"Prevalence and secular trend of neural tube defects in fetal deaths in Argentina, 1994-2019".

BACKGROUND: Fetal deaths are a major source of information on the epidemiology of neural tube defects (NTDs; anencephaly and myelomeningocele). We analyzed NTDs prevalence and secular trend using fetal death records between 1994 and 2019 in Argentina. MATERIALS AND METHODS: Data were obtained from the Department of Statistics and Information of the Ministry of Health (DEIS). Using the number of fetal deaths due to anencephaly and myelomeningocele, we estimated the proportion of all fetal deaths due to anencephaly, myelomeningocele, and NTDs (anencephaly + myelomeningocele) during pre- and post-fortification period in Argentina. We also estimated the ratio of fetal deaths due to anencephaly, myelomeningocele, and NTDs (anencephaly + myelomeningocele) to 10,000 live births. Secular trend in the outcomes was analyzed using a Poisson model and Joinpoint regression analysis. RESULTS: In the entire period analyzed, the NTD proportion on fetal deaths was 1.32. In 1994, NTDs accounted for 34.7% of congenital malformations fetal deaths (CM) and 1.7% of all fetal deaths, whereas in 2019, these percentages were 9.4% and 0.5%, respectively. NTDs present a negative secular trend (p < .05). The risk of fetal death due to anencephaly and myelomeningocele decreases between 2005 and 2019 by 67% and 51% respectively (p < .05) in comparison to the period between 1994 and 2004 before the effective fortification of wheat flour used in the food industry destined for the domestic market. DISCUSSION AND CONCLUSION: We found a significant decrease in the risk of all fetal deaths due to NTDs, particularly anencephaly, in Argentina over the study period, with most reduction observed during the mandatory flour fortification era (introduced in Argentina in 2002). The inclusion of fetal deaths in NTD surveillance, coupled or uncoupled with other pregnancy outcomes, is essential for monitoring preventive supplementation measures.

Neonatal anthropometry of malformed newborns: A large South American population-based study.

BACKGROUND: Population-based anthropometric evaluation of malformed newborns is scarce. OBJECTIVES: To evaluate malformed newborns' foetal growth using the ICD 10 malformations' classification. METHODS: A study including 33,769 newborns (14,857 malformed and 18,912 nonmalformed), selected from 678,840 births from nine South American countries, period 2010-2018, was conducted. Prevalence of severe small and small for gestational age was calculated for malformed and nonmalformed newborns classified by preterm birth categories. Prevalence and relative risk (RR) with its 95% confidence interval (CI) were calculated. The associations between anthropometric phenotypes and congenital malformations were evaluated with generalized linear models. RESULTS: Prevalence of preterm and term severe small and small for gestational age newborns was higher in malformed than that in nonmalformed neonates. For grouped ICD 10 malformations categories, the RR for severe small for gestational age was 2.88 (95% CI 2.51, 3.30) and 2.10 (95% CI 1.92, 2.30) for small for gestational age. For at-term and preterm malformed newborns, the RR for severe small for gestational age was 2.21 (95% CI 1.87, 2.61) and 3.21 (95% CI 2.52, 4.10), respectively; for small for gestational age, the RR was 2.31 (95% CI 2.11, 2.53) for at-term newborns and 2.58 (95% CI 2.16, 3.08) for preterm ones. CONCLUSIONS: Prevalence and relative risk of severe small and small for gestational age vary according to the group of malformations and gestational age; they increase in congenital malformations of the nervous, respiratory and digestive systems, and in chromosomal abnormalities and are lower for malformations of eye, ear, face and neck and cleft lip and palate. Foetal growth considered together with malformed newborns' gestational age would allow for inferring different risks of morbidity and mortality.

Secular trend in infant deaths by congenital malformations in Argentina (1980-2018). / [Tendencia secular (1980-2018) de las muertes infantiles por malformaciones congenitas en Argentina.]

Introduction: Congenital malformations (CM) represent the second cause of infant death in Argentina. Objective: To analyze the secular trend (1980-2018) of infant deaths due to CM at the regional and provincial level. Material and methods: The data come from the DEIS (Ministry of Health) and include the absolute number of deaths and live births and deaths by CM coded according to ICD-10 (Codes Q00-Q99). Infant mortality rate due to CM (IMR-CM) (number of deaths due to congenital malformations / number of newborns) and the proportion of deaths from CM (PD-CM) (percentage of deaths from congenital malformations / deaths from all causes) were calculated by regions (Center, NOA, NEA, Cuyo and Patagonia) and provinces. The period was divided into 7 subgroups of five years and one of 4. Secular trend was analyzed using a Poisson model. A line and bar graph were used to represent graphically the differences in the IRM-CM and PD-CM at the regional level. Results: At the country level, there was a pattern characterized by the significant decrease and increase of the IMR-CM and PD-CM respectively. This pattern is repeated in the Central, Cuyo and Patagonia regions and in the provinces of Buenos Aires, Santa Fé, Entre Ríos, Neuquén, La Pampa, Mendoza and Santa Cruz. In the remaining regions and provinces, the IMR-CM exhibits a heterogeneous behavior. Conclusion: To analyze the secular trend (1980-2018) of infant deaths due to CM at the regional and provincial level.

Introducción: Las malformaciones congénitas (MC) representan la segunda causa de muertes infantiles en Argentina. Objetivo: Analizar la tendencia secular (1980-2018) de las muertes infantiles por MC a nivel regional y provincial. Material y métodos: Los datos proceden de la DEIS (Ministerio de Salud) y comprenden el número absoluto de fallecidos y de nacidos vivos y las defunciones por MC codificadas según CIE-10 (Códigos Q00-Q99). Se calculó por regiones (Centro, NOA, NEA, Cuyo y Patagonia) y provincias la tasa de MI por MC (TMI-MC) (número de muertos por malformaciones congénitas / número de recién nacidos) y la proporción de muertes infantiles por malformaciones congénitas (PM-MC) (porcentaje de muertes por malformaciones congénitas / muertes por todas las causas). El período se dividió en 7 subgrupos de cinco años y uno de 4. La tendencia secular se analizó mediante un modelo de Poisson. Para representar de manera gráfica las diferencias en la TMI-MC y PM-MC a nivel regional se utilizó un gráfico de líneas y barras. Resultados: A nivel país se registró un patrón caracterizado por el descenso y ascenso significativos de la TMI-MC y PM-MC respectivamente. Este patrón se repite en las regiones Centro, Cuyo y Patagonia y en las provincias de Buenos Aires, Santa Fé, Entre Ríos, Neuquén, La Pampa, Mendoza y Santa Cruz. En las restantes regiones y provincias la TMI-MC exhibe un comportamiento heterogéneo. Conclusión: La heterogeneidad regional y provincial de la tendencia de TMI-MC y PM-MC refleja las inequidades espaciales socioeconómicas del país en las últimas décadas.

Birth prevalence of congenital anomalies in Argentina, according to socioeconomic level.

Birth prevalence of congenital anomalies (CA) in Argentina is estimated around 1.7%. CA are the second leading cause of infant mortality. Poverty and other adverse socioeconomic conditions have been associated with birth defects. To describe the prevalence at birth of CA, according to the two proxy variables of socioeconomic level: the health subsector of the hospital where the cases were born (PUB-public versus PRI-private or social security) and its geographical location. The design of the study was ecological using the data of the National Network of Congenital Anomalies of Argentina (RENAC); from October 2010 to December 2018. CA birth prevalence was estimated using the Poisson regression. We used a logistic regression model to analyze the association birth prevalence to health subsector and geographical region. A total of 2,202,994 births were examined in the study period, with a global CA prevalence of 1.69% (95% CI 1.68-1.71). The highest prevalence was observed in PUB hospitals when comparing to PRI hospitals at the country level and in all regions. There were differences in the prevalence of selected congenital anomalies with a statistically significant association to PUB (observed in anencephaly, encephalocele, hydrocephalus, microcephaly, holoprosencephaly, microtia/anotia, cleft lip and palate, postaxial polydactyly, talipes equinovarus, talipes calcaneovalgus, and gastroschisis). The prevalence of critical heart defects and chromosomal anomalies was significantly higher in PRI hospitals. Although this is an ecological study with no information on socioeconomic status at individual level, we found an association between CA frequency and selected CA with the PUB subsector. Vulnerable populations affected with CA require a greater effort from policy makers and health care providers to allocate more resources and design strategies to access to health.

Birth prevalence of congenital anomalies in the City of Buenos Aires, Argentina, according to socioeconomic level.

The goal of our study is to describe the prevalence of congenital anomalies (CA) in hospitals of the City of Buenos Aires, Argentina, according to two proxy variables of the socioeconomic level: health subsector, public (PUB) versus private/social security (PRI), and geographical location, northern (N) versus southern (S). The source of data was the National Network of Congenital Anomalies of Argentina (RENAC) (period 2010-2016). From a total of 228,208 births, 4872 newborns with CA were detected (2.14%). The prevalence in PRI-N, PUB-N, PRI-S, and PUB-S hospitals were 1.59%, 1.91%, 2.20%, and 2.43%, respectively. Prevalence of neural tube defects, abdominal wall defects, and oral clefts was significantly higher in PUB than in PRI hospitals. Prevalence of critical heart defects was significantly lower in PUB-N and in PRI-S hospitals. Prevalence of anencephaly, encephalocele, hydrocephalus, microcephaly, gastroschisis, cleft lip and palate, ductus arteriosus, and bilateral renal agenesis was higher in PUB hospitals, both N and S, as well as microphthalmia/anophthalmia and ambiguous genitalia, spina bifida, anotia/microtia, postaxial polydactyly, and diaphragmatic hernia had higher prevalences in PUB-S hospitals. Omphalocele was more frequent in PUB-N hospitals. Results suggest that vulnerable populations in the public and southern subsectors of the city still require a greater support to reinforce resources and strategies that lead to greater equity in access to health.

Microcephaly infant mortality in Brazil before zika outbreak.

Introduction: We present temporal and spatial variation of deaths from microcephaly in children under 1 year of age is analyzed at regional, state, and municipal level in the pre-Zika period in Brazil. Materials and Methods: Data on births and deaths of infants with microcephaly was obtained from DATASUS from 1996 to 2013. Infant mortality rate from microcephaly (IMR-M) was estimated at Region, Federative Unit (UF), and Municipality level. Secular trend (ST) and risk of death variation were estimated using a Poisson regression model. Satscan software was used to obtain a statistic spatial scan for the Poisson model. Results: IMR-M shows a non-significant negative ST in the Southeast, South and Central West Regions of Brazil. A greater IMR-M risk of death variation is found in the North and Northeast Regions. Most UFs in the Southeast, South and Central West Regions showed a negative ST, in contrast to what occurs in the UFs of the North and Northeast Regions showed a positive ST. Six high risk significant clusters were found: 3 in the North-Northeast and 3 in the South-SouthWest-Center-West. Conclusions: The North and Northeast Regions showed positive ST for IRM-M and higher death risk, which was not observed in the other regions. Cluster distribution for higher IMR-M and risk resembles the distribution of the microcephaly and Zika cases in the outbreak period.

Introducción: Presentamos la variación temporal y espacial de las muertes por microcefalia en niños menores de 1 año de edad que se analizan a nivel regional, estatal y municipal en el período pre-Zika en Brasil. Materiales y métodos: Los datos sobre nacimientos y muertes de niños con microcefalia se obtuvieron de DATASUS de 1996 a 2013. La tasa de mortalidad infantil por microcefalia (TMI-M) se estimó a nivel de Región, Unidad de Federativa (UF) y Municipio. La tendencia secular (TS) y la variación del riesgo de muerte se estimaron utilizando un modelo de regresión de Poisson. El análisis estadístico espacial fue realizado por un modelo de Poisson utilizando el software Satscan. Resultados: La TMI-M muestra un TS negativo no significativo en las regiones sudeste, sur y centro-oeste de Brasil. Una mayor variación de riesgo de muerte se encuentra en las regiones Norte y Noreste. La mayoría de las UF en las regiones Sureste, Sur y Centro-Oeste mostraron un TS negativa, en contraste con lo que ocurre en las UF de las Regiones Norte y Noreste mostraron una TS positiva. Se encontraron seis agrupamientos significativos de alto riesgo: 3 en el Norte-Noreste y 3 en el Sur-Sur-Oeste-Centro-Oeste. Conclusiones Las regiones Norte y Noreste mostraron una TS positiva para la TMI-M y un mayor riesgo de muerte, que no se observó en las otras regiones. La distribución de los agrupamientos de mayor TMI-M y riesgo se asemeja a la distribución de los casos de microcefalia y Zika en el período del brote. Conclusiones: Las regiones Norte y Noreste mostraron una TS positiva para la TMI-M y un mayor riesgo de muerte, que no se observó en las otras regiones. La distribución de los agrupamientos de mayor TMI-M y riesgo se asemeja a la distribución de los casos de microcefalia y Zika en el período del brote.

Epidemiología de las muertes súbitas infantiles inesperadas en Argentina: tendencia secular y variación espacial / Epidemiology of sudden unexpected death in infancy in Argentina: secular trend and spatial variation

Introducción. La mortalidad infantil incluye defunciones de menores de un año. La proporción de muerte súbita inesperada infantil (MSII) varía entre países y según las causas de muerte consideradas. Objetivo. Describir la variación espacial y temporal de MSII en Argentina entre 1991 y 2014 utilizando la Clasificación Internacional de Enfermedades, décima revisión. Materiales y métodos. A partir de la información de defunciones infantiles (Dirección de Estadísticas e Información de Salud), se calculó el porcentaje de MSII sobre el total de muertes infantiles y la frecuencia de las causas que la componían a nivel nacional, regional y provincial. El riesgo de muerte y la tendencia secular se calcularon con regresión de Poisson. Para detectar agrupamientos departamentales con porcentajes de MSII significativamente diferentes a los nacionales, se utilizó el programa SaTScan v9.1.1. Resultados. En Argentina, entre 1991 y 2014, fallecieron 267 552 menores de un año; el 7 % fueron MSII; la tendencia secular de estas causas fue negativa y estadísticamente significativa; el riesgo de MSII fue de 0,86, y se observó una gran heterogeneidad espacial. A nivel nacional, la causa más frecuente fue síndrome de la muerte súbita del lactante, con diferencias interregionales. Nueve agrupamientos departamentales tuvieron riesgo de MSII entre 4,36 y 1,24, significativamente diferentes al resto del país. Conclusiones. La proporción de MSII y de las causas que la componen presenta heterogeneidad interregional con predominio de códigos relacionados con diagnósticos imprecisos en las regiones más desfavorecidas y de síndrome de muerte súbita del lactante en las más desarrolladas.

Introduction. Infant mortality comprises deaths among infants younger than one year old. The proportion of sudden unexpected death in infancy (SUDI) varies by country and based on the cause of death. Objective. To describe the spatial and temporal variation of SUDI in Argentina between 1991 and 2014 according to the International Classification of Diseases, tenth revision. Materials and methods. Based on infant death data (provided by the Health Statistics and Information Department), we estimated the percentage of SUDI over the total number of infant deaths and the frequency of causes of death at a provincial, regional, and national level. The risk for death and the secular trend were estimated using a Poisson regression. The SaTScan software, v9.1.1, was used to detect clusters of districts where the percentage of SUDI was significantly different from the national percentage. Results. In Argentina, between 1991 and 2014, 267 552 infants younger than 1 year died; 7 % corresponded to SUDI; the secular trend of causes was negative and statistically significant; the risk for SUDI was 0.86, and a great spatial heterogeneity was observed. At a national level, the most common cause was sudden infant death syndrome, with inter-regional differences. In nine district clusters, the risk for SUDI ranged between 4.36 and 1.24, which is significantly different from the rest of the country. Conclusions. The proportion of SUDI and its causes show inter-regional heterogeneity; codes related to inaccurate diagnoses predominated in more unfavorable regions, while sudden infant death syndrome was prevalent in the more developed regions.

Mortalidad infantil por malformaciones congénitas en la Ciudad Autónoma de Buenos Aires (1998-2015): Análisis espacial, temporal y relación con la condición socioeconómica / Infant mortality due to congenital malformations in the Autonomous City of Buenos Aires (1998-2015): Spatial, temporal analysis and relation to the socioeconomic status

Introducción. En Argentina, las malformaciones congénitas (MC) representan la segunda causa de muerte en menores de 1 año. Objetivo. Analizar la variación temporal y espacial de la mortalidad infantil por MC en la Ciudad Autónoma de Buenos Aires y su relación con un indicador de desarrollo socioeconómico. Materiales y método. Los datos de nacimientos y muertes de menores de 1 año de edad codificados con la Clasificación Internacional de Enfermedades (CIE-10) provinieron del Ministerio de Salud. Para las zonas geográficas (Norte, Centro y Sur), sistemas (nervioso, cardiovascular y anomalías cromosómicas) y 28 malformaciones específicas, se estimaron la tasa de mortalidad infantil por MC (TMI-MC) y el porcentaje de muertes por MC (PM-MC) en 3 períodos (1998-2003, 2004-2009, 2010-2015). La tendencia secular y el riesgo de muerte se estimaron con un modelo de regresión de Poisson. Mediante el análisis de componentes principales, se definió un indicador de desarrollo socioeconómico que se correlacionó con la TMI-MC y el PM-MC. Resultados. La TMI-MC y el PM-MC presentaron, respectivamente, una tendencia secular negativa y positiva con significación estadística y exhibieron una diferenciación por zonas. La TMI-MC descendió para las malformaciones del sistema nervioso central y cardiovascular, y aumentó en las anomalías cromosómicas (p < 0,05). La TMI-MC y el PM-MC se correlacionaron de modo positivo y negativo, respectivamente, con el indicador socioeconómico (p < 0,05). Conclusión. Los indicadores de mortalidad infantil por MC de la Ciudad Autónoma de Buenos Aires exhiben una heterogeneidad espacial y temporal, y se relacionan con las características socioeconómicas zonales.

Introduction. In Argentina, congenital malformations (CM) account for the second cause of death among infants younger than 1 year. Objective. To analyze spatial and temporal variation in infant mortality due to CM in the Autonomous City of Buenos Aires and its relation to a socioeconomic development indicator. Materials and methods. Births and deaths among infants younger than 1 year were coded using the International Classification of Diseases (ICD-10); data were provided by the Ministry of Health. Geographical areas: northern, central and southern. The nervous system, the cardiovascular system, chromosomal abnormalities, and 28 specific malformations were evaluated. Infant mortality rate due to CM (IMR-CM) and the percentage of deaths from CM (PD-CM) were estimated in 3 periods (1998-2003, 2004-2009, 2010-2015). Secular trend and risk of death were estimated using the Poisson regression model. A socioeconomic development indicator correlated to the IMR-CM and the PD-CM was obtained by means of a principal component analysis. Results. The IMR-CM and the PD-CM had, respectively, a negative and positive secular trend with statistical significance, and exhibited a differentiation by areas. The IMR-CM values decreased for central nervous system and cardiovascular system malformations, and increased for chromosomal abnormalities (p < 0.05). The IMR-CM and the PD-CM were positively and negatively correlated, respectively, with the socioeconomic indicator (p < 0.05). Conclusion. Infant mortality indicators due to CM in the Autonomous City of Buenos Aires are spatially and temporally heterogeneous, and are related to the socioeconomic characteristics of the areas.

Epidemiology of sudden unexpected death in infancy in Argentina: secular trend and spatial variation. / Epidemiología de las muertes súbitas infantiles inesperadas en Argentina: tendencia secular y variación espacial.

Introduction: Infant mortality comprises deaths among infants younger than one year old. The proportion of sudden unexpected death in infancy (SUDI) varies by country and based on the cause of death. Objective: To describe the spatial and temporal variation of SUDI in Argentina between 1991 and 2014 according to the International Classification of Diseases, tenth revision. Materials and methods: Based on infant death data (provided by the Health Statistics and Information Department), we estimated the percentage of SUDI over the total number of infant deaths and the frequency of causes of death at a provincial, regional, and national level. The risk for death and the secular trend were estimated using a Poisson regression. The SaTScan software, v9.1.1, was used to detect clusters of districts where the percentage of SUDI was significantly different from the national percentage. Results: In Argentina, between 1991 and 2014, 267 552 infants younger than 1 year died; 7 % corresponded to SUDI; the secular trend of causes was negative and statistically significant; the risk for SUDI was 0.86, and a great spatial heterogeneity was observed. At a national level, the most common cause was sudden infant death syndrome, with inter-regional differences. In nine district clusters, the risk for SUDI ranged between 4.36 and 1.24, which is significantly different from the rest of the country. Conclusions: The proportion of SUDI and its causes show inter-regional heterogeneity; codes related to inaccurate diagnoses predominated in more unfavorable regions, while sudden infant death syndrome was prevalent in the more developed regions.

Introducción. La mortalidad infantil incluye defunciones de menores de un año. La proporción de muerte súbita inesperada infantil (MSII) varía entre países y según las causas de muerte consideradas. Objetivo. Describir la variación espacial y temporal de MSII en Argentina entre 1991 y 2014 utilizando la Clasificación Internacional de Enfermedades, décima revisión. Materiales y métodos. A partir de la información de defunciones infantiles (Dirección de Estadísticas e Información de Salud), se calculó el porcentaje de MSII sobre el total de muertes infantiles y la frecuencia de las causas que la componían a nivel nacional, regional y provincial. El riesgo de muerte y la tendencia secular se calcularon con regresión de Poisson. Para detectar agrupamientos departamentales con porcentajes de MSII significativamente diferentes a los nacionales, se utilizó el programa SaTScan v9.1.1. Resultados. En Argentina, entre 1991 y 2014, fallecieron 267 552 menores de un año; el 7 % fueron MSII; la tendencia secular de estas causas fue negativa y estadísticamente significativa; el riesgo de MSII fue de 0,86, y se observó una gran heterogeneidad espacial. A nivel nacional, la causa más frecuente fue síndrome de la muerte súbita del lactante, con diferencias interregionales. Nueve agrupamientos departamentales tuvieron riesgo de MSII entre 4,36 y 1,24, significativamente diferentes al resto del país. Conclusiones. La proporción de MSII y de las causas que la componen presenta heterogeneidad interregional con predominio de códigos relacionados con diagnósticos imprecisos en las regiones más desfavorecidas y de síndrome de muerte súbita del lactante en las más desarrolladas.

Infant mortality due to congenital malformations in the Autonomous City of Buenos Aires (1998-2015): Spatial, temporal analysis and relation to the socioeconomic status. / Mortalidad infantil por malformaciones congénitas en la Ciudad Autónoma de Buenos Aires (1998-2015): Análisis espacial, temporal y relación con la condición socioeconómica.

Introduction: In Argentina, congenital malformations (CM) account for the second cause of death among infants younger than 1 year. Objective: To analyze spatial and temporal variation in infant mortality due to CM in the Autonomous City of Buenos Aires and its relation to a socioeconomic development indicator. Materials and methods: Births and deaths among infants younger than 1 year were coded using the International Classification of Diseases (ICD-10); data were provided by the Ministry of Health. Geographical areas: northern, central and southern. The nervous system, the cardiovascular system, chromosomal abnormalities, and 28 specific malformations were evaluated. Infant mortality rate due to CM (IMR-CM) and the percentage of deaths from CM (PD-CM) were estimated in 3 periods (1998-2003, 2004-2009, 2010-2015). Secular trend and risk of death were estimated using the Poisson regression model. A socioeconomic development indicator correlated to the IMR-CM and the PD-CM was obtained by means of a principal component analysis. Results: The IMR-CM and the PD-CM had, respectively, a negative and positive secular trend with statistical significance, and exhibited a differentiation by areas. The IMR-CM values decreased for central nervous system and cardiovascular system malformations, and increased for chromosomal abnormalities (p < 0.05). The IMR-CM and the PD-CM were positively and negatively correlated, respectively, with the socioeconomic indicator (p < 0.05). Conclusion: Infant mortality indicators due to CM in the Autonomous City of Buenos Aires are spatially and temporally heterogeneous, and are related to the socioeconomic characteristics of the areas.

Introducción. En Argentina, las malformaciones congénitas (MC) representan la segunda causa de muerte en menores de 1 año. Objetivo. Analizar la variación temporal y espacial de la mortalidad infantil por MC en la Ciudad Autónoma de Buenos Aires y su relación con un indicador de desarrollo socioeconómico. Materiales y método. Los datos de nacimientos y muertes de menores de 1 año de edad codificados con la Clasificación Internacional de Enfermedades (CIE-10) provinieron del Ministerio de Salud. Para las zonas geográficas (Norte, Centro y Sur), sistemas (nervioso, cardiovascular y anomalías cromosómicas) y 28 malformaciones específicas, se estimaron la tasa de mortalidad infantil por MC (TMI-MC) y el porcentaje de muertes por MC (PM-MC) en 3 períodos (1998-2003, 2004-2009, 2010-2015). La tendencia secular y el riesgo de muerte se estimaron con un modelo de regresión de Poisson. Mediante el análisis de componentes principales, se definió un indicador de desarrollo socioeconómico que se correlacionó con la TMI-MC y el PM-MC. Resultados. La TMI-MC y el PM-MC presentaron, respectivamente, una tendencia secular negativa y positiva con significación estadística y exhibieron una diferenciación por zonas. La TMI-MC descendió para las malformaciones del sistema nervioso central y cardiovascular, y aumentó en las anomalías cromosómicas (p< 0,05). La TMI-MC y el PM-MC se correlacionaron de modo positivo y negativo, respectivamente, con el indicador socioeconómico (p < 0,05). Conclusión. Los indicadores de mortalidad infantil por MC de la Ciudad Autónoma de Buenos Aires exhiben una heterogeneidad espacial y temporal, y se relacionan con las características socioeconómicas zonales.

Relación de la mortalidad infantil con la altura geográfica en el Noroeste Argentino / Relationship between infant mortality and altitude in the Northwest region of Argentina

Introducción. Por su localización sobre los Andes, el Noroeste Argentino presenta una heterogeneidad geográfica, socioeconómica, cultural y biológica reflejada en tasas de mortalidad infantil (TMI) superiores a casi todas las regiones argentinas. Objetivo. Calcular la TMI, tasa de mortalidad neonatal (TMN) y la tasa de mortalidad posneonatal (TMP) para analizar su variación temporal y espacial, a través de la tendencia secular y el riesgo relativo de acuerdo con el nivel altitudinal. Población y método. En un estudio retrospectivo, descriptivo y de correlación basado en datos de nacimientos y defunciones infantiles sucedidos en el Noroeste Argentino (1998-2010), se calcularon por departamentos y nivel altitudinal (departamentos a < 2000metros sobre el nivel del mar, tierras bajas y > 2000 msnm, tierras altas) TMI, TMN y TMP, tendencia secular y riesgo relativo de muerte, realizando un análisis de agrupamiento. Resultados y conclusiones. Las tasas fueron más elevadas en tierras altas, la TMI fue de 29,8%o (en tierras bajas, 15,6%); la TMP en tierras altas fue de 17,7% y 5,2% en tierras bajas. Las tierras altas mostraron un descenso promedio anual del 3,9% para la TMI y del 4,1% para la TMP; en tierras bajas, el descenso fue de 7,0% para la TMI y del 9,3% para la TMP. El riesgo relativo fue significativamente mayor a grandes alturas para TMI y TMP. La TMN, su tendencia secular y riesgo relativo no mostraron diferencias estadísticamente significativas entre niveles de altura.

Introduction. Given its location on the Andes, the Northwest region of Argentina is geographically, socioeconomically, culturally, and biologically heterogeneous, and this is reflected on an infant mortality rate (IMR) that is higher than in any other Argentine region. Objective. To estimate IMR, neonatal mortality rate (NMR), and post-neonatal mortality rate (PNMR), and to analyze their spatial and temporal variations using secular trends and the relative risk based on altitudinal zones. Population and method. This was a retrospective, descriptive, correlational study based on birth and death data recorded in the Northwest region of Argentina (1998-2010); IMR, NMR, PNMR, secular trends, and the relative risk of death were calculated by district and altitudinal zone (districts at < 2000 meters above sea level, lowlands; at > 2000 meters above sea level, highlands) by means of a cluster analysis. Results and conclusions. Rates were higher in the highlands; IMR was 29.8%o (versus 15.6%o in the lowlands); PNMR was 17.7% in the highlands (versus 5.2% in the lowlands). In the highlands, there was an annual average reduction of 3.9% in IMR and of 4.1% in PNMR; in the lowlands, such reduction was of 7.0% in IMR and of 9.3% in PNMR. The relative risk of IMR and PNMR was significantly higher at high-altitude zones. NMR, its secular trend, and the relative risk did not show statistically significant differences between both altitudinal zones.

Relationship between infant mortality and altitude in the Northwest region of Argentina. / Relación de la mortalidad infantil con la altura geográfica en el Noroeste Argentino.

INTRODUCTION: Given its location on the Andes, the Northwest region of Argentina is geographically, socioeconomically, culturally, and biologically heterogeneous, and this is reflected on an infant mortality rate (IMR) that is higher than in any other Argentine region. OBJETIVE: To estimate IMR, neonatal mortality rate (NMR), and post-neonatal mortality rate (PNMR), and to analyze their spatial and temporal variations using secular trends and the relative risk based on altitudinal zones. POPULATION AND METHOD: This was a retrospective, descriptive, correlational study based on birth and death data recorded in the Northwest region of Argentina (1998-2010); IMR, NMR, PNMR, secular trends, and the relative risk of death were calculated by district and altitudinal zone (districts at < 2000 meters above sea level, lowlands; at > 2000 meters above sea level, highlands) by means of a cluster analysis. RESULTS AND CONCLUSIONS: Rates were higher in the highlands; IMR was 29.8%o (versus 15.6%o in the lowlands); PNMR was 17.7% in the highlands (versus 5.2% in the lowlands). In the highlands, there was an annual average reduction of 3.9% in IMR and of 4.1% in PNMR; in the lowlands, such reduction was of 7.0% in IMR and of 9.3% in PNMR. The relative risk of IMR and PNMR was significantly higher at high-altitude zones. NMR, its secular trend, and the relative risk did not show statistically significant differences between both altitudinal zones.

INTRODUCCIÓN: Por su localización sobre los Andes, el Noroeste Argentino presenta una heterogeneidad geográfica, socioeconómica, cultural y biológica reflejada en tasas de mortalidad infantil (TMI) superiores a casi todas las regiones argentinas. OBJETIVO: Calcular la TMI, tasa de mortalidad neonatal (TMN) y la tasa de mortalidad posneonatal (TMP) para analizar su variación temporal y espacial, a través de la tendencia secular y el riesgo relativo de acuerdo con el nivel altitudinal. POBLACIÓN Y MÉTODO: En un estudio retrospectivo, descriptivo y de correlación basado en datos de nacimientos y defunciones infantiles sucedidos en el Noroeste Argentino (1998-2010), se calcularon por departamentos y nivel altitudinal (departamentos a < 2000metros sobre el nivel del mar, tierras bajas y > 2000 msnm, tierras altas) TMI, TMN y TMP, tendencia secular y riesgo relativo de muerte, realizando un análisis de agrupamiento. RESULTADOS Y CONCLUSIONES: Las tasas fueron más elevadas en tierras altas, la TMI fue de 29,8%o (en tierras bajas, 15,6%); la TMP en tierras altas fue de 17,7% y 5,2% en tierras bajas. Las tierras altas mostraron un descenso promedio anual del 3,9% para la TMI y del 4,1% para la TMP; en tierras bajas, el descenso fue de 7,0% para la TMI y del 9,3% para la TMP. El riesgo relativo fue significativamente mayor a grandes alturas para TMI y TMP. La TMN, su tendencia secular y riesgo relativo no mostraron diferencias estadísticamente significativas entre niveles de altura.

[Spatial and temporal analysis of infant mortality from microcephaly in Argentina (1998-2012)]. / Analisis temporal y espacial de las muertes infantiles por microcefalia en Argentina (1998-2012).

Due to the increase in cases of microcephaly caused by Zika virus in Brazil, the Ministry of Health of Argentina recommends increasing surveillance of this malformation. In order to deepen the knowledge of the epidemiological behavior of microcephaly in the country, infant mortality by microcephaly is analyzed between 1998 and 2012. The data come from the Direction of Statistics and Health Information (DEIS). The infant mortality rate by microcephaly (IMR-M) was calculated by provinces and regions and a clustering analysis was performed at the departmental level. The highest rates were observed in the regions and provinces of the north of the country. The spatial distribution of IMR-M is related to the prevalence of microcephaly in newborns. This distribution is related to the greater poverty and consanguinity of the north of Argentina, synergic factors predisposing to the occurrence of congenital malformations in general and microcephaly in particular.

Debido al incremento de casos de microcefalia por virus Zika en Brasil el Ministerio de Salud de Argentina recomienda incrementar la vigilancia de esta malformación. A fin de profundizar el conocimiento del comportamiento epidemiológico de microcefalia en el país se analiza la mortalidad infantil por microcefalia entre 1998-2012. Los datos proceden de la Dirección de Estadísticas e Información de Salud (DEIS). Se calculó por provincias y regiones la tasa de mortalidad infantil por microcefalia (TMI-M) y se realizó un análisis de agrupamiento a nivel departamental. Las tasas más elevadas se observaron en las regiones y provincias del norte del país. La distribución espacial de la TMI-M guarda relación con las prevalencias de microcefalia en recién nacidos. Esta distribución se relaciona con la mayor pobreza y consanguinidad del norte de la Argentina, factores sinérgicos predisponentes de la ocurrencia de malformaciones congénitas en general y de microcefalia en particular.

Biosocial correlates and spatial distribution of consanguinity in South America.

OBJECTIVE: To analyze potential biosocial factors in consanguineous unions according to the level of consanguinity and its spatial distribution in South America. METHODS: The data used came from the Latin American Collaborative Study of Congenital Malformations. Information on 126,213 nonmalformed newborns out of 6,014,749 births was used. This information was collected between 1967 and 2011 at 204 hospitals in 116 cities in 10 South American countries. The spatial scan statistic was performed under a model of nonhierarchical k-means segmentation, based on statistically significant clusters, areas with levels of high, medium, and low consanguinity were determined. RESULTS: Consanguinity in South America is heterogeneously distributed, with two groups of high consanguinity, in northwestern Venezuela and southeast of Brazil, and two clusters of low consanguinity located in the south of the continent, mainly Argentina. The socio-demographic factors associated with consanguinity influence the population structure in areas of high consanguinity. CONCLUSIONS: This study demonstrates that consanguinity in the South American continent is strongly associated with a greater magnitude of poverty in the area of high consanguinity. Am. J. Hum. Biol. 28:405-411, 2016. © 2015 Wiley Periodicals, Inc.

Mortalidad infantil por malformaciones congénitas en Chile: análisis temporal y espacial, 1997–2011 / Infant mortality from congenital malformations in Chile: temporal and spatial analysis, 1997–2011

Objetivo. Analizar la distribución espacial y temporal (1997–2011) de la mortalidad infantile por malformaciones congénitas (MC) en Chile. Métodos. Los datos de nacimientos y muertes en menores de 1 año de edad codificados con la CIE-10 se obtuvieron del Instituto Nacional de Estadísticas. Para las regiones administrativas y las naturales (Norte Grande, Norte Chico, Central, Austral y Sur), sistemas (nervioso, cardiovascular, digestivo, genitourinario, musculo esquelético, anomalías cromosómicas) y 28 malformaciones específicas, se estimaron el porcentaje de muertes por MC (PM-MC) y la tasa de mortalidad infantil por MC (TMI-MC) en 3 períodos (1997–2001, 2002–2009, 2007–2011). La tendencia secular y la variación del riesgo de muerte se estimaron con un modelo de regression de Poisson. Resultados. Para todo Chile, la tendencia secular de la TMI-MC y el PM-MC fueron negative y positiva, respectivamente (P < 0,01). La TMI-MC y el PM-MC exhibieron una heterogeneidad espacial discreta en las regiones administrativas y naturales. La región natural que más se acercó al patrón nacional fue la Central. La tendencia secular de la TMI-MC de los sistemas nervioso y cardíaco y de algunas MC específicas (anencefalia, espina bífida, y comunicaciones interauricular e interventricular) fue negativa. El patrón de mortalidad infantil por MC para todo Chile se caracteriza por presentar en el período 1997–2011 un descenso de la TMI-MC y un aumento del PM-MC. Conclusiones. Los resultados indican que Chile se encuentra en un estadio avanzado de la transición epidemiológica de las causas de mortalidad infantil. Sin embargo, se observan disparidades interregionales de estos indicadores, más notorias en el sur del país.

Objective. To analyze the spatial and temporal distribution (1997–2011) of infant mortality resulting from congenital malformations (CM) in Chile. Methods. Data on births and deaths among infants aged less than one year using ICD-10 coding were obtained from the National Statistics Institute. The percentage of deaths from CM (PD-CM) and the infant mortality rate from CM (IMR-CM) during three different periods (1997–2001, 2002–2009, 2007–2011) were estimated for Chile’s administrative and natural regions (Norte Grande, Norte Chico, Central, Austral, and Sur), broken down by systems (nervous, cardiovascular, digestive, genitourinary, musculoskeletal, and chromosomal abnormalities) and by 28 specific malformations. The secular trend and the variation in the risk of death were estimated using a Poisson regression model. Results. For the whole of Chile, the secular trend for the IMR-CM was negative, and the secular trend for the PD-CM was positive (P < 0,01). The IMR-CM and the PD-CM both showed mild spatial heterogeneity in all administrative and natural regions. The Central region was the natural region that came closest to showing the pattern observed nationwide. The IMR-CM involving the nervous and cardiovascular systems and specific types of CM (anencephaly, spina bifida, and atrial and ventricular septal defects) showed a negative secular trend. For Chile as a whole, the pattern of infant mortality from CM is marked by a drop in the IMR-CM and by an increase in the PD-CM over the period from 1997 to 2011. Conclusion. The findings suggest that Chile is in the latter stages of the epidemiological transition with respect to the causes of infant mortality. However, these indicators show disparities between regions, more pronounced in the south of the country.

Mortalidad infantil por malformaciones congénitas en Chile: análisis temporal y espacial, 1997-2011 / Infant mortality from congenital malformations in Chile: temporal and spatial analysis, 1997-2011

OBJETIVO:Analizar la distribución espacial y temporal (1997-2011) de la mortalidad infantil por malformaciones congénitas (MC) en Chile. MÉTODOS: Los datos de nacimientos y muertes en menores de 1 año de edad codificados con la CIE-10 se obtuvieron del Instituto Nacional de Estadísticas. Para las regiones administrativas y las naturales (Norte Grande, Norte Chico, Central, Austral y Sur), sistemas (nervioso, cardiovascular, digestivo, genitourinario, musculo esquelético, anomalías cromosómicas) y 28 malformaciones específicas, se estimaron el porcentaje de muertes por MC (PM-MC) y la tasa de mortalidad infantil por MC (TMI-MC) en 3 períodos (1997-2001, 2002-2009, 2007-2011). La tendencia secular y la variación del riesgo de muerte se estimaron con un modelo de regresión de Poisson. RESULTADOS: Para todo Chile, la tendencia secular de la TMI-MC y el PM-MC fueron negativa y positiva, respectivamente (P < 0,01). La TMI-MC y el PM-MC exhibieron una heterogeneidad espacial discreta en las regiones administrativas y naturales. La región natural que más se acercó al patrón nacional fue la Central. La tendencia secular de la TMI-MC de los sistemas nervioso y cardíaco y de algunas MC específicas (anencefalia, espina bífida, y comunicaciones interauricular e interventricular) fue negativa. El patrón de mortalidad infantil por MC para todo Chile se caracteriza por presentar en el período 1997-2011 un descenso de la TMI-MC y un aumento del PM-MC. CONCLUSIONES: Los resultados indican que Chile se encuentra en un estadio avanzado de la transición epidemiológica de las causas de mortalidad infantil. Sin embargo, se observan disparidades interregionales de estos indicadores, más notorias en el sur del país.

OBJECTIVE: To analyze the spatial and temporal distribution (1997-2011) of infant mortality resulting from congenital malformations (CM) in Chile. METHODS: Data on births and deaths among infants aged less than one year using ICD-10 coding were obtained from the National Statistics Institute. The percentage of deaths from CM (PD-CM) and the infant mortality rate from CM (IMR-CM) during three different periods (1997-2001, 2002-2009, 2007-2011) were estimated for Chile's administrative and natural regions (Norte Grande, Norte Chico, Central, Austral, and Sur), broken down by systems (nervous, cardiovascular, digestive, genitourinary, musculoskeletal, and chromosomal abnormalities) and by 28 specific malformations. The secular trend and the variation in the risk of death were estimated using a Poisson regression model. RESULTS: For the whole of Chile, the secular trend for the IMR-CM was negative, and the secular trend for the PD-CM was positive (P < 0,01). The IMR-CM and the PD-CM both showed mild spatial heterogeneity in all administrative and natural regions. The Central region was the natural region that came closest to showing the pattern observed nationwide. The IMR-CM involving the nervous and cardiovascular systems and specific types of CM (anencephaly, spina bifida, and atrial and ventricular septal defects) showed a negative secular trend. For Chile as a whole, the pattern of infant mortality from CM is marked by a drop in the IMR-CM and by an increase in the PD-CM over the period from 1997 to 2011. CONCLUSION: The findings suggest that Chile is in the latter stages of the epidemiological transition with respect to the causes of infant mortality. However, these indicators show disparities between regions, more pronounced in the south of the country.

[Infant mortality from congenital malformations in Chile: temporal and spatial analysis, 1997-2011]. / Mortalidad infantil por malformaciones congénitas en Chile: análisis temporal y espacial, 1997-2011.

OBJECTIVE: To analyze the spatial and temporal distribution (1997-2011) of infant mortality resulting from congenital malformations (CM) in Chile. METHODS: Data on births and deaths among infants aged less than one year using ICD-10 coding were obtained from the National Statistics Institute. The percentage of deaths from CM (PD-CM) and the infant mortality rate from CM (IMR-CM) during three different periods (1997-2001, 2002-2009, 2007-2011) were estimated for Chile's administrative and natural regions (Norte Grande, Norte Chico, Central, Austral, and Sur), broken down by systems (nervous, cardiovascular, digestive, genitourinary, musculoskeletal, and chromosomal abnormalities) and by 28 specific malformations. The secular trend and the variation in the risk of death were estimated using a Poisson regression model. RESULTS: For the whole of Chile, the secular trend for the IMR-CM was negative, and the secular trend for the PD-CM was positive (P < 0,01). The IMR-CM and the PD-CM both showed mild spatial heterogeneity in all administrative and natural regions. The Central region was the natural region that came closest to showing the pattern observed nationwide. The IMR-CM involving the nervous and cardiovascular systems and specific types of CM (anencephaly, spina bifida, and atrial and ventricular septal defects) showed a negative secular trend. For Chile as a whole, the pattern of infant mortality from CM is marked by a drop in the IMR-CM and by an increase in the PD-CM over the period from 1997 to 2011. CONCLUSION: The findings suggest that Chile is in the latter stages of the epidemiological transition with respect to the causes of infant mortality. However, these indicators show disparities between regions, more pronounced in the south of the country.

Random inbreeding, isonymy, and population isolates in Argentina.

Population isolates are an important tool in identifying and mapping genes of Mendelian diseases and complex traits. The geographical identification of isolates represents a priority from a genetic and health care standpoint. The purpose of this study is to analyze the spatial distribution of consanguinity by random isonymy (F ST) in Argentina and its relationship with the isolates previously identified in the country. F ST was estimated from the surname distribution of 22.6 million electors registered for the year 2001 in the 24 provinces, 5 geographical regions, and 510 departments of the country. Statistically significant spatial clustering of F ST was determined using the SaTScan V5.1 software. F ST exhibited a marked regional and departamental variation, showing the highest values towards the North and West of Argentina. The clusters of high consanguinity by random isonymy followed the same distribution. Recognized Argentinean genetic isolates are mainly localized at the north of the country, in clusters of high inbreeding. Given the availability of listings of surnames in high-capacity storage devices for different countries, estimating F ST from them can provide information on inbreeding for all levels of administrative subdivisions, to be used as a demographic variable for the identification of isolates within the country for public health purposes.