Arch Dis Child 2000;82:349-352 ( May )

Article

Socioeconomic inequalities in risk of congenital anomaly M Vrijheid^a, H Dolk^a, D Stone^b, L Abramsky^c, E Alberman^d, J E S Scott^e

^a Environmental Epidemiology Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK, ^b Glasgow Eurocat Register, Paediatric Epidemiology and Community Health Unit, Department of Child Health, University of Glasgow, Scotland, UK, ^c North Thames (West) Congenital Malformation Register, Department of Medical and Community Genetics, Imperial School of Medicine, Northwick Park Hospital, Harrow, UK, ^d National Downs Syndrome Cytogenetic Register, The Wolfson Institute of Preventive Medicine, St Bartholomew's and the Royal School of Medicine and Dentistry, London, UK, ^e Northern Congenital Abnormality Survey, Maternity Survey Office, University of Newcastle-upon-Tyne, UK

Correspondence to: Ms Vrijheid email: mvrijheid{at}lshtm.ac.uk

Accepted 4 February 2000

AIMSTo investigate socioeconomic inequalities in the risk of congenital anomalies, focusing on risk of specific anomaly subgroups.
METHODSA total of 858 cases of congenital anomaly and 1764 non-malformed control births were collected between 1986 and 1993 from four UK congenital malformation registers, for the purposes of a European multicentre case control study on congenital anomaly risk near hazardous waste landfill sites. As a measure of socioeconomic status, cases and controls were given a value for the area level Carstairs deprivation index, by linking the postcode of residence at birth to census enumeration districts (areas of approximately 150 households).
RESULTSRisk of non-chromosomal anomalies increased with increasing socioeconomic deprivation. The risk in the most deprived quintile of the deprivation index was 40% higher than in the most affluent quintile. Some malformation subgroups also showed increasing risk with increasing deprivation: all cardiac defects, malformations of the cardiac septa, malformations of the digestive system, and multiple malformations. No evidence for socioeconomic variation was found for other non-chromosomal malformation groups, including neural tube defects and oral clefts. A decreasing risk with increasing deprivation found for all chromosomal malformations and Down's syndrome in unadjusted analyses, occurred mainly as a result of differences in the maternal age distribution between social classes.
CONCLUSIONOur data, although based on limited numbers of cases and geographical coverage, suggest that more deprived populations have a higher risk of congenital anomalies of non-chromosomal origin and some specific anomalies. Larger studies are needed to confirm these findings and to explore their aetiological implications.


Keywords: congenital anomaly; inequalities; social class; deprivation

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© 2000 by Archives of Disease in Childhood
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