title: Spatial distribution of orofacial cleft defect births in Harris County, Texas, 1990 to 1994, and historical evidence for the presence of low-level radioactivity in tap water.
abstract: BACKGROUND
  While both ionizing and nonionizing radiation are known to impair human reproductive capacity, the role of low-level domestic radiation continues to be an unsettled issue.
  
  
  OBJECTIVE
  We examined the geostatistical distribution (residential longitude and latitude) of orofacial cleft birth cases adjusted for the underlying population distribution. Furthermore, we examined the cleft birth rates enumerated by zip codes for possible associations with levels of radium and radon in drinking water.
  
  
  METHODS
  Cleft births and unaffected live births in Harris County, Texas, from 1990 to 1994, were geocoded by residential addresses and tested for spatial clusters using the space-time clustering program SaTScan. Historical sample data on local variations in water quality facilitated the assessment of the association of orofacial cleft defect births with low-level radiation exposure.
  
  
  RESULTS
  A cluster of significantly greater than expected numbers of cleft defect births was identified in northwest Harris County, (relative risk = 3.0, P = 0.043), where the presence of elevated levels of radium (> 3 pCi/L) and radon (> 300 pCi/L) in the tap water has been known since the 1980s.
  
  
  CONCLUSIONS
  Despite the ecological design of the study, lacking individual exposure measurements for cleft birth residences, there was strong suggestive evidence of an association between elevated radiation levels in tap water and elevated cleft birth prevalence rates by zip codes. Attention of physicians is invited to environmental causes as potential risk factors for orofacial cleft. This would aid in genetic counseling and the development of future preventive measures.
authors.affiliation: University of Texas at Houston, Health Science Center, School of Public Health, Houston, TX 77030, USA. irina.cech@uth.tmc.edu
authors.forename: Irina
authors.initials: I
authors.lastname: Cech
authors.forename: Keith D
authors.initials: KD
authors.lastname: Burau
authors.forename: Jane
authors.initials: J
authors.lastname: Walston
mesh_terms: D002971:Cleft Lip / Q000453:epidemiology / Q000209:etiology*; D002972:Cleft Palate / Q000453:epidemiology / Q000209:etiology*; D040362:Geographic Information Systems; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015999:Multivariate Analysis; D011883:Radium / Q000009:adverse effects*; D011886:Radon / Q000009:adverse effects*; D013029:Space-Time Clustering; D013781:Texas / Q000453:epidemiology; D014875:Water Pollutants, Radioactive / Q000009:adverse effects*; D014881:Water Supply / Q000032:analysis*
chemical_list: D014875:Water Pollutants, Radioactive; D011886:Radon; D011883:Radium