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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 21, 2022
Accepted:
September 17,
2022
Received in revised form:
September 15,
2022
Received:
May 23,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
