This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal

Washington State, 1987-2003

Maneesh Batra, MD, MPH; Carrie L. Heike, MD, MS; Richard C. Phillips, MD; Noel S. Weiss, MD, DPH

Arch Pediatr Adolesc Med. 2007;161(1):89-95.

Objective  Ventricular septal defect (VSD) is currently the most common congenital cardiac malformation in the United States, but little is known about its etiology. The objective of this study was to address the hypothesis that parents' residence in eastern Washington, a region heavily dominated by the agricultural industry, and employment in agriculturally related occupations can influence the presence of a VSD in their offspring.

Design  Population-based case-control study.

Setting  Washington State from January 1, 1987, through December 31, 2003.

Patients  Children aged 0 to 2 years diagnosed as having a VSD (n = 3489), and other infants selected at random as control subjects (n = 13 290).

Main Exposures  Parental occupation and county of maternal residence were obtained from the birth certificate. The latter was categorized according to region (east vs west), rural-urban classification, and the proportion of farm and crop land.

Main Outcome Measures  Diagnosis of VSD within the first 2 years of life.

Results  The risk of VSD was greater for infants whose mothers resided in eastern Washington (odds ratio, 1.30; 95% confidence interval, 1.03-1.65). The risk of VSD with other cardiac malformations (n = 1205) exhibited a stronger geographic association than did isolated VSD (n = 2284). Analyses restricted to eastern Washington did not reveal a clear relationship between the risk of VSD and an increasing proportion of agricultural land in the mother's county of residence. Parental occupation in agriculture was not associated with the presence of VSD.

Conclusion  Although these findings suggest regional variation in Washington State in the occurrence of VSD, the basis for this variation remains to be determined. 

Author Affiliations: Department of Epidemiology, School of Public Health and Community Medicine, University of Washington (Drs Batra, Heike, Phillips, and Weiss), and Department of Pediatrics (Drs Batra and Heike) and Department of Medical Education and Health Informatics (Dr Phillips), University of Washington School of Medicine, Seattle.