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Geospatial analysis of hypospadias and cryptorchidism prevalence rates based on postal code in a Canadian province with stable population

Published:September 21, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.09.017

      Summary

      Introduction

      Hypospadias and cryptorchidism are hormone-mediated malformations that occur during male development. Prevalence rates of hypospadias and cryptorchidism are thought to be increasing worldwide. In-utero exposure to endocrine-disrupting chemicals (EDCs) may have a role in the occurrence of these malformations. Our group has reported significant clustering of hypospadias and cryptorchidism at the county level in areas of intense agricultural activity in the Canadian province of Nova Scotia (NS). Finer scale spatial analysis has shown clustering near urban centres.

      Objectives

      The objectives of the study were: 1) to perform a granular geospatial analysis of hypospadias and cryptorchidism prevalence, at the postal code level, of all babies born in NS over a 26-year period; and 2) to determine whether there is spatial correlation between these conditions and industries linked to toxic output.

      Study design

      Cases of hypospadias and cryptorchidism were identified based on ICD-10 codes from the Nova Scotia Atlee Perinatal Database with records of all live births in NS between 1988 and 2013. Data were geocoded and mapped based on the three first digits of the maternal postal code (Forward Sortation Area [FSA]). Regional prevalence of congenital anomalies was calculated for each of the 77 FSAs. To identify statistically significant high and low prevalence clusters for each anomaly, Local Morans I was used on the spatial data. Geospatial point data was created for industries linked to toxic output and correlation between clusters of malformations and proximity to these industries was assessed.

      Results

      During the study period, there were 1045 cases of hypospadias and 993 cases of cryptorchidism. Both hypospadias and cryptorchidism demonstrated statistically significant areas of high prevalence clusters. There was no significant spatial correlation between the local clustering of the congenital malformations and proximity to toxic industries.

      Discussion and conclusion

      Our study shows heterogeneity in the distribution of hypospadias and cryptorchidism, which is consistent with previously published works. In this follow-up, granular geospatial analysis of hypospadias and cryptorchidism prevalence in an area with stable population, we did not confirm the previous findings of high clustering in areas of intense agricultural activity. Furthermore, our analysis did not find high clustering of the congenital malformations in areas near toxic industries to support a clear environmental role in their development. Some of the limitations include underdiagnosis of hypospadias and cryptorchidism (as they both present with a clinical spectrum and are non-life threatening), and limited data currently available on the route of exposure to EDC industries in Nova Scotia.

      Keywords

      Abbreviations:

      EDC (Endocrine disrupting chemical), RPC (Reproductive Care Program of Nova Scotia), FSA (Forward Sortation Area), NSAPD (Nova Scotia Atlee Perinatal Database), GIS (Geographic information system), HRM (Halifax Regional Municipality)
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      References

        • Springer A.
        • van den Heijkant M.
        • Baumann S.
        Worldwide prevalence of hypospadias.
        J Pediatr Urol. 2016; 12: 152.e1-152.e7https://doi.org/10.1016/j.jpurol.2015.12.002
        • Toppari J.
        • Kaleva M.
        • Virtanen H.E.
        Trends in the incidence of cryptorchidism and hypospadias, and methodological limitations of registry-based data.
        Hum Reprod Update. 2001; 7: 282-286https://doi.org/10.1093/humupd/7.3.282
        • Dagnino S.
        • Picot B.
        • Escande A.
        • Balaguer P.
        • Fenet H.
        Occurrence and removal of endocrine disrupters in wastewater treatment plants for small communities.
        Desalination Water Treat. 2009; 4: 93-97https://doi.org/10.5004/dwt.2009.361
        • Fernandez M.F.
        • Olmos B.
        • Granada A.
        • López-Espinosa M.J.
        • Molina-Molina J.-M.
        • Fernandez J.M.
        • et al.
        Human exposure to endocrine-disrupting chemicals and prenatal risk factors for cryptorchidism and hypospadias: a nested case-control study.
        Environ Health Perspect. 2007; 115: 8-14https://doi.org/10.1289/ehp.9351
        • Mattiske D.M.
        • Pask A.J.
        Endocrine disrupting chemicals in the pathogenesis of hypospadias; developmental and toxicological perspectives.
        Curr Res Toxicol. 2021; 2: 179-191https://doi.org/10.1016/j.crtox.2021.03.004
        • Kristensen P.
        • Irgens L.M.
        • Andersen A.
        • Bye A.S.
        • Sundheim L.
        Birth defects among offspring of Norwegian farmers.
        Epidemiology. 1997; 8 (1967-1991): 537-544https://doi.org/10.1097/00001648-199709000-00011
        • Gurney J.K.
        • McGlynn K.A.
        • Stanley J.
        • Merriman T.
        • Signal V.
        • Shaw C.
        • et al.
        Risk factors for cryptorchidism.
        Nat Rev Urol. 2017; 14: 534-548https://doi.org/10.1038/nrurol.2017.90
        • Kalliora C.
        • Mamoulakis C.
        • Vasilopoulos E.
        • Stamatiades G.A.
        • Kalafati L.
        • Barouni R.
        • et al.
        Association of pesticide exposure with human congenital abnormalities.
        Toxicol Appl Pharmacol. 2018; 346: 58-75https://doi.org/10.1016/j.taap.2018.03.025
        • Lane C.
        • Boxall J.
        • MacLellan D.
        • Anderson P.A.
        • Dodds L.
        • Romao R.L.P.
        A population-based study of prevalence trends and geospatial analysis of hypospadias and cryptorchidism compared with non-endocrine mediated congenital anomalies.
        J Pediatr Urol. 2017; 13: 284.e1-284.e7https://doi.org/10.1016/j.jpurol.2017.02.007
        • Elliott P.
        • Briggs D.
        • Morris S.
        • de Hoogh C.
        • Hurt C.
        • Jensen T.K.
        • et al.
        Risk of adverse birth outcomes in populations living near landfill sites.
        BMJ. 2001; 323: 363-368https://doi.org/10.1136/bmj.323.7309.363
        • Dolk H.
        • Vrijheid M.
        • Armstrong B.
        • Abramsky L.
        • Bianchi F.
        • Garne E.
        • et al.
        Risk of congenital anomalies near hazardous-waste landfill sites in Europe: the EUROHAZCON study.
        Lancet (London, England). 1998; 352: 423-427https://doi.org/10.1016/s0140-6736(98)01352-x
        • Xing Z.
        • Zhang S.
        • Jiang Y.-T.
        • Wang X.-X.
        • Cui H.
        Association between prenatal air pollution exposure and risk of hypospadias in offspring: a systematic review and meta-analysis of observational studies.
        Aging (Albany NY). 2021; 13: 8865-8879https://doi.org/10.18632/aging.202698
        • Chung E.
        • Brock G.B.
        Cryptorchidism and its impact on male fertility: a state of art review of current literature.
        Can Urol Assoc J. 2011; 5: 210-214https://doi.org/10.5489/cuaj.10106
        • Schneuer F.J.
        • Milne E.
        • Jamieson S.E.
        • Pereira G.
        • Hansen M.
        • Barker A.
        • et al.
        Association between male genital anomalies and adult male reproductive disorders: a population-based data linkage study spanning more than 40 years.
        Lancet Child Adolesc Heal. 2018; 2: 736-743https://doi.org/10.1016/S2352-4642(18)30254-2
        • Sullivan K.J.
        • Hunter Z.
        • Andrioli V.
        • Guerra L.
        • Leonard M.
        • Klassen A.
        • et al.
        Assessing quality of life of patients with hypospadias: a systematic review of validated patient-reported outcome instruments.
        J Pediatr Urol. 2017; 13: 19-27https://doi.org/10.1016/j.jpurol.2016.11.010
        • Government of Nova Scotia
        Recycling and waste.
        2021
        • Nova Scotia Power
        How we make electricity.
        2021
        • Dale M.B.
        • Anand M.
        • Desrochers R.E.
        Measuring information-based complexity across scales using cluster analysis.
        Ecol Inform. 2007; 2: 121-127https://doi.org/10.1016/j.ecoinf.2007.03.011
        • Canda Statistics
        Census of population.
        2021
        • Thorup J.
        • Nordenskjöld A.
        • Hutson J.M.
        Genetic and environmental origins of hypospadias.
        Curr Opin Endocrinol Diabetes Obes. 2014; 21: 227-232https://doi.org/10.1097/MED.0000000000000063
        • Kalfa N.
        • Philibert P.
        • Baskin L.S.
        • Sultan C.
        Hypospadias: interactions between environment and genetics.
        Mol Cell Endocrinol. 2011; 335: 89-95https://doi.org/10.1016/j.mce.2011.01.006
        • Venkatesan R.
        • Mathiyarasu R.
        • Somayaji K.M.
        A study of atmospheric dispersion of radionuclides at a coastal site using a modified Gaussian model and a mesoscale sea breeze model.
        Atmos Environ. 2002; 36: 2933-2942https://doi.org/10.1016/S1352-2310(02)00258-3
        • Lauriot Dit Prevost A.
        • Genin M.
        • Occelli F.
        • Priso R.-H.
        • Besson R.
        • Lanier C.
        • et al.
        Spatial analysis of hypospadias cases in northern France: taking clinical data into account.
        BMC Pediatr. 2020; 20: 442https://doi.org/10.1186/s12887-020-02332-1
        • Winston J.J.
        • Meyer R.E.
        • Emch M.E.
        Geographic analysis of individual and environmental risk factors for hypospadias births.
        Birth Defects Res A Clin Mol Teratol. 2014; 100: 887-894https://doi.org/10.1002/bdra.23306
        • Abdullah N.A.
        • Pearce M.S.
        • Parker L.
        • Wilkinson J.R.
        • McNally R.J.Q.
        Evidence of an environmental contribution to the aetiology of cryptorchidism and hypospadias?.
        Eur J Epidemiol. 2007; 22: 615-620https://doi.org/10.1007/s10654-007-9160-z
        • Fernández N.
        • Lorenzo A.
        • Bägli D.
        • Zarante I.
        Altitude as a risk factor for the development of hypospadias. Geographical cluster distribution analysis in South America.
        J Pediatr Urol. 2016; 12: 307.e1-307.e5https://doi.org/10.1016/j.jpurol.2016.03.015