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. 2024 May 1;7(5):e2410056.
doi: 10.1001/jamanetworkopen.2024.10056.

County-Level Atrazine Use and Gastroschisis

Sunaya R Krishnapura  1   2 , Elizabeth McNeer  2   3 , William D Dupont  2   3 , Stephen W Patrick  2   3   4   5
Affiliations

County-Level Atrazine Use and Gastroschisis

Sunaya R Krishnapura et al. JAMA Netw Open. .

Abstract

Importance: The incidence of gastroschisis, a birth defect involving the herniation of the small bowel through the abdominal wall, has increased in the US since the 1960s. The pesticide atrazine is a hypothesized cause of gastroschisis; however, examination of the association between atrazine and gastroschisis has been limited.

Objective: To evaluate national trends in gastroschisis incidence, maternal and infant characteristics associated with gastroschisis, and whether county-level atrazine use is associated with gastroschisis.

Design, setting, and participants: This retrospective, repeated cross-sectional study examined birth certificate data of all live births in the US and data on atrazine use from the US Geological Survey from January 1, 2009, through December 31, 2019. The data analysis was performed between August 5, 2021, and May 26, 2023.

Exposures: County-level atrazine use.

Main outcomes and measures: The primary outcome was gastroschisis incidence. Covariates included maternal age, race and ethnicity, body mass index (measured by weight in kilograms divided by height in meters squared), parity, insurance type, Chlamydia infection during pregnancy, smoking, and rurality. Mixed-effects logistic regression models (year fixed effects and county random effects) were constructed using different county-level atrazine exposure variables (1-, 5-, and 10-year means).

Results: Between 2009 and 2019, 39 282 566 live births were identified, with 10 527 infant diagnoses of gastroschisis. Infants with gastroschisis were more likely to have mothers who identified as non-Hispanic White (61% vs 54%; P < .001), had a lower body mass index (median [IQR], 23.4 [20.8-27.2] vs 25.4 [22.0-30.8]; P < .001), were more likely to be nulliparous (median [IQR], 0 [0-1] vs 1 [0-2]; P < .001), and were more commonly covered by Medicaid (63% vs 43%; P < .001). During the study period, the rate (per 1000 live births) of gastroschisis decreased from 0.31 (95% CI, 0.29-0.33) to 0.22 (95% CI, 0.21-0.24). The median (IQR) county-level atrazine use estimates were higher among infants with gastroschisis (1 year, 1389 [IQR, 198-10 162] vs 1023 [IQR, 167-6960] kg; 5 years, 1425 [IQR, 273-9895] vs 1057 [IQR, 199-6926] kg; 10 years, 1508 [IQR, 286-10 271] vs 1113 [IQR, 200-6650] kg; P < .001). In adjusted models, higher county levels of atrazine (each 100 000-kg increase) were associated with a higher incidence of gastroschisis (1 year: adjusted odds ratio [AOR], 1.12 [95% CI, 1.01-1.24]; 5 years: AOR, 1.15 [95% CI, 1.02-1.30]; 10 years: AOR, 1.21 [95% CI, 1.07-1.38]).

Conclusions and relevance: In this cross-sectional study, higher county levels of atrazine were associated with infant diagnoses of gastroschisis. While atrazine is the second-most used herbicide in the US, numerous countries around the world have banned it out of concern for adverse effects on human health. These findings suggest that exploring alternatives to atrazine in the US may be warranted.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dupont reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Patrick reported receiving grants from the National Institute on Drug Abuse, National Institute of Child Health and Human Development, National Institute of Mental Health, Center for Medicare and Medicaid Innovation, and The Boedecker Foundation outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Rates of Gastroschisis in the US, 2009-2019
Shaded areas indicate 95% CIs.
Figure 2.
Figure 2.. Gastroschisis Incidence and Atrazine Use
See this image and copyright information in PMC

References

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