Dolk H, Busby A, Armstrong B G, Walls P H
Environmental Epidemiology Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
BMJ. 1998 Oct 3;317(7163):905-9; discussion 910. doi: 10.1136/bmj.317.7163.905.
To investigate the geographical variation and clustering of congenital anophthalmia and microphthalmia in England, in response to media reports of clusters.
Comparison of pattern of residence at birth of cases of anophthalmia and microphthalmia in England in 1988-94, notified to a special register, with pattern of residence of all births. Three groups studied included all cases, all severe cases, and all severe cases of unknown aetiology.
Prevalence rates of anophthalmia and microphthalmia by region and district, and by ward population density and socioeconomic deprivation index of enumeration district grouped into fifths. Clustering expressed as the tendency for the three nearest neighbours of a case to be more likely to be cases than expected by chance, or for there to be more cases within circles of fixed radius of a case than expected by chance.
The overall prevalence of anophthalmia and microphthalmia was 1.0 per 10 000 births. Regional and district variation in prevalence did not reach statistical significance. Prevalence was higher in rural than urban areas: the relative risk in the group of wards of lowest population density compared with the most densely populated group was 1.79 (95% confidence interval 1.15 to 2.81) for all cases and 2.37 (1.38 to 4. 08) for severe cases. There was no evidence of a trend in risk with socioeconomic deprivation. There was very little evidence of localised clustering.
There is very little evidence to support the presence of strongly localised environmental exposures causing clusters of children to be born with anophthalmia or microphthalmia. The excess risk in rural areas requires further investigation.
鉴于媒体对病例聚集现象的报道，调查英格兰先天性无眼畸形和小眼畸形的地理差异及聚集情况。
将1988 - 1994年英格兰上报至一个特殊登记处的无眼畸形和小眼畸形病例的出生居住地模式，与所有出生人口的居住地模式进行比较。研究的三组包括所有病例、所有重症病例以及所有病因不明的重症病例。
按地区和行政区划分，以及按病房人口密度和划分为五等份的枚举区社会经济剥夺指数，统计无眼畸形和小眼畸形的患病率。聚集性表现为病例的三个最近邻域比随机预期更有可能是病例，或者在病例固定半径范围内的病例数比随机预期更多。
无眼畸形和小眼畸形的总体患病率为每10000例出生中有1.0例。患病率的地区和行政区差异未达到统计学显著性。农村地区的患病率高于城市地区：与人口最密集组相比，人口密度最低组病房中的所有病例相对风险为1.79（95%置信区间1.15至2.81），重症病例为2.37（1.38至4.08）。没有证据表明风险随社会经济剥夺程度存在趋势。几乎没有证据表明存在局部聚集现象。
几乎没有证据支持存在强烈局部化的环境暴露导致儿童出生时患有无眼畸形或小眼畸形的聚集现象。农村地区的额外风险需要进一步调查。
