title: Spatial Analysis of Neonatal Congenital Hypothyroidism and Nitrate as an Environmental Pollutant in Isfahan Province During 2010-2013.
abstract: BACKGROUND
  Thyroid absorption of iodine could be encumbered by nitrate drinking water when it is transported to the fetal thyroid gland. Therefore, nitrate potentially causes congenital hypothyroidism (CH) due to thyroid dysfunction. In this study, we have not only aimed at spatial determination of CH distribution and nitrate concentration (NC) existing in drinking water, but also we intended to evaluate the probable impact of nitrate on CH incidence.
  
  
  METHODS
  Annual average of nitrate in drinking-water as well as number of CH infants diagnosed through the screening program were applied to determine the incidence ratio of the disease for each town (from 2010 to 2013). Afterward, Arc GIS 9.3 was used to draw choropleth maps with quantile classification. Data were entered into SPSS 16.0 and Excel 2010 software. Finally, linear regression was applied for data analysis.
  
  
  RESULTS
  The incidence rate of CH (considering transient and permanent cases) was about one in every 413 births. Khansar, Golpaygan, Naein, and Ardestan had the highest incidence rate of CH respectively. On the other hand, Tiran, Dehaghan, Khansar, and Fereydan had the highest level of nitrate drinking water. There was a strong relationship between the NC and incidence of CH in Khansar; however, this relationship was not significant (P = 0.392) in Isfahan province.
  
  
  CONCLUSIONS
  Since there was not a significant relationship between NC in drinking-water and incidence of CH through linear regression analysis, more studies should be implemented to confirm or refute our observations.
authors.affiliation: Department of Physical Geography, School of Geography and Planning, Isfahan University, Isfahan, Iran.
authors.forename: Neda
authors.initials: N
authors.lastname: Mehrnejat
authors.affiliation: Department of Physical Geography, School of Geography and Planning, Isfahan University, Isfahan, Iran.
authors.forename: Hojatollah
authors.initials: H
authors.lastname: Yazdanpanah
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Fadaei Nobari
authors.affiliation: Department of Pediatrics, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mahin
authors.initials: M
authors.lastname: Hashemipour
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University Of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Maracy
authors.affiliation: Department of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Moafi
authors.affiliation: Department of Environmental Health, Expert of Environmental Health Engineering, Environmental Health Unit, Isfahan Province Health Center, Isfahan, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Mousavian
keywords: Congenital hypothyroidism; Isfahan; Nitrate; spatial distribution