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Evidence of an environmental contribution to the aetiology of cryptorchidism and hypospadias?

  • perinatal epidemiology
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Objectives

Evidence suggests that there is geographical variation in the birth prevalence of both cryptorchidism and hypospadias. The aim was to determine if there is evidence of spatial heterogeneity in the prevalence of these conditions and to test the hypothesis that environmental factors may contribute to aetiology.

Methods

A population-based dataset of cryptorchidism and hypospadias cases was constructed from the hospital episodes statistics that covered the Northern Region of England and assigned to a small area based on the residential address at time of admission. Expected numbers of cases for each small area were computed. The ratio of observed to expected cases was determined for each small area and analysed with respect to both geographical heterogeneity and small area level socio-economic deprivation. The Potthoff–Whittinghill method was used to determine if there was localized spatial clustering of cases.

Results

There was statistically significant spatial clustering for cases of both cryptorchidism [estimated Extra-Poisson Variation (EPV) = 0.14; 95% CI, 0.03–0.25] and hypospadias (EPV = 0.17; 95% CI, 0.05–0.28). In addition, increased prevalence was associated with lower levels of deprivation for hypospadias (P = 0.06), but there was no such relationship for cryptorchidism (P = 0.61).

Conclusions

The finding of localized spatial heterogeneity in the prevalence of cryptorchidism and hypospadias is consistent with the involvement of a spatially varying environmental risk factor. The apparent social patterning of hypospadias is likely to reflect an association with lifestyle and other factors which underpin social variation in health. However, there also remains a possibility that these findings may be due to variability in ascertainment of cases.

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Abbreviations

E :

Expected

ED-LINE:

Census enumeration district-LINE

EPV:

Extra-Poisson variation

ESRC:

Economic and social research council

HES:

Hospital episode statistics

ICD:

International classification of diseases

JISC:

Joint information systems committee

NEPHO:

North east public health observatory

O :

Observed

ONS:

Office for national statistics

P–W:

Potthoff–Whittinghill

RR:

Relative risk

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Acknowledgements

This study was funded by the Birth Defects Foundation. We thank Mr. Neil McKnight, NEPHO, for data abstraction. The work is based on Census data and boundary material, which are copyright of The Crown and the ED-LINE consortium. Data were provided with the support of the ESRC and JISC.

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Authors and Affiliations

  1. School of Clinical Medical Sciences (Child Health), Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK

    N. A. Abdullah, M. S. Pearce & R. J. Q. McNally

  2. Institute of Health and Society, Newcastle University, Newcastle, UK

    M. S. Pearce & R. J. Q. McNally

  3. Department of Paediatrics, Dalhousie University, Halifax, Canada

    L. Parker

  4. North East Public Health Observatory, University of Durham, Durham, UK

    J. R. Wilkinson

Authors
  1. N. A. Abdullah
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  2. M. S. Pearce
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  3. L. Parker
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  4. J. R. Wilkinson
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  5. R. J. Q. McNally
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Corresponding author

Correspondence to R. J. Q. McNally.

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Abdullah, N.A., Pearce, M.S., Parker, L. et al. Evidence of an environmental contribution to the aetiology of cryptorchidism and hypospadias?. Eur J Epidemiol 22, 615–620 (2007). https://doi.org/10.1007/s10654-007-9160-z

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  • DOI: https://doi.org/10.1007/s10654-007-9160-z

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