title: Risk factors, prevalence trend, and clustering of hypospadias cases in Puerto Rico.
abstract: OBJECTIVE
  The aim was to determine the distribution pattern of hypospadias cases across a well-defined geographic space.
  
  
  METHODS
  The dataset for this study was produced by the Birth Defects Prevention and Surveillance System of the Department of Health of Puerto Rico (BDSS-PR), which linked the information of male newborns of the Puerto Rico Birth Cohort dataset (PRBC; n=92,285) from 2007 to 2010. A population-based case-control study was conducted to determine prevalence trend and to estimate the potential effects of maternal age, paternal age, birth-related variables, and health insurance status on hypospadias. Two types of geographic information systems (GIS) methods (Anselin Local Moran's I and Getis-Ord G) were used to determine the spatial distribution of hypospadias prevalence.
  
  
  RESULTS
  Birthweight (<2500 g), age of mother (40+years), and private health insurance were associated with hypospadias as confirmed with univariate and multivariate analyses at 95% CI. A cluster of hypospadias cases was detected in the north-central region of Puerto Rico with both GIS methods (p≤0.05).
  
  
  CONCLUSIONS
  The clustering of hypospadias prevalence provides an opportunity to assess the underlying causes of the condition and their relationships with geographical space.
authors.affiliation: Department of Social Sciences, School of Public Health, University of Puerto Rico, Puerto Rico.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Avilés
authors.affiliation: Birth Defects Prevention and Surveillance System, Department of Health of Puerto Rico, Puerto Rico.
authors.forename: Laureane
authors.initials: L
authors.lastname: Alvelo-Maldonado
authors.affiliation: Department of Environmental Health, School of Public Health, University of Puerto Rico, Puerto Rico.
authors.forename: Irmari
authors.initials: I
authors.lastname: Padró-Mojica
authors.affiliation: Department of Environmental Health, School of Public Health, University of Puerto Rico, Puerto Rico.
authors.forename: José
authors.initials: J
authors.lastname: Seguinot
authors.affiliation: Department of Anatomy and Neurobiology, School of Medicine, University of Puerto Rico, PO Box 365067, San Juan 00936 5067, Puerto Rico. Electronic address: jcjorge@ymail.com.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Jorge
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D006801:Humans; D007021:Hypospadias / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011647:Puerto Rico / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Geographic information systems; Hypospadias; Prevalence; Risk factors