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Spatial epidemiology of indicators of male reproductive health in Scotland

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FarragherTM_2006redux.pdf (46.80Mb)
Date
2005
Author
Farragher, Tracey Marie
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Abstract
 
 
BACKGROUND In recent years there are a number of reports showing a deterioration in male reproductive health, i.e. diminished semen quality and increases in the incidence of testicular cancer and the congenital malformations cryptorchidism and hypospadias. It is hypothesised that these changes have been caused by increasing in utero exposure to environmental oestrogens and/or anti-androgens
 
OBJECTIVES (i) Describe the geographical distributions of three indicators of male reproductive health in Scotland (i.e. testicular cancer, cryptorchidism and hypospadias). (ii) Describe the conjoint geographical distribution of the three indicators specified in (i). (iii) Identify explanatory factors that might account for the geographical distribution of male reproductive health in Scotland.
 
METHODS An epidemiology study modelling the geographical distributions using routinely collected data of the three indicators. The primary assessment of the geographical distribution of the indicators was by means of the relative risks at postcode sector level. If geographically varying risk factors (environmental or not) are associated with these conditions then would expect to see clustering of relative risks. Bayesian methods were used to estimate the relative risks so as to account for their variability due to areas with small number of cases. These Bayesian models were developed further by including potential covariates to assess if these area specific factors explain the spatial variation of the three indicators. In addition, Bayesian modelling of individual data pertaining to the cryptorchidism cases was also carried out to explore whether the spatial variation in risk might also be explained by the nature of the cases within each postcode sector rather than area specific covariates. Finally, a Bayesian model which combined all three indicators was developed to examine the spatial relationships between the three disease/conditions.
 
RESULTS There are similarities in the spatial pattern of the cryptorchidism and hypospadias relative risks, with both conditions having clusters of high relative risks in the East and South-West of Scotland. The spatial variation of the testicular cancer relative risks is not similar to the other two conditions nor is it conclusive that it has a distinct spatial pattern. The relative risks of the postcode sectors for all the indicators are associated with radon measurements and the rural/urban indicator. The spatial analysis of individual information concerning the cryptorchidism cases indicate that the spatial variation of the relative risks might also be explained by individual information; namely maternal age and co-morbidity with hypospadias.
 
CONCLUSIONS There does appear to be geographically varying risk factors associated with these three conditions. Furthermore, as the spatial variation of cryptorchidism and hypospadias is similar it is likely that they have some common aetiology. As the same risk factors were found to be associated with testicular cancer and the congenital malformations, then this carcinoma appears to share some aetiology with cryptorchidism and hypospadias. Therefore there are geographically varying risk factors whose exposure occurs in utero, that are associated with all three conditions, providing some evidence to support the proposed hypothesis. Flowever, the common aetiology of these conditions could not only to be environmental but also due to genetic and life-style factors, that could pertain to the individual cases rather than the specific area. Therefore, further studies are required to investigate the associations between all the disease/conditions of male reproductive heath and the various potential risk factors.
 
URI
http://hdl.handle.net/1842/29096
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