regional distribution of orofacial cleft defects in wisconsin
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Regional Distribution of Orofacial Cleft Defects in Wisconsin. Allison Derrick Masters of Public Health Candidate UW School of Medicine and Public Health. Acknowledgements. Delora Mount, MD; UW Plastic and Reconstructive Surgery Glen Leverson, PhD; Biostatistics

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regional distribution of orofacial cleft defects in wisconsin

Regional Distribution of Orofacial Cleft Defects in Wisconsin

Allison Derrick

Masters of Public Health Candidate

UW School of Medicine and Public Health

acknowledgements
Acknowledgements
  • Delora Mount, MD; UW Plastic and Reconstructive Surgery
  • Glen Leverson, PhD; Biostatistics
  • Henry Anderson, MD, MPH; DHFS
  • Kristen Malecki, PhD; DHFS
  • Liz Oftedahl, MPH; DHFS
  • Laura Ninneman, DHFS
outline
Outline
  • Background
  • Objectives
  • Methods
  • Results
  • Discussion
  • Conclusion
background1
Background
  • Orofacial clefts are the most common craniofacial birth defects
  • Incidence ranging from approximately 0.5 to 2 per 1,000 births*
  • Multifactorial etiology
    • Both genetic and environmental factors implicated
  • Public health Problem
    • significant lifelong morbidity
    • complex etiology
    • requires extensive treatment
      • surgical, psychological, speech and dental interventions
      • Lifetime cost of >$101,000

Marazita, M. L. and M. P. Mooney. Clin Plast Surg 2004; 31(2): 125-40

Waitzman NJ, Romano PS, Scheffler RM. Inquiry 1994;31:188-205.

objectives
Objectives
  • Perform the first analysis of the distribution of orofacial cleft births in Wisconsin
  • Evaluate the incidence of orofacial cleft births in the Fox River Valley with respect to the rest of Wisconsin
  • Examine the geographical distribution for potential associations between environmental factors and orofacial cleft defects
methods
Methods
  • Performed a comprehensive literature review on the etiology and CL/P, environmental risk factors, research methodology
  • IRB approval
  • Data Collection:
    • Vital Records: 1997-2006*
    • WBDR: 2005-2006
    • WISH database: 1997-2006
  • Calculated incidences by county*
  • Logistical regression to adjust for confounders*
  • Determined OR for OFCs w/in FRV vs. WI-FRV*
results2
Results

Incidence Rates

WI…………..1.046/1,000

FRV………..…1.463/1,000

WI - FRV……..0.997/1,000

Adjusted OR …1.52

(95% CI 1.23, 1.89; p=0.0001)

results3
Results

Demographic Trends

  • Maternal age - NS
  • Maternal race - NS
  • Maternal educational achievement - NS
  • Maternal smoking status

OR 1.032 (95% CI 1.017,1.048)

P-value = 0.0009

discussion
Discussion
  • Interpretation of results
    • Incidence of 1.46/1,000 births in FRV is significantly higher than the rest of WI, but still WNL
  • Cluster by chance?
  • Potential Environmental associations
    • PCBs?
    • TTHMs?
    • Pesticides?
slide13
PCBs

WI DNR: http://www.dnr.state.wi.us/org/gmu

US EPA: www.epa.gov/region5/foxriver/lower_fox_river_map

results4
Results*

*TexasSharpshooter

distribution of drinking water from surface water sources

TTHMs*

Distribution of Drinking Water from Surface Water Sources

*TexasSharpshooter

WI DNR: http://dnr.wi.gov/org/water/dwg/swap/delineation.htm

Bove et al. Am J Epidemiol. 1995; 141 (9): 850-62.

pesticides in groundwater
Pesticides in Groundwater*

*TexasSharpshooter

U.S. Geological Survey Fact Sheet: Pesticides in ground water in the Western Lake Michigan Drainages. 1996

discussion1
Discussion

Limitations of study

  • Sensitivity of Birth Certificate Data
  • Differences in reporting among counties
  • Maternal migration during pregnancy
    • Misclassification bias
  • No differentiation between CL/P and CP alone, or those cases associated with syndromes
  • Potential Confounders
    • prenatal care/nutritional status
    • alcohol intake during pregnancy
  • Descriptive geographic study
    • Cannot define causality

Watkins ML et al. Am J Public Health 1996;86:731-4.

conclusions
Conclusions
  • Established a geographic distribution of OFC births in WI
  • Found a statistically significant elevated risk of OFCs in the FRV
  • Useful for formulating hypotheses for future testing, but no causal relationship can be established
  • Need to encourage reliable birth defect reporting and regular environmental exposure measurements
    • WI EPHT system Sept 2008…
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