■腹裂的发生率,涉及通过腹壁的小肠疝的出生缺陷,自20世纪60年代以来,美国的情况有所增加。农药阿特拉津是腹裂的假设原因;然而,对阿特拉津和腹裂之间的关联的检查有限。
■为了评估全国腹裂发病率的趋势,与腹裂相关的母婴特征,以及县级使用阿特拉津是否与腹裂有关。
■这次回顾展,重复的横断面研究检查了2009年1月1日至2019年12月31日美国地质调查局所有活产的出生证明数据和阿特拉津使用数据.数据分析是在2021年8月5日至2023年5月26日之间进行的。
■县级使用阿特拉津。
■主要结局是腹裂发生率。协变量包括产妇年龄,种族和民族,身体质量指数(以千克为单位的体重除以以米为单位的身高的平方来衡量),奇偶校验,保险类型,怀孕期间衣原体感染,吸烟,和乡村。使用不同的县级阿特拉津暴露变量(1-,5-,和10年意味着)。
■在2009年至2019年之间,确定了39282566例活产,10527例婴儿诊断为腹裂。患有腹裂的婴儿更有可能拥有非西班牙裔白人的母亲(61%vs54%;P<.001),体重指数较低(中位数[IQR],23.4[20.8-27.2]vs25.4[22.0-30.8];P<.001),更有可能是未产的(中位数[IQR],0[0-1]对1[0-2];P<.001),更常见的是医疗补助(63%vs43%;P<.001)。在学习期间,腹裂的发生率(每1000例活产)从0.31(95%CI,0.29-0.33)降至0.22(95%CI,0.21-0.24)。中位(IQR)县级阿特拉津使用估计值在腹裂婴儿中更高(1岁,1389[IQR,198-10162]vs1023[IQR,167-6960]千克;5年,1425[IQR,273-9895]vs1057[IQR,199-6926]千克;10年,1508[IQR,286-10271]vs1113[IQR,200-6650]kg;P<.001)。在调整后的模型中,阿特拉津的县级水平较高(每增加100000公斤)与腹裂的发病率较高相关(1年:调整后的比值比[AOR],1.12[95%CI,1.01-1.24];5年:AOR,1.15[95%CI,1.02-1.30];10年:AOR,1.21[95%CI,1.07-1.38])。
■在这项横断面研究中,县级水平较高的阿特拉津与婴儿腹裂的诊断相关。虽然阿特拉津是美国第二常用的除草剂,出于对人类健康的不利影响,世界上许多国家都禁止了它。这些发现表明,在美国探索阿特拉津的替代品可能是有必要的。
UNASSIGNED: The incidence of
gastroschisis, a birth defect involving the herniation of the small bowel through the abdominal wall, has increased in the US since the 1960s. The pesticide atrazine is a hypothesized cause of
gastroschisis; however, examination of the association between atrazine and
gastroschisis has been limited.
UNASSIGNED: To evaluate national trends in gastroschisis incidence, maternal and infant characteristics associated with
gastroschisis, and whether county-level atrazine use is associated with
gastroschisis.
UNASSIGNED: This retrospective, repeated cross-sectional study examined birth certificate data of all live births in the US and data on atrazine use from the US Geological Survey from January 1, 2009, through December 31, 2019. The data analysis was performed between August 5, 2021, and May 26, 2023.
UNASSIGNED: County-level atrazine use.
UNASSIGNED: The primary outcome was
gastroschisis incidence. Covariates included maternal age, race and ethnicity, body mass index (measured by weight in kilograms divided by height in meters squared), parity, insurance type, Chlamydia infection during pregnancy, smoking, and rurality. Mixed-effects logistic regression models (year fixed effects and county random effects) were constructed using different county-level atrazine exposure variables (1-, 5-, and 10-year means).
UNASSIGNED: Between 2009 and 2019, 39 282 566 live births were identified, with 10 527 infant diagnoses of gastroschisis. Infants with gastroschisis were more likely to have mothers who identified as non-Hispanic White (61% vs 54%; P < .001), had a lower body mass index (median [IQR], 23.4 [20.8-27.2] vs 25.4 [22.0-30.8]; P < .001), were more likely to be nulliparous (median [IQR], 0 [0-1] vs 1 [0-2]; P < .001), and were more commonly covered by Medicaid (63% vs 43%; P < .001). During the study period, the rate (per 1000 live births) of gastroschisis decreased from 0.31 (95% CI, 0.29-0.33) to 0.22 (95% CI, 0.21-0.24). The median (IQR) county-level atrazine use estimates were higher among infants with gastroschisis (1 year, 1389 [IQR, 198-10 162] vs 1023 [IQR, 167-6960] kg; 5 years, 1425 [IQR, 273-9895] vs 1057 [IQR, 199-6926] kg; 10 years, 1508 [IQR, 286-10 271] vs 1113 [IQR, 200-6650] kg; P < .001). In adjusted models, higher county levels of atrazine (each 100 000-kg increase) were associated with a higher incidence of gastroschisis (1 year: adjusted odds ratio [AOR], 1.12 [95% CI, 1.01-1.24]; 5 years: AOR, 1.15 [95% CI, 1.02-1.30]; 10 years: AOR, 1.21 [95% CI, 1.07-1.38]).
UNASSIGNED: In this cross-sectional study, higher county levels of atrazine were associated with infant diagnoses of gastroschisis. While atrazine is the second-most used herbicide in the US, numerous countries around the world have banned it out of concern for adverse effects on human health. These findings suggest that exploring alternatives to atrazine in the US may be warranted.