Utilizing geographic information system (GIS) and statistical analysis to assess the relationship between the built environment and gastroschisis in the Inland Empire Region of Southern California

Background: Gastroschisis, the most common congenital birth defect of the abdominal wall, is increasing in incidence on both a local and global scale. Purpose: The pathogenesis of gastroschisis remains unknown, but investigating the geographic distribution of this birth defect can be useful in exploratory etiologic research. Elucidating prenatal predictors of gastroschisis is key to improving diagnosis. Methods: A retrospective chart review was performed on gastroschisis cases (n= 257) in order to determine rates during a ­14 year time period (1998- 2012) in the Inland Empire Region of Southern California. GIS was used to determine if geographic clustering was present utilizing zip codes from maternal residence. Results: Spatial analysis shows possible geographic clustering surrounding major transportation routes, suggesting environmental or chemical contaminants contributing to increased gastroschisis cases. Discussion: This study demonstrates the usefulness of the spatial scan statistics in exploratory etiologic research and can potentially lead to earlier prenatal diagnosis, improved clinical care, decreased morbidity, and potential to reduce the health disparity. Further study should be directed at specific geographic data and determining spatial-temporal association between gastroschisis case clusters and environmental toxins from archived EPA voluntary sites, Superfund sites, and current industries reporting permitted emission releases (air, soil, and water). Additionally, this contributes towards achieving the Millennium Development Goals for reducing child mortality rates and improving maternal health by 2015, by deepening our understanding of contributing risk factors linked to this birth defect through the use of geoinformation technology.