title: Geographic clusters of congenital anomalies in Argentina.
abstract: Geographical clusters are defined as the occurrence of an unusual number of cases higher than expected in a given geographical area in a certain period of time. The aim of this study was to identify potential geographical clusters of specific selected congenital anomalies (CA) in Argentina. The cases were ascertained from 703,325 births, examined in 133 maternity hospitals in the 24 provinces of Argentina. We used the spatial scan statistic to determine areas of Argentina which had statistically significant elevations of prevalence. Prenatal diagnosis followed by referral of high-risk pregnancies to high complexity hospitals in a hospital-based surveillance system can create artifactual clusters. We assessed the referral bias by evaluating the prevalence heterogeneity within each cluster. Eight clusters of selected CAs with unusually high birth prevalence were identified: anencephaly, encephalocele, spina bifida, diaphragmatic hernia, talipes equinovarus, omphalocele, Cleft lip with or without cleft palate (CL/P), and Down syndrome. The clusters of Down syndrome and CL/P observed in this study match the previously reported clusters. These findings support local targeted interventions to lower the prevalence of the CAs and/or further research on the cause of each cluster. The clusters of spina bifida, anencephaly, encephalocele, omphalocele, congenital diaphragmatic hernia, and talipes equinovarus may be influenced by prenatal diagnosis and referral to high complexity hospitals.
authors.affiliation: National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Av. Las Heras 2670, 3er piso, Ciudad de Buenos Aires, 1425, Argentina. bgroisman@gmail.com.
authors.forename: Boris
authors.identifier: http://orcid.org/0000-0001-6263-2562
authors.initials: B
authors.lastname: Groisman
authors.affiliation: ECLAMC (Latin American Collaborative Study of Congenital Malformations) at CEMIC (Center for Medical Education and Clinical Research), Buenos Aires, Argentina.
authors.forename: Juan
authors.initials: J
authors.lastname: Gili
authors.affiliation: ECLAMC (Latin American Collaborative Study of Congenital Malformations) at CEMIC (Center for Medical Education and Clinical Research), Buenos Aires, Argentina.
authors.forename: Lucas
authors.initials: L
authors.lastname: Giménez
authors.affiliation: ECLAMC (Latin American Collaborative Study of Congenital Malformations) at CEMIC (Center for Medical Education and Clinical Research), Buenos Aires, Argentina.|ECLAMC (Latin-American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Poletta
authors.affiliation: National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Av. Las Heras 2670, 3er piso, Ciudad de Buenos Aires, 1425, Argentina.|Department of Cellular Biology, Histology, Embryology and Genetics. Medicine College, University of Buenos Aires (UBA), Buenos Aires, Argentina.
authors.forename: María Paz
authors.initials: MP
authors.lastname: Bidondo
authors.affiliation: National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Av. Las Heras 2670, 3er piso, Ciudad de Buenos Aires, 1425, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Barbero
authors.affiliation: National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Av. Las Heras 2670, 3er piso, Ciudad de Buenos Aires, 1425, Argentina.
authors.forename: Rosa
authors.initials: R
authors.lastname: Liascovich
authors.affiliation: ECLAMC (Latin American Collaborative Study of Congenital Malformations) at CEMIC (Center for Medical Education and Clinical Research), Buenos Aires, Argentina.|ECLAMC (Latin-American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil.
authors.forename: Jorge
authors.initials: J
authors.lastname: López-Camelo
keywords: Birth prevalence; Congenital anomalies; Geographic clusters; National Network of Congenital Anomalies of Argentina (RENAC)