GEOSPATIAL ANALYSIS OF GASTROSCHISIS INCIDENCE IN SOUTHERN WEST VIRGINIA: A CASE CONTROL STUDY

Objectives: Gastroschisis, a fetal abdominal wall defect, is the only birth defect that has an increasing prevalence rate over the last few decades. Previous studies have suggested a relationship to environmental factors. The association between gastroschisis and Federal Registry Sites (FRS) containing potentially harmful chemicals is still poorly understood. The objective of this study was to evaluate characteristics and geographic location of gastroschisis cases in southern West Virginia and analyze for potential spatial clustering of cases.

Methods: In order to measure if there is a spatial relationship between cases of gastroschisis and FRS sites which are subject to federal regulation and oversight, a case-control study was conducted of fetal and neonatal diagnoses of gastroschisis at Charleston Area Medical Center from February 2006 to July 2020. An Emerging Hot spot analysis and Ripley’s K-Function were used to measure the relationship between these sites and residences of gastroschisis cases and create a measured temporal trend.

Results: There were a total of 39,674 deliveries during the 15-year study period of which, 63 had fetal and/or neonatal diagnosis of gastroschisis (1.6 per 1000 births). One case was excluded from analysis during to maternal residence outside of WV. Of the 62 cases with WV residency, there was one termination, one miscarriage, two without birth information with prenatal obstetrical care provided by outlying hospitals. In the 58 cases of neonatal gastroschisis in comparison to health controls, maternal age was younger, pre-pregnancy BMI was lower, and rates of tobacco use higher in the gastroschisis cohort compared to health controls. Rates of maternal race, alcohol or illicit drug use, gestational diabetes, and neonatal gender did not significantly differ between the two cohorts. Out of the 63 cases of gastroschisis, residential information was obtained in 62 cases (4 fetal ultrasounds only, 58 delivery). The majority of gastroschisis case locations followed the traditional industrial watershed area of Kanawha County, West Virginia. Of the FRS sites there appeared to several areas of concern with the emerging hot spot analysis with New (n=8), Consecutive (n=1), Intensifying (n=1), Persistent (n=37), Sporadic (n=43). The observed K was higher at all 10 distance bands measured and illustrates that the distribution of cases is being influenced.

Conclusion: The results suggest a potential relationship between gastroschisis cases and FRS locations in CAMC’s service area during the study period. Further research is needed to understand this possible spatial relationship.