Geographical variation in anophthalmia and microphthalmia in England, 1988-94.
OBJECTIVE
To investigate the geographical variation and clustering of congenital anophthalmia and microphthalmia in England, in response to media reports of clusters.


METHODS
Comparison of pattern of residence at birth of cases of anophthalmia and microphthalmia in England in 1988-94, notified to a special register, with pattern of residence of all births. Three groups studied included all cases, all severe cases, and all severe cases of unknown aetiology.


METHODS
Prevalence rates of anophthalmia and microphthalmia by region and district, and by ward population density and socioeconomic deprivation index of enumeration district grouped into fifths. Clustering expressed as the tendency for the three nearest neighbours of a case to be more likely to be cases than expected by chance, or for there to be more cases within circles of fixed radius of a case than expected by chance.


RESULTS
The overall prevalence of anophthalmia and microphthalmia was 1.0 per 10 000 births. Regional and district variation in prevalence did not reach statistical significance. Prevalence was higher in rural than urban areas: the relative risk in the group of wards of lowest population density compared with the most densely populated group was 1.79 (95% confidence interval 1.15 to 2.81) for all cases and 2.37 (1.38 to 4. 08) for severe cases. There was no evidence of a trend in risk with socioeconomic deprivation. There was very little evidence of localised clustering.


CONCLUSIONS
There is very little evidence to support the presence of strongly localised environmental exposures causing clusters of children to be born with anophthalmia or microphthalmia. The excess risk in rural areas requires further investigation.
Environmental Epidemiology Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT. h.dolk@lshtm.ac.uk
H
H
Dolk
A
A
Busby
B G
BG
Armstrong
P H
PH
Walls
D000853:Anophthalmos / Q000453:epidemiology*; D016000:Cluster Analysis; D004739:England / Q000453:epidemiology; D004787:Environmental Pollution / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018811:Maternal Exposure; D008850:Microphthalmos / Q000453:epidemiology*; D010575:Pesticides / Q000009:adverse effects; D011156:Population Density; D015995:Prevalence; D012111:Residence Characteristics; D012423:Rural Health / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data
D010575:Pesticides