1
|
Nava de Escalante Y, Abayomi A, Langlois S, Ye X, Erickson A, Ngo H, Armour R, Okamoto R, Arbour L, Bedard T, Der K, Van Allen M, Skarsgard E, Lavoie M, Henry B. Validation of case definition algorithms for the ascertainment of congenital anomalies. Birth Defects Res 2023; 115:302-317. [PMID: 36369700 PMCID: PMC10099451 DOI: 10.1002/bdr2.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital anomalies (CA) are one of the leading causes of infant mortality and long-term disability. Many jurisdictions rely on health administrative data to monitor these conditions. Case definition algorithms can be used to monitor CA; however, validation of these algorithms is needed to understand the strengths and limitations of the data. This study aimed to validate case definition algorithms used in a CA surveillance system in British Columbia (BC), Canada. METHODS A cohort of births between March 2000 and April 2002 in BC was linked to the Health Status Registry (HSR) and the BC Congenital Anomalies Surveillance System (BCCASS) to identify cases and non-cases of specific anomalies within each surveillance system. Measures of algorithm performance were calculated for each CA using the HSR as the reference standard. Agreement between both databases was calculated using kappa coefficient. The modified Standards for Reporting Diagnostic Accuracy guidelines were used to enhance the quality of the study. RESULTS Measures of algorithm performance varied by condition. Positive predictive value (PPV) ranged between approximately 73%-100%. Sensitivity was lower than PPV for most conditions. Internal congenital anomalies or conditions not easily identifiable at birth had the lowest sensitivity. Specificity and negative predictive value exceeded 99% for all algorithms. CONCLUSION Case definition algorithms may be used to monitor CA at the population level. Accuracy of algorithms is higher for conditions that are easily identified at birth. Jurisdictions with similar administrative data may benefit from using validated case definitions for CA surveillance as this facilitates cross-jurisdictional comparison.
Collapse
Affiliation(s)
| | - Aanu Abayomi
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Xibiao Ye
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,Health Information Science, University of Victoria, Vancouver, British Columbia, Canada
| | - Anders Erickson
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Henry Ngo
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Rosemary Armour
- British Columbia Vital Statistics Agency, Vancouver, British Columbia, Canada
| | - Reiko Okamoto
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,Digital Technologies Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
| | - Laura Arbour
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Community Genetics Research Program/Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
| | - Tanya Bedard
- Health Standards, Quality and Performance, Alberta Health, Edmonton, Alberta, Canada
| | - Kenny Der
- Health Information Science, University of Victoria, Vancouver, British Columbia, Canada
| | - Margot Van Allen
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Medical Genetics, Vancouver Island Health Authority, Vancouver, British Columbia, Canada
| | - Erik Skarsgard
- Department of Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Martin Lavoie
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Requia WJ, Kill E, Papatheodorou S, Koutrakis P, Schwartz JD. Prenatal exposure to wildfire-related air pollution and birth defects in Brazil. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:596-603. [PMID: 34504295 DOI: 10.1038/s41370-021-00380-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Birth defects are a major cause of poor health outcomes during both childhood and adulthood. A growing body of evidence demonstrated associations between air pollution exposure during pregnancy and birth defects. To date, there is no study looking at birth defects and exposure to wildfire-related air pollution, which is suggested as a type of air pollution source with high toxicity for reproductive health. OBJECTIVE Our study addresses this gap by examining the association between birth defects and wildfire smoke exposure in Brazil between 2001 and 2018. Based on known differences of impacts of wildfires across different regions of Brazil, we hypothesized differences in risks of birth defects for different regions. METHODS We used a logistic regression model to estimate the odds ratios (ORs) for individual birth defects (12 categories) associated with wildfire exposure during each trimester of pregnancy. RESULTS Among the 16,825,497 birth records in our study population, there were a total of 7595 infants born in Brazil between 2001 and 2018 with birth defects in any of the selected categories. After adjusting for several confounders in the primary analysis, we found statistically significant OR for three birth defects, including cleft lip/cleft palate [OR: 1.007 (95% CI: 1.001; 1.013)] during the second trimester of exposure, congenital anomalies of the respiratory system [OR: 1.013 (95% CI: 1.002; 1.023)] in the second trimester of exposure, and congenital anomalies of the nervous system [OR: 1.002 (95% CI: 1.001; 1.003)] during the first trimester of exposure for the regions South, North, and Midwest, respectively. SIGNIFICANCE Our results suggest that maternal exposure to wildfire smoke during pregnancy may increase the risk of an infant being born with some congenital anomaly. Considering that birth defects are associated with long-term disability, impacting families and the healthcare system (e.g., healthcare costs), our findings should be of great concern to the public health community. IMPACT STATEMENT Our study focused on the association between maternal exposure to wildfire smoke in Brazil during pregnancy and the risk of an infant being born with congenital anomalies, which presents serious public health and environmental challenges.
Collapse
Affiliation(s)
- Weeberb J Requia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil.
| | - Erick Kill
- Faculty of Medicine, Department of Pathology, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Joel D Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
3
|
Binsfeld L, Gomes MADSM, Kuschnir R. Malformações congênitas de abordagem cirúrgica imediata no Estado do Rio de Janeiro, Brasil: análise para a organização do cuidado em rede. CAD SAUDE PUBLICA 2022; 38:e00109521. [DOI: 10.1590/0102-311x00109521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022] Open
Abstract
Resumo: Este trabalho teve como objetivo realizar uma análise da frequência dos casos, distribuição regional e análise do perfil dos estabelecimentos em que ocorreram nascimentos com malformações congênitas de abordagem cirúrgica imediata no Estado do Rio de Janeiro, Brasil. É um estudo descritivo, de abordagem quantitativa, que utilizou como fonte de informação as bases de dados sobre nascidos vivos e o cadastro nacional de estabelecimentos de saúde. Os dados analisados apontam uma grande dispersão dos nascimentos com malformações congênitas, sendo que a grande maioria das unidades de saúde registrou menos de um nascimento/ano. Essas unidades também não têm infraestrutura com capacidade potencial para que os cuidados neonatais cirúrgicos ocorram no mesmo local do parto. A manutenção dessa configuração de dispersão dos nascimentos e estruturação dos serviços de saúde resulta em perdas de oportunidades tanto do ponto de vista da qualidade e segurança - não contribui para o alcance do volume mínimo de procedimentos/ano definido por especialistas para a potencialização dos resultados na atenção de casos cirúrgicos neonatais - quanto de economia de escala e acesso oportuno. Com base na análise e classificação das unidades, utilizando os critérios de volume de atendimento e capacidade instalada potencial, foi possível apontar caminhos para a definição de unidades de referência e a organização da rede de atenção.
Collapse
|
4
|
Cardoso-Dos-Santos AC, Alves RSDM, Medeiros-de-Souza AC, Bremm JM, Gomes JDA, Alves RFS, Araujo VEMD, França GVAD. National congenital anomaly registers in the world: historical and operational aspects. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2021075. [PMID: 34755811 DOI: 10.1590/s1679-49742021000400015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/24/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify registers of congenital anomalies with national coverage currently available around the world, highlighting their main historical and operational characteristics. METHODS This was a documentary study by means of a Medline database search (via PubMed) and searches involving reports, official documents and websites. Studies reporting at least one national registry were included. RESULTS 40 registers of national congenital anomalies were identified in 39 different countries. All registers included in the study were concentrated in upper-middle or high-income countries located in Europe. Most of the registers were population-based, compulsory notification and with a time limit for notification of up to 1 year of age. The Brazilian register showed the highest annual coverage. CONCLUSION The registers analyzed showed different characteristics, related to the reality of each country. The results presented provide support for the theme of congenital anomalies surveillance, especially in places where such activity is intended to be implemented.
Collapse
Affiliation(s)
| | | | | | - João Matheus Bremm
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | | | | | | | | |
Collapse
|
5
|
Malherbe HL, Aldous C, Christianson AL, Darlison MW, Modell B. Modelled epidemiological data for selected congenital disorders in South Africa. J Community Genet 2021; 12:357-376. [PMID: 33674966 PMCID: PMC8241974 DOI: 10.1007/s12687-021-00513-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/18/2021] [Indexed: 12/11/2022] Open
Abstract
Congenital disorders (CD) remain an unprioritized health care issue in South Africa with national surveillance underreporting by > 95%. This lack of empiric data contributes to an underestimation of the CD disease burden, resulting in a lack of services for those affected. Modelling offers estimated figures for policymakers to plan services until surveillance is improved. This study applied the Modell Global Database (MGDb) method to quantify the South African CD disease burden in 2012. The MGDb combines birth prevalence data from well-established registries with local demographic data to generate national baseline estimates (birth prevalence and outcomes) for specific early-onset, endogenous CDs. The MGBd was adapted with local South African demographic data to generate baseline (no care) and current care national and provincial estimates for a sub-set of early-onset endogenous CDs. Access to care/impact of interventions was quantified using the infant mortality rate as proxy. With available care in 2012, baseline birth prevalence (27.56 per 1000 live births, n = 32,190) decreased by 7% with 2130 less affected births, with 5400 (17%) less under-5 CD-related deaths and 3530 (11%) more survivors at 5 years, including 4720 (15%) effectively cured and 1190 (4%) less living with disability. Results indicate a higher proportion of CD-affected births than currently indicated by national surveillance. By offering evidence-based estimates, the MGDb may be considered a tool for policymakers until accurate empiric data becomes available. Further work is needed on key CD groups and costing of specific interventions.
Collapse
Affiliation(s)
- Helen L Malherbe
- KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Arnold L Christianson
- Wits Centre for Ethics (WiCE), University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew W Darlison
- WHO Collaborating Centre for Community Genetics, Institute of Health Informatics, University College London, London, UK
| | - Bernadette Modell
- WHO Collaborating Centre for Community Genetics, Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
6
|
Groisman B, Liascovich R, Bidondo MP, Barbero P, Duarte S, Tellechea AL, Holguín J, Rodríguez C, Hurtado-Villa P, Caicedo N, Botta G, Zarante I. Birth defects surveillance: experiences in Argentina and Colombia. J Community Genet 2019; 10:385-393. [PMID: 30607893 PMCID: PMC6591326 DOI: 10.1007/s12687-018-00403-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/05/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022] Open
Abstract
Birth defects (BDs) are structural or functional anomalies, sporadic or hereditary, of prenatal origin. Public health surveillance is defined as the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice. BD surveillance systems may have different characteristics according to design, coverage, type of surveillance, case ascertainment, case definition, BD description, maximum age of diagnosis, pregnancy outcomes, coding systems, and the location of the coding process (central or local). The aim of this article is to describe and compare methodology, applications, and results of birth defect surveillance systems in two South-American countries: Colombia and Argentina. In both countries, the surveillance systems developed activities in relation to the Zika virus emergency. For most BDs, a statistically significant higher prevalence is observed in Argentina-RENAC than in Colombian registries. This may be due to methodological reasons or real differences in prevalence. The strengths, weaknesses, and the future perspectives of the Argentine and Colombian systems are presented. When developing a surveillance system, the objectives, the available resources, and previous experiences in similar contexts must be taken into account. In that sense, the experience of Argentina and Colombia can be useful for others when developing a birth defect surveillance system.
Collapse
Affiliation(s)
- Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina.
| | - Rosa Liascovich
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - María Paz Bidondo
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Pablo Barbero
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Santiago Duarte
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Ana Laura Tellechea
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Jorge Holguín
- Secretaria de Salud Pública Municipal de Cali, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Catherine Rodríguez
- Congenital Malformations Surveillance Programme of Bogotá, Secretaria de Salud de Bogotá, Bogotá, Colombia
| | - Paula Hurtado-Villa
- Congenital Birth Defects Surveillance Programme of Cali, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Natalia Caicedo
- Congenital Birth Defects Surveillance Programme of Cali, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | | | | |
Collapse
|
7
|
Bidondo MP, Groisman B, Barbero P, Liascovich R. Public health approach to birth defects: the Argentine experience. J Community Genet 2015; 6:147-56. [PMID: 25564015 DOI: 10.1007/s12687-014-0209-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
Abstract
Birth defects are a global problem, but their impact is particularly severe in low and middle income countries, where the conditions for prevention, treatment, and rehabilitation are more critical. The epidemiological transition in the infant mortality causes, and the concern of the community and the mass media about the teratogenic risk of environmental pollutants, has made health authorities aware of the importance of birth defects in Argentina. The objective of this paper is to outline those actions specifically taken in Argentina aimed at the prevention of birth defects at a national level. Firstly, we focus on birth defects in Argentina on a general basis, and then we present different laws and actions taken in terms of surveillance and public health programs, primary, secondary, and tertiary prevention. Finally, we present the Teratology Information Service "Fetal Health Line", and the genetic services organization and health professionals training by the National Center of Medical Genetics and the National Program of Genetics Network. In conclusion, in the country, several programs focus on different approaches to the problem, and the challenge is to coordinate the teamwork between them. Finally, we list tips to address birth defects from the public health perspective.
Collapse
Affiliation(s)
- María Paz Bidondo
- National Registry of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Av. Las Heras 2670, 3er piso, 1425, Buenos Aires, Argentina
| | | | | | | |
Collapse
|