Original Study
Prevalence, Mortality, and Spatial Distribution of Gastroschisis in Mexico

https://doi.org/10.1016/j.jpag.2017.12.013Get rights and content

Abstract

Study Objective

To explore the prevalence, mortality, and spatial distribution of gastroschisis using a large population-based sample with cases identified according to birth and death certificates (ICD-10 diagnosis code Q79.3, gastroschisis) through the General Directorate of Health Information of the Secretary Health of Mexico, over the course of a 15-year period.

Design, Setting, Participants, Interventions, and Main Outcome Measures

A descriptive study examining 10,287 cases of gastroschisis was performed from 2000-2014 using public natality data for denominators (more than 25 million live births). Gastroschisis prevalence and mortality was calculated for each of year, state, maternal, and newborn characteristics. Spatial distribution was analyzed according to gastroschisis prevalence in the 32 states of Mexico.

Results

Gastroschisis prevalence was 4.01 per 10,000 live births (annual trend 2.09-6.85). Mortality associated with gastroschisis was 1.28 per 10,000 live births. Women younger than 20 years old, primiparae, and preterm infants had the highest gastroschisis-related prevalence (13.12, 5.83, and 7.51 per 10,000 live births, respectively). Gastroschisis prevalence and mortality did not differ according to newborn sex. A negative binomial distribution, variance (82,391.87) greater than the mean (321.47) was identified.

Conclusion

Our findings show an increasing temporal trend for gastroschisis since 2000 in Mexico. Additionally, gastroschisis might follow in future instances a positive binomial or Poisson distribution. Therefore, improving surveillance of risk factors and supporting research for gastroschisis is warranted among maternal age younger than 25, particularly, younger than 20 years of age.

Introduction

Gastroschisis is a severe congenital anomaly characterized by evisceration of abdominal organs through a ventral abdominal wall defect, usually to the right of a normally inserted umbilicus without any protective membrane. After delivery, the child with gastroschisis requires neonatal surgical intervention, which is associated with significant health care costs, neonatal morbidity, and perinatal mortality.1, 2 Whereas the cause of gastroschisis is uncertain, well documented risk factors include young maternal age with a lower body mass index and maternal nativity; nevertheless, when stratified specifically according to maternal age, no other risk factor has consistently been associated with gastroschisis.3, 4, 5, 6, 7, 8, 9, 10 Besides the contribution of these risk factors, gastroschisis has been identified to occur in clusters as a clue in understanding its etiology.11, 12, 13, 14 Despite the recognition of the aforementioned findings, an extensive number of reports indicate an increasing prevalence of gastroschisis worldwide (10- to 20-fold over the past 50 years).3, 4, 5, 6, 7, 8, 9, 15, 16, 17, 18, 19 Furthermore, Mexico is recognized as a country with the highest prevalence of gastroschisis.15, 18, 19, 20, 21, 22 To date, Mexican studies on gastroschisis have been limited by the small case counts, which might have prevented recognition of social, demographic, and clinical factors. Moreover, no study has assessed the prevalence, mortality, and spatial distribution of gastroschisis in Mexico using large population-based data. Therefore, we draw on the General Directorate of Health Information of the Secretary of Health of Mexico to pool data from a large, population-based, and nationally representative sample of gastroschisis cases over the course of 15 years with a threefold purpose; to explore the prevalence, mortality, and spatial distribution of gastroschisis in Mexico from 2000-2014.

Section snippets

Materials and Methods

An analysis was performed in all infants with gastroschisis registered in the databases of hospital discharges of public institutions in the 32 states of Mexico from 2000-2014. These databases are produced at the General Directorate of Health Information of the Secretary of Health of Mexico.23 Continuous data from 2014 backward to whatever full calendar year was the earliest available and gastroschisis diagnoses confirmed by birth or death certificates (ICD-10 diagnosis code Q79.3,

Results

From 2000-2014, there were 25,635,416 live births (approximately 70% of total Mexican births over the course of the study period) and 10,287 gastroschisis cases among the 32 states of Mexico (birth prevalence rate, 4.01 per 10,000 live births). A consistent increase in the prevalence rate of gastroschisis was noted during the study period, from 2.09 per 10,000 in 2000 to 6.85 per 10,000 in 2014. There were 3305 deaths associated with gastroschisis (mortality rate, 1.28 per 10,000 live births).

Discussion

This is the first study to explore the prevalence, mortality, and spatial distribution of gastroschisis in Mexico using large population-based data. The present study shows a consistent increasing trend (at least threefold) in the birth prevalence of gastroschisis in Mexico during the period 2000-2014. Our findings agree with other reports around the world, indicating that the prevalence of gastroschisis has been increasing during the past two decades, particularly, among young maternal age

References (35)

  • B.G. Benjamin et al.

    Gastroschisis prevalence in Texas 1999-2003

    Birth Defects Res A Clin Mol Teratol

    (2010)
  • R.S. Kirby et al.

    Prevalence and correlates of gastroschisis in 15 states, 1995 to 2005

    Obstet Gynecol

    (2013)
  • A.M. Jones et al.

    Increasing prevalence of gastroschisis–14 states, 1995-2012

    MMWR Morb Mortal Wkly Rep

    (2016)
  • Z.G. Khodr et al.

    Hispanic ethnicity and acculturation, maternal age and the risk of gastroschisis in the national birth defects prevention study

    Birth Defects Res A Clin Mol Teratol

    (2013)
  • A. Materna-Kiryluk et al.

    Geospatial clustering of gastroschisis in Poland: data from the Polish Registry of Congenital Malformations (PRCM)

    Int J Occup Med Environ Health

    (2016)
  • K.L. Bassil et al.

    Spatial variability of gastroschisis in Canada, 2006-2011: an exploratory analysis

    Can J Public Health

    (2016)
  • G.L. Di Tanna et al.

    Prevalence of gastroschisis at birth: retrospective study

    BMJ

    (2002)
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    The authors indicate no conflicts of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Secretary of Health of Mexico.

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