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. 2022 Oct 23;19(21):13769.
doi: 10.3390/ijerph192113769.

Epidemiological Patterns of Cannabis- and Substance- Related Congenital Uronephrological Anomalies in Europe: Geospatiotemporal and Causal Inferential Study

Albert Stuart Reece  1   2 , Gary Kenneth Hulse  1   2
Affiliations

Epidemiological Patterns of Cannabis- and Substance- Related Congenital Uronephrological Anomalies in Europe: Geospatiotemporal and Causal Inferential Study

Albert Stuart Reece et al. Int J Environ Res Public Health. .

Abstract

Introduction: Recent reports linking prenatal and community cannabis exposure to elevated uronephrological congenital anomaly (UCA) rates (UCAR's) raise the question of its European epidemiology given recent increases in community cannabinoid penetration there.

Methods: UCAR data from Eurocat. Drug use data from European Monitoring Centre for Drugs and Drug Addiction. Income from World bank.

Results: UCAR increased across Spain, Netherlands, Poland and France. UCAR's and cannabis resin THC increased simultaneously in France, Spain, Netherlands and Bulgaria. At bivariate analysis all UCA's were related to cannabis herb and resin THC concentrations. All UCAR's were bivariately related to cannabis metrics ordered by median minimum E-value (mEV) as hypospadias > multicystic renal disease > bilateral renal agenesis > UCA's > hydronephrosis > posterior urethral valve > bladder exstrophy/epispadias. At inverse probability weighted multivariable analysis terms including cannabis were significant for the following series of anomalies: UCA's, multicystic renal disease, bilateral renal agenesis, hydronephrosis, congenital posterior urethral valves from P = 1.91 × 10-5, 2.61 × 10-8, 4.60 × 10-15, 4.60 × 10-15 and 2.66 × 10-10. At geospatial analysis the same series of UCA's were significantly related to cannabis from P = 7.84 × 10-15, 7.72 × 10-5, 0.0023, 6.95 × 10-5, and 8.82 × 10-5. 45/51 (88.2%) of E-value estimates and 31/51 (60.8%) of mEV's >9.

Conclusion: Analysis confirms a close relationship between cannabis metrics and all seven UCA's and fulfill formal criteria for quantitative causal inference. Given the exponential cannabinoid genotoxicity dose-response relationship results provide a powerful stimulus to constrain community cannabinoid exposure including protection of the food chain to preserve the genome and epigenome of coming generations.

Keywords: alcohol; cancer; cancerogenesis; cannabinoid; cannabis; epigenotoxicity; genotoxicity; mutagenesis; oncogenesis; tobacco; transgenerational inheritance.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 2
Figure 2
Bivariate plots of selected uronephrological congenital anomalies against various metrics of cannabis exposure.
Figure 3
Figure 3
Time sequential map-graph of log (uronephrological anomaly rate) across surveyed European nations over time.
Figure 4
Figure 4
Time sequential map-graph of log (bilateral renal agenesis anomaly rate) across surveyed European nations over time.
Figure 5
Figure 5
Time sequential map-graph of log (congenital posterior urethral valve rate) across surveyed European nations over time.
Figure 6
Figure 6
Time sequential map-graph of log (Multicystic renal disease rate) across surveyed European nations over time.
Figure 7
Figure 7
Time sequential map-graph of last month cannabis use: cannabis resin THC concentration across surveyed European nations over time.
Figure 8
Figure 8
Colorplane bivariate time sequential map-graph of log (uronephrological congenital anomaly rate) by last month cannabis use: cannabis resin THC concentration across surveyed European nations over time.
Figure 9
Figure 9
Colorplane bivariate time sequential map-graph of log (bilateral renal agenesis congenital anomaly rate) by last month cannabis use: cannabis resin THC concentration across surveyed European nations over time.
Figure 10
Figure 10
Colorplane bivariate time sequential map-graph of log (posterior urethral valve congenital anomaly rate) by last month cannabis use: cannabis resin THC concentration across surveyed European nations over time.
Figure 11
Figure 11
Colorplane bivariate time sequential map-graph of log (multicystic renal disease congenital anomaly rate) by last month cannabis use: cannabis resin THC concentration across surveyed European nations over time.
Figure 12
Figure 12
Overall rate of log (uronephrolgical congenital anomaly rate) against time by rising of falling daily cannabis use rates (see Methods section for country classification).
Figure 13
Figure 13
Rate of log (uronephrological congenital anomaly rate) against time by rising of falling daily cannabis use rates by congenital anomaly.
Figure 1
Figure 1
Bivariate plots of selected uronephrological congenital anomalies against various substances.
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References

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