Congenital Abnormalities in Greece

Congenital AbnormalitiesCongenital Abnormalities

in Greecein Greece

Functional Functional evaluation of evaluation of statistical datastatistical data

Emmanuel Brilakis, Medical DoctorEmmanuel Brilakis, Medical DoctorEvangelos Fousteris, Medical DoctorEvangelos Fousteris, Medical DoctorJannis Papadopulos, Ass. ProfessorJannis Papadopulos, Ass. Professor

Medical School of Athens UniversityMedical School of Athens University

EpidemiologyEpidemiology

Affects 3 – 4 % of all live birthsAffects 3 – 4 % of all live births Causes many elective or spontaneous Causes many elective or spontaneous

abortionsabortions 15 – 30 % of all pediatric 15 – 30 % of all pediatric

hospitalizationshospitalizations Significant burden to families & societySignificant burden to families & society

CausalCausal Factors Factors

Genetic factorsGenetic factors Environmental factorsEnvironmental factors Lifestyle factorsLifestyle factors

50 – 60 % cannot be attributed in 50 – 60 % cannot be attributed in known causes known causes

Multifactorial Multifactorial EtiologyEtiology

ObjectiveObjective

To record the regional distribution of mortality To record the regional distribution of mortality and hospitalization caused by congenital and hospitalization caused by congenital abnormalities in Greeceabnormalities in Greece

To compare the mortality and infantile To compare the mortality and infantile mortality by congenital abnormalities between mortality by congenital abnormalities between Greece and other countriesGreece and other countries

To evaluate the existence of local factors that To evaluate the existence of local factors that may be involved in the generation of the may be involved in the generation of the problemproblem

Material and MethodsMaterial and Methods

• Monthly Statistical Bulletin

• Statistics of Population’s Physical Movement

• Annual Statistical Yearbook of Greece

• Annuals

National Statistical Service of GreeceNational Statistical Service of Greece

World Health OrganizationWorld Health Organization

Specific infantile mortality index by Specific infantile mortality index by congenital abnormalities per 1.000 live congenital abnormalities per 1.000 live

birthsbirths

YearYear GreeceGreece U.S.AU.S.A..

BulgariaBulgaria FrancFrancee

ItalyItalyTheThe

Nether-Nether-landslands

PortugalPortugal SwedeSwedenn

JapanJapan

19811981 4,84

19821982 4,77

19831983 4,65 3,09

19841984 4,44 2,33 3,04

19851985 4,57 2,28 3,80 1,79 2,71 2,67

19861986 3,37 2,19 3,50 1,67 2,45 2,52 3,08 1,68

19871987 3,66 2,07 3,60 1,73 2,61 2,74 3,35 2,23 1,65

19881988 3,49 2,08 3,60 1,54 2,46 2,34 2,89 1,95 1,68

19891989 3,26 2,01 3,73 1,53 2,36 2,15 3,10 2,16 1,65

19901990 4,83 1,98 1,48 2,04 2,40 2,83 2,04 1,66

19911991 4,46 1,87 1,36 1,97 2,26 2,71 2,16 1,60

19921992 4,81 1,83 1,25 2,00 2,40 2,60 1,82 1,69

19931993 3,40 1,78 1,42 2,17 2,30 2,58 1,66 1,54

19941994 3,19 1,73 1,32 1,94 2,11 2,55 1,67 1,47

19951995 3,03 1,85 2,22


birthsbirths

0,00

1,00

2,00

3,00

4,00

5,00

6,00

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95 0,00

1,00

2,00

3,00

4,00

5,00

6,00

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

0,00

1,00

2,00

3,00

4,00

5,00

6,00

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

0,00

1,00

2,00

3,00

4,00

5,00

6,00

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

BULGARIA

ITALY

GREECE

GREECEGREECE

GREECE

U.S.A.

FRANCE

JAPANTHE NETHERLANDS

SWEDENPORTUGAL

0,00

1,00

2,00

3,00

4,00

5,00

6,00

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95 0,00

1,00

2,00

3,00

4,00

5,00

6,00

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

0,00

1,00

2,00

3,00

4,00

5,00

6,00

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

0,00

1,00

2,00

3,00

4,00

5,00

6,00

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

BULGARIA

ITALY

GREECE

GREECEGREECE

GREECE

U.S.A.

FRANCE

JAPANTHE NETHERLANDS

SWEDENPORTUGAL


birthsbirths

Percentage of decrease of specific infantile Percentage of decrease of specific infantile mortality index by congenital abnormalities per mortality index by congenital abnormalities per

1.000 live births for each country between 1987 and 1.000 live births for each country between 1987 and 19941994

13%

16%

24%26%

23%24%

25%

11%

Gre

ece

U.S

.A.

Bu

lgari

a

Fra

nce

Italy

Th

e N

eth

erl

an

ds

Port

ugal

Sw

eden

Japan

Perc

en

tage o

f decr

ease

Perc

en

tage o

f decr

ease

* * Data not available for all this periodData not available for all this period

**

Percentage of decrease of specific infantile Percentage of decrease of specific infantile mortality index by congenital abnormalities per mortality index by congenital abnormalities per

1.000 live births for each country between 1987 and 1.000 live births for each country between 1987 and 19941994

13%

16%

24%26%

23%24%

25%

11%

Gre

ece

U.S

.A.

Bu

lgari

a

Fra

nce

Italy

Th

e N

eth

erl

an

ds

Port

ugal

Sw

eden

Japan

Perc

en

tage o

f decr

ease

Perc

en

tage o

f decr

ease

**

* * Data not available for all this periodData not available for all this period

MAP OF GREECEMAP OF GREECE

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Specific infantile mortality index by congenital Specific infantile mortality index by congenital abnormalities per 1.000 live birthsabnormalities per 1.000 live births

in Greece in Greece &&

Specific mortality index by congenital abnormalities Specific mortality index by congenital abnormalities per 100.000 of population in Greeceper 100.000 of population in Greece

0

2

4

6

8

10

12

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

Specific infantile mortality indexper 1.000 live births

0

2

4

6

8

10

12

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

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1995

Specific infantile mortality index by congenital Specific infantile mortality index by congenital abnormalities per 1.000 live birthsabnormalities per 1.000 live births

in Greece in Greece &&

Specific mortality index by congenital abnormalities Specific mortality index by congenital abnormalities per 100.000 of population in Greeceper 100.000 of population in Greece

Specific infantile mortality indexper 1.000 live births

Specific mortality indexper 100.000 of population

Percentage of deaths by congenital Percentage of deaths by congenital abnormalities in Greece from 1981 to 1995 abnormalities in Greece from 1981 to 1995

per age of deathper age of death

till 365days old

1–2 yearsold

3–4yearsold

5–19yearsold

20–49yearsold

>50yearsold

80%

3% 4%

10%

2% 1%

1981–1987 & 1989-1995

1988

Congenital abnormalities in Greece Congenital abnormalities in Greece from 1981 to 1995 per category of from 1981 to 1995 per category of

congenital abnormalitycongenital abnormality

Congenital abnormalities of heart & circulatory system 46.075 25%

Undescended testicles 29.826 16%

Other congenital abnormalities of musculoskeletal system 22.033 12%

Other deformities of digestive system 13.747 7%

Congenital dislocation of hip 9.200 5%

Spina bifida & hydrocephalus 4.591 3%

Cleft palate & cleft lip 4.358 2%

Other deformities of C.N.S. 2.971 2%

Other congenital abnormalities 50.516 28%

Specific mortality index by congenital Specific mortality index by congenital abnormalities per 100.000 of population per abnormalities per 100.000 of population per

geographic department of Greece from 1981 to geographic department of Greece from 1981 to 19951995

YearGreate

r Athens

Rest of central Greece & Evia

Pelopon-nesus

Ionian sea

islandsIpiros

Thessaly

Macedonia

Thrace

Aegean sea

islandsCrete

1981

10,65 7,45 6,31 6,58 6,48 7,62 7,70 9,97 7,48 4,38

1982

11,11 5,48 6,74 6,01 5,54 8,39 5,97 10,96 4,42 6,72

1983

8,70 5,95 6,58 4,36 9,82 5,07 6,79 9,88 7,66 8,84

1984

8,08 6,06 5,85 3,80 6,43 6,98 6,72 6,66 5,0910,5

4

1985

8,58 5,05 5,71 6,50 5,80 6,78 6,32 8,88 7,63 2,72

1986

6,52 4,41 4,36 3,79 4,27 2,48 4,26 7,69 5,54 4,06

1987

7,47 3,43 4,92 3,24 4,57 3,98 3,88 7,06 5,52 5,96

1988

10,68 7,94 10,30 12,95 7,90 6,31 9,56 10,09 11,9310,8

8

1989

5,10 2,54 4,16 2,68 3,65 4,66 4,02 7,32 2,73 5,29

1990

7,03 4,68 4,58 3,19 3,30 6,02 6,42 10,07 5,20 5,42

1991

6,96 4,07 4,21 4,19 6,15 3,67 4,96 6,73 4,49 6,10

1992

7,23 3,98 5,12 4,14 5,73 5,01 5,75 9,52 5,14 5,50

1993

4,96 2,88 4,06 2,56 5,05 4,05 4,42 6,79 2,90 5,83

1994

4,37 3,43 3,84 2,54 3,60 2,56 4,09 9,27 3,78 3,45

1995

3,75 2,90 3,19 3,54 4,39 3,91 3,12 7,43 5,32 4,86

Diff. -65% -61% -49% -46% -32% -49% -59% -25% -29% 11%

Discharged patients with congenital abnormalities Discharged patients with congenital abnormalities per 100.000 of population per geographic per 100.000 of population per geographic department of Greece from 1981 to 1995department of Greece from 1981 to 1995

YearGreater Athens

Rest of central Greece & Evia

Pelopon-nesus

Ionian sea

islandsIpiros

Thessaly

Macedonia

Thrace

Aegean sea

islands

Crete

1981

142 98 101 89 75 93 92 77 97 116

1982

151 91 111 83 96 102 95 83 87 125

1983

133 108 104 142 103 104 99 91 130 129

1984

122 81 91 81 93 87 94 95 84 102

1985

117 86 96 82 86 85 98 93 93 99

1986

139 88 95 87 108 95 96 92 95 121

1987

132 82 94 101 108 74 95 94 84 139

1988

119 85 86 86 115 91 93 98 88 124

1989

117 92 105 96 109 93 112 114 93 144

1990

115 96 100 102 109 96 106 110 99 113

1991

116 79 95 101 103 89 114 98 91 118

1992

124 86 94 90 85 94 118 102 100 123

1993

131 82 92 112 70 91 115 117 100 129

1994

127 85 95 111 98 92 115 117 102 138

1995

128 68 79 84 77 82 110 93 85 112

Diff. -10% -31% -22% -5% 3% -11% 20% 21% -12% -4%

Problematic areasProblematic areas

ThraceThrace

greater greater AthensAthens

CreteCrete

Deaths and discharged patients due to Deaths and discharged patients due to congenital abnormalities in congenital abnormalities in ATHENSATHENS from from

1981 to 19951981 to 1995

ATHENSATHENS

81 83 85 87 89 91 93 95

2

6

10

GREECEGREECE

DEATHSDEATHS

DISCHARGED PATIENTSDISCHARGED PATIENTS

81 83 85 87 89 91 93 95

20

80

140

GREECEGREECE

ATHENSATHENS

Deaths and discharged patients due to Deaths and discharged patients due to congenital abnormalities in congenital abnormalities in CRETECRETE from from

1981 to 19951981 to 1995

81 83 85 87 89 91 93

DEATHSDEATHS


81 83 85 87 89 91 93 95

GREECEGREECE

CRETECRETE

20

80

140

95

2

6

10

CRETECRETE GREECEGREECE

Deaths and discharged patients due to Deaths and discharged patients due to congenital abnormalities in congenital abnormalities in THRACETHRACE from from

1981 to 19951981 to 1995

81 83 85 87 89 91 93

DEATHSDEATHS


81 83 85 87 89 91 93 95

GREECEGREECETHRACETHRACE

20

80

140

95

2

6

10

GREECEGREECE

THRACETHRACE

GREECEGREECE

Average annual specific mortality index by Average annual specific mortality index by congenital abnormalities per 100.000 of congenital abnormalities per 100.000 of

population in geographic regions of Greece population in geographic regions of Greece for time period 1981 – 1995for time period 1981 – 1995

7,30

4,80

5,37

4,71

5,61

5,12

5,63

8,61

5,67 6,06 6,09

0

1

2

3

4

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7

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““Average annual specific index” of Average annual specific index” of discharged patients with congenital discharged patients with congenital

abnormalities per 100.000 of population in abnormalities per 100.000 of population in geographic regions of Greece for time geographic regions of Greece for time

period 1981 – 1995period 1981 – 1995

126

9097 97

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““Average annual specific index” of Average annual specific index” of discharged patients with congenital discharged patients with congenital

abnormalities per 100.000 of population in abnormalities per 100.000 of population in geographic regions of Greece for time geographic regions of Greece for time

period 1981 – 1995period 1981 – 1995

““Percentage of deaths/ discharged Percentage of deaths/ discharged patients” with congenital abnormalities in patients” with congenital abnormalities in

geographic regions of Greece for time geographic regions of Greece for time period 1981 – 1995period 1981 – 1995

5,83%

5,30% 5,53% 4,81%

5,76%5,63%

5,37%

8,74%

5,92%

4,92% 5,37%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

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ConclusionsConclusions

More deaths by congenital abnormalities are registered in Greece than in U.S.A., France, Italy, The Netherlands, Portugal, Sweden and Japan.

Greece’s infantile mortality index by congenital abnormalities presents the second lowest reduction between the selected countries in the under study period.

Many fluctuations are observed in the course of indexes concerning in mortality and hospitalization in Greece during 1981 to 1995. Significant disproportions are also revealed among the geographic departments of Greece. There are lots of peaks that need further investigation.

ConclusionsConclusions

We tried to isolate concrete factors responsible for the problem but the data available is not sufficient. Thus, we avoided to name causal factors because we only would be hypothetical. We should mention the need of planning specific epidemiological studies (perspective and retrospective) in order to approach the possible causes.

We propose the establishment of birth defects registration centres to evaluate genetic and environmental factors associated with the occurrence of congenital diseases.

Thank You !!!Thank You !!!

Congenital Abnormalities in Greece

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