011 in Texas. The effect of geographic location was measured using a bivariable smooth term of geocoded birth address within a logistic regression framework. We calculated and mapped odds ratios (ORs) and 95% confidence intervals (CIs) for birth defects subtypes across Texas, and adjusted for maternal characteristics, environmental indicators, and community-level covariates. We also performed time-stratified spatiotemporal analyses for more prevalent birth defects.

RESULTS

Location was significantly associated with crude odds of all birth defects except hypoplastic left heart syndrome. After adjusting for maternal characteristics, environmental indicators, and community-level factors, ORs in many geographic areas were no longer statistically significant for most defects, especially CHDs. However, areas of significant and insignificant elevated risk remained for defects in all groups in North and South Texas, with ORs for ventricular septal defects increasing over time. Low risk of birth defects was often present in the northern part of East Texas.

CONCLUSION

Significant spatial patterns of birth defects were identified and varied depending on adjustment of different categories of covariates. Further investigation of areas with increased risks may aid in our understanding of birth defects.

Risk of congenital heart disease due to exposure to common electrical appliances during early pregnancy: a case-control study

To examine the association between exposure to common electrical appliances in early pregnancy and congenital heart disease (CHD). A case-control study of 2339 participants was conducted in six hospitals in Xi'an, Shaanxi Province, Northwest China from 2014 to 2016. All infants with CHD were diagnosed according to ICD-10 classification. Selected controls consisted of newborns from the same hospital, without any birth defects, and 1:3 matched by birthdate. We conducted personal interviews with the mothers to gather information on any exposure to electrical appliances during pregnancy. Multivariate logistic regression was used to estimate the effects of exposure to common electrical appliances on CHD. We observed that the mothers exposed to computers (OR: 1.33, 95% CI: 1.03, 1.71), induction cookers (OR: 2.79, 95% CI: 2.19, 3.55), and microwave ovens (OR: 1.53, 95% CI: 1.01, 2.31) during early pregnancy were more likely to give birth to infants with CHD. Mothers who wore radiation protection suits (OR: 0.67, 95% CI: 0.52, 0.87) during early pregnancy decreased the risk of CHD in their neonate. There was an interaction for induction cooker exposure with wore radiation protection suits on CHD (RERI: - 1.44, 95% CI: - 2.48, - 0.39; S: 0.37, 95% CI: 0.16, 0.84; AP: - 0.79, 95% CI: - 1.53, - 0.05). Our study confirmed that exposure to some electrical appliances was associated with a higher risk of CHD, and wearing a radiation protection suit was associated with a lower risk of CHD. Women should therefore reduce the usage of electrical appliances before and during pregnancy.

Analysis of Heavy Metal Contamination of Agricultural Soils and Related Effect on Population Health-A Case Study for East River Basin in China

To understand the heavy metal pollution in agricultural soils along the East River basin and assess the pollution related health effect to local residents, interviews and archived data were obtained to identify the study sites affected by polluted tailing. Soil samples were collected and tested for heavy metal content and the Comprehensive Pollution Index (CPI). The degree of pollution of agricultural soils in the area was assessed using GIS-based Spatial distribution map of heavy metals and the trend of soil heavy metal risk. Two villages (Matian and Zhudui) near the East River were included in this study for health effect assessment. A total of 193 residents aged 15 or above from each village were tested for the present status of chronic diseases. Convenient sampling method was used to collect blood samples from 78 residents for heavy metal concentration. The contents of Pb, Cd, As, Zn, and Cu in the agricultural soils were all over the standards with a moderate to severe CPI. Among these metals, Cd was the highest followed by Pb, and Cu was the lowest. The contents of Pb, Cd, As, and Zn tend to be higher in soils closer to the river. The prevalence of chronic diseases was over 30%, which is significantly higher than the report from the national central region (23.15%). The average blood lead level (BLL) among children under 14 years is 7.42 μg/dL. Although the adults in Matian village had a significantly higher BLL (χ2 = 8.70, p = 0.03) as compared to Zhudui village, there was no significant difference for the prevalence of chronic diseases between the two villages (χ2 = 3.23, p = 0.09). The mean BLL of children and the proportion of children with BLL ≥ 10 µg/dL in this study are equivalent to the national average. The higher BLL concentration and prevalence of chronic diseases in adults might be due to their long-term exposure to heavy metal contamination environment and higher background level of heavy metals. Findings from this study will form the baseline information for local government to the development of effective approaches to control the heavy metal contamination and reduce the pollution related adverse health effect on local residents.

Distribution of congenital anomalies by race/ethnicity and geospatial location in Oklahoma, 1997-2009

INTRODUCTION

Congenital anomalies were the leading cause of infant mortality, responsible for 23 and 21% of deaths in Oklahoma and the USA, respectively, in 2016. We aimed to determine the prevalence by race/ethnicity and spatial distribution of congenital anomalies to identify geographic and racial/ethnic disparities, particularly among American Indian/Alaska Natives (AI/AN).

METHODS

We evaluated the prevalence of anomalies by type and race/ethnicity among 648,074 live births in Oklahoma from 1997 to 2009. Prevalence proportion ratios (PPRs) and 95% confidence intervals (CIs) were calculated using Poisson regression. We used Moran's I and Getis-Ord Gi* to evaluate spatial clustering for neural tube defects, critical congenital heart defects (CCHDs), and oral clefts among births whose residence geocoded to the ZIP code or finer level.

RESULTS

Overall prevalence of anomalies among live births was 3.9%. Non-Hispanic (NH) African American (PPR: 0.87, 95% CI: 0.83, 0.91), Asian/Pacific Islander (PPR: 0.70, 95% CI: 0.63, 0.78), and Hispanic (PPR: 0.87, 95% CI: 0.83, 0.91) children had a lower prevalence of anomalies compared to NH whites. The prevalence in NH AI/AN children was similar to NH whites (PPR: 1.01, 95% CI: 0.97, 1.05). However, differences in specific types of anomalies were observed by race/ethnicity. We observed no spatial autocorrelation for CCHD and oral clefts. Neural tube defects demonstrated spatial autocorrelation (p < .0001). Local hot spots varied by anomaly.

DISCUSSION

The prevalence of anomalies by race/ethnicity and geography differed by race/ethnicity and region, though this varied by anomaly. Additional research is needed to identify behavioral or environmental factors to target for prevention.

Analysis of the Seasonal Trend of Congenital Heart Defects

OBJECTIVE

To determine the seasonal trend of congenital heart defects (CHDs) in China using hospital-based clinical data.

STUDY DESIGN

We included 40 501 patients with CHD hospitalized at the Shanghai Children Medical Center between 2006 and 2017. The birth rate of CHD in each month was adjusted by sex, year of birth, and monthly birth rate of the general population. Negative binomial regression models were used to assess the seasonal trend of CHD.

RESULTS

The included patients consisted of 22 600 boys (55.8%), resulting in a male-to-female ratio of 1.26:1. Among subtypes of CHDs, ventricular septal defects and atrial septal defects were the most common, accounting for 39.7% and 12.6%, respectively. A statistically significant seasonal trend in the monthly birth rate of patients with CHDs was found; the highest relative rate of CHD was found in October and the lowest in April. After adjusting for the potential confounders, the highest relative rate of CHD was found in October and the lowest in November.

CONCLUSIONS

There seems to be a significant monthly birth rate variation of CHDs in China. The highest relative rate of CHDs occurred in October, suggesting possible maternal exposure to environmental hazards from January to March. These hazards may include air pollution, virus infection, and unhealthy lifestyle behaviors during the Spring Festival.

Exploring spatial patterns of cardiovascular disease in Sweden between 2000 and 2010

AIMS

Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity worldwide, including in Sweden. The main aim of this study was to explore the temporal trends and spatial patterns of CVD in Sweden using spatial autocorrelation analyses.

METHODS

The CVD admission rates between 2000 and 2010 throughout Sweden were entered as the input disease data for the analytic processes performed for the Swedish capital, Stockholm, and also for the whole of Sweden. Age-adjusted admission rates were calculated using a direct standardisation approach for men and women, and temporal trends analysis were performed on the standardised rates. Global Moran's I was used to explore the structure of patterns and Anselin's local Moran's I, together with Kulldorff's scan statistic were applied to explore the geographical patterns of admission rates.

RESULTS

The rates followed a spatially clustered pattern in Sweden with differences occurring between sexes. Accordingly, hot spots were identified in northern Sweden, with higher intensity identified for men, together with clusters in central Sweden. Cold spots were identified in the adjacency of the three major Swedish cities of Stockholm, Gothenburg and Malmö.

CONCLUSIONS

The findings of this study can serve as a basis for distribution of health-care resources, preventive measures and exploration of aetiological factors.

Spatial pattern and variations in the prevalence of congenital heart disease in children aged 4-18 years in the Qinghai-Tibetan Plateau

PURPOSE

This study aimed to investigate the spatial distribution pattern of the prevalence of congenital heart disease (CHD) in children in Qinghai-Tibetan Plateau (QTP), a high-altitude region in China.

METHODS

Epidemiological data from a survey on the prevalence of CHD in Qinghai Province including 288,066 children (4-18 years) were used in this study. The prevalence and distribution pattern of CHD was determined by sex, CHD subtype, and nationality and altitude. Spatial pattern analysis using Getis-Ord Gi^⁎ was used to identify the spatial distribution of CHD. Bayesian spatial binomial regression was performed to examine the relationship between the prevalence of CHD and environmental risk factors in the QTP.

RESULTS

The prevalence of CHD showed a significant spatial clustering pattern. The Tibetan autonomous prefecture of Yushu (average altitude > 4000 m) and the Mongolian autonomous county of Henan (average altitude > 3600 m) in Huangnan had the highest prevalence of CHD. Univariate analysis showed that with ascending altitude, the total prevalence of CHD, that in girls and boys with CHD, and that of the subtypes PDA and ASD increasing accordingly. Thus, environmental factors greatly contributed to the prevalence of CHD.

CONCLUSIONS

The prevalence of CHD shows significant spatial clustering pattern in the QTP. The CHD subtype prevalence clustering pattern has statistical regularity which would provide convenient clues of environmental risk factors. Our results may provide support to make strategies of CHD prevention, to reduce the incidence of CHD in high altitude regions of China.

Using Watershed Boundaries to Map Adverse Health Outcomes: Examples From Nebraska, USA

In 2009, a paper was published suggesting that watersheds provide a geospatial platform for establishing linkages between aquatic contaminants, the health of the environment, and human health. This article is a follow-up to that original article. From an environmental perspective, watersheds segregate landscapes into geospatial units that may be relevant to human health outcomes. From an epidemiologic perspective, the watershed concept places anthropogenic health data into a geospatial framework that has environmental relevance. Research discussed in this article includes information gathered from the literature, as well as recent data collected and analyzed by this research group. It is our contention that the use of watersheds to stratify geospatial information may be both environmentally and epidemiologically valuable.

Do toxic metals and trace elements have a role in the pathogenesis of conotruncal heart malformations?

OBJECTIVE

The aim of the present study was to determine the role of toxic elements and trace elements in the pathogenesis of conotruncal heart defects by measuring their concentrations in the first meconium specimens of the affected newborns.

METHODS

Concentrations of lead, cadmium, iron, zinc, and copper were measured in 1st-day meconium specimens that were collected from 60 newborns with conotruncal heart defects (Group I) and 72 healthy newborns (Group II).

RESULTS

The newborns with conotruncal defects and the healthy newborns had statistically similar demographic and clinical characteristics. When compared with healthy newborns, mean concentrations of lead, cadmium, iron, zinc, and copper were significantly higher in newborns with conotruncal heart defects (p=0.001 for each). In total, 51 newborns with conotruncal heart defects had normal karyotype. These newborns had significantly higher concentrations of lead, cadmium, iron, zinc, and copper when compared with healthy newborns. There were significant and positive correlations between the concentrations of lead and cadmium (r=0.618, p=0.001), lead and iron (r=0.368, p=0.001), lead and zinc (r=0.245, p=0.005), lead and copper (r=0.291, p=0.001), cadmium and iron (r=0.485, p=0.001), cadmium and zinc (r=0.386, p=0.001), and cadmium and copper (r=0.329, p=0.001).

CONCLUSION

Toxic metals and trace elements may disturb DNA repair mechanisms by impairing DNA methylation profiles, and thus have a role in the pathogenesis of conotruncal heart defects.

Differences by Altitude in the Frequency of Congenital Heart Defects in Colombia

More evidence is needed that links the diagnosis of different congenital heart diseases (CHD) identified after birth, with intermediate altitudes above sea level in geographically and ethnically diverse populations. Our aim was to estimate relative frequencies of CHD diagnosis by altitude and gender in the pediatric population of 12 cities in Colombia. This was a cross-sectional study based on the information collected between 2008 and 2013 in Colombia, during annual congenital heart disease (CHD) case detection campaigns in the post-natal period. All children underwent physical examination, pulse-oximetry, and echocardiography. The odds ratio (OR) was used as the summary statistic to assess associations with altitude in the relative frequency of CHD diagnosis. Data from 5900 children who attended the campaigns were evaluated (54.3 % male), out of which 3309 (56.1 %) were diagnosed with CHD. There were statistically significant differences in the relative distribution of the different CHD by city altitude and gender (p < 0.0001). When compared with sea level, altitudes between 1285 and 3000 m above sea level were associated with increased Patent Ductus Arteriosus (PDA) (ORmh 1.68, 95 % CI 1.34-2.09; p < 0.0001) and left ventricular outflow tract obstruction (LVOTO) diagnoses (ORmh 2.06, 95 % CI 1.63-2.61; p < 0.0001), while the opposite was true for right ventricular outflow tract (RVOTO) diagnosis (OR 0.60; 95 % CI 0.49-0.74, p < 0.0001). These associations were not modified by gender differences. In a geographically and ethnically diverse population, altitudes between 1285 and 3000 m above sea level carried an independent and clinically important excess diagnostic risk of PDA and of LVOTO, when compared to all other CHD.