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.
['Tang|Ian W|IW|0000-0002-0775-891X', 'Langlois|Peter H|PH|0000-0001-6765-4963', 'Vieira|Verónica M|VM|0000-0001-7153-4606']
D002971:Cleft Lip D020139:Gastroschisis D006330:Heart Defects, Congenital D006801:Humans D062206:Spatial Analysis D013781:Texas
spatial analysis birth defects Texas environmental maternal