the spatial distribution of known predictors of autism spectrum disorders impacts geographic variability in prevalence in central north carolina已知的空间分布预测的自闭症谱系障碍影响地理变异在北卡罗来纳州中部的患病率.pdfVIP

Hoffman et al. Environmental Health 2012, 11:80 /content/11/1/80 RESEARCH Open Access The spatial distribution of known predictors of autism spectrum disorders impacts geographic variability in prevalence in central North Carolina Kate Hoffman1*, Amy E Kalkbrenner1,2, Veronica M Vieira3,4 and Julie L Daniels1 Abstract Background: The causes of autism spectrum disorders (ASD) remain largely unknown and widely debated; however, evidence increasingly points to the importance of environmental exposures. A growing number of studies use geographic variability in ASD prevalence or exposure patterns to investigate the association between environmental factors and ASD. However, differences in the geographic distribution of established risk and predictive factors for ASD, such as maternal education or age, can interfere with investigations of ASD etiology. We evaluated geographic variability in the prevalence of ASD in central North Carolina and the impact of spatial confounding by known risk and predictive factors. Methods: Children meeting a standardized case definition for ASD at 8 years of age were identified through records-based surveillance for 8 counties biennially from 2002 to 2008 (n=532). Vital records were used to identify the underlying cohort (15% random sample of children born in the same years as children with an ASD, n=11,034), and to obtain birth addresses. We used generalized additive models (GAMs) to estimate the prevalence of ASD across the region by smoothing latitude and longitude. GAMs, unlike methods used in previous spatial analyses of ASD, allow for extensive adjustment of individual-level risk factors (e.g. maternal age and education) when evaluating spatial variability of disease prevalence. Results: Unadjusted maps revealed geographic variation in surveillance-recognized ASD. Chil