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Congenital AbnormalitiesCongenital Abnormalities
in Greecein Greece
Functional Functional evaluation of evaluation of statistical datastatistical data
Emmanuel Brilakis, Medical DoctorEmmanuel Brilakis, Medical DoctorEvangelos Fousteris, Medical DoctorEvangelos Fousteris, Medical DoctorJannis Papadopulos, Ass. ProfessorJannis Papadopulos, Ass. Professor
Medical School of Athens UniversityMedical School of Athens University
EpidemiologyEpidemiology
Affects 3 – 4 % of all live birthsAffects 3 – 4 % of all live births Causes many elective or spontaneous Causes many elective or spontaneous
abortionsabortions 15 – 30 % of all pediatric 15 – 30 % of all pediatric
hospitalizationshospitalizations Significant burden to families & societySignificant burden to families & society
CausalCausal Factors Factors
Genetic factorsGenetic factors Environmental factorsEnvironmental factors Lifestyle factorsLifestyle factors
50 – 60 % cannot be attributed in 50 – 60 % cannot be attributed in known causes known causes
Multifactorial Multifactorial EtiologyEtiology
ObjectiveObjective
To record the regional distribution of mortality To record the regional distribution of mortality and hospitalization caused by congenital and hospitalization caused by congenital abnormalities in Greeceabnormalities in Greece
To compare the mortality and infantile To compare the mortality and infantile mortality by congenital abnormalities between mortality by congenital abnormalities between Greece and other countriesGreece and other countries
To evaluate the existence of local factors that To evaluate the existence of local factors that may be involved in the generation of the may be involved in the generation of the problemproblem
Material and MethodsMaterial and Methods
• Monthly Statistical Bulletin
• Statistics of Population’s Physical Movement
• Annual Statistical Yearbook of Greece
• Annuals
National Statistical Service of GreeceNational Statistical Service of Greece
World Health OrganizationWorld Health Organization
Specific infantile mortality index by Specific infantile mortality index by congenital abnormalities per 1.000 live congenital abnormalities per 1.000 live
birthsbirths
YearYear GreeceGreece U.S.AU.S.A..
BulgariaBulgaria FrancFrancee
ItalyItalyTheThe
Nether-Nether-landslands
PortugalPortugal SwedeSwedenn
JapanJapan
19811981 4,84
19821982 4,77
19831983 4,65 3,09
19841984 4,44 2,33 3,04
19851985 4,57 2,28 3,80 1,79 2,71 2,67
19861986 3,37 2,19 3,50 1,67 2,45 2,52 3,08 1,68
19871987 3,66 2,07 3,60 1,73 2,61 2,74 3,35 2,23 1,65
19881988 3,49 2,08 3,60 1,54 2,46 2,34 2,89 1,95 1,68
19891989 3,26 2,01 3,73 1,53 2,36 2,15 3,10 2,16 1,65
19901990 4,83 1,98 1,48 2,04 2,40 2,83 2,04 1,66
19911991 4,46 1,87 1,36 1,97 2,26 2,71 2,16 1,60
19921992 4,81 1,83 1,25 2,00 2,40 2,60 1,82 1,69
19931993 3,40 1,78 1,42 2,17 2,30 2,58 1,66 1,54
19941994 3,19 1,73 1,32 1,94 2,11 2,55 1,67 1,47
19951995 3,03 1,85 2,22
Specific infantile mortality index by Specific infantile mortality index by congenital abnormalities per 1.000 live congenital abnormalities per 1.000 live
birthsbirths
YearYear GreeceGreece U.S.AU.S.A..
BulgariaBulgaria FrancFrancee
ItalyItalyTheThe
Nether-Nether-landslands
PortugalPortugal SwedeSwedenn
JapanJapan
19811981 4,84
19821982 4,77
19831983 4,65 3,09
19841984 4,44 2,33 3,04
19851985 4,57 2,28 3,80 1,79 2,71 2,67
19861986 3,37 2,19 3,50 1,67 2,45 2,52 3,08 1,68
19871987 3,66 2,07 3,60 1,73 2,61 2,74 3,35 2,23 1,65
19881988 3,49 2,08 3,60 1,54 2,46 2,34 2,89 1,95 1,68
19891989 3,26 2,01 3,73 1,53 2,36 2,15 3,10 2,16 1,65
19901990 4,83 1,98 1,48 2,04 2,40 2,83 2,04 1,66
19911991 4,46 1,87 1,36 1,97 2,26 2,71 2,16 1,60
19921992 4,81 1,83 1,25 2,00 2,40 2,60 1,82 1,69
19931993 3,40 1,78 1,42 2,17 2,30 2,58 1,66 1,54
19941994 3,19 1,73 1,32 1,94 2,11 2,55 1,67 1,47
19951995 3,03 1,85 2,22
Specific infantile mortality index by Specific infantile mortality index by congenital abnormalities per 1.000 live congenital abnormalities per 1.000 live
birthsbirths
YearYear GreeceGreece U.S.AU.S.A..
BulgariaBulgaria FrancFrancee
ItalyItalyTheThe
Nether-Nether-landslands
PortugalPortugal SwedeSwedenn
JapanJapan
19811981 4,84
19821982 4,77
19831983 4,65 3,09
19841984 4,44 2,33 3,04
19851985 4,57 2,28 3,80 1,79 2,71 2,67
19861986 3,37 2,19 3,50 1,67 2,45 2,52 3,08 1,68
19871987 3,66 2,07 3,60 1,73 2,61 2,74 3,35 2,23 1,65
19881988 3,49 2,08 3,60 1,54 2,46 2,34 2,89 1,95 1,68
19891989 3,26 2,01 3,73 1,53 2,36 2,15 3,10 2,16 1,65
19901990 4,83 1,98 1,48 2,04 2,40 2,83 2,04 1,66
19911991 4,46 1,87 1,36 1,97 2,26 2,71 2,16 1,60
19921992 4,81 1,83 1,25 2,00 2,40 2,60 1,82 1,69
19931993 3,40 1,78 1,42 2,17 2,30 2,58 1,66 1,54
19941994 3,19 1,73 1,32 1,94 2,11 2,55 1,67 1,47
19951995 3,03 1,85 2,22
Specific infantile mortality index by Specific infantile mortality index by congenital abnormalities per 1.000 live congenital abnormalities per 1.000 live
birthsbirths
0,00
1,00
2,00
3,00
4,00
5,00
6,00
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95 0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
BULGARIA
ITALY
GREECE
GREECEGREECE
GREECE
U.S.A.
FRANCE
JAPANTHE NETHERLANDS
SWEDENPORTUGAL
0,00
1,00
2,00
3,00
4,00
5,00
6,00
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95 0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
BULGARIA
ITALY
GREECE
GREECEGREECE
GREECE
U.S.A.
FRANCE
JAPANTHE NETHERLANDS
SWEDENPORTUGAL
Specific infantile mortality index by Specific infantile mortality index by congenital abnormalities per 1.000 live congenital abnormalities per 1.000 live
birthsbirths
0,00
1,00
2,00
3,00
4,00
5,00
6,00
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95 0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
0,00
1,00
2,00
3,00
4,00
5,00
6,00
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
BULGARIA
ITALY
GREECE
GREECEGREECE
GREECE
U.S.A.
FRANCE
JAPANTHE NETHERLANDS
SWEDENPORTUGAL
Specific infantile mortality index by Specific infantile mortality index by congenital abnormalities per 1.000 live congenital abnormalities per 1.000 live
birthsbirths
Percentage of decrease of specific infantile Percentage of decrease of specific infantile mortality index by congenital abnormalities per mortality index by congenital abnormalities per
1.000 live births for each country between 1987 and 1.000 live births for each country between 1987 and 19941994
13%
16%
24%26%
23%24%
25%
11%
Gre
ece
U.S
.A.
Bu
lgari
a
Fra
nce
Italy
Th
e N
eth
erl
an
ds
Port
ugal
Sw
eden
Japan
Perc
en
tage o
f decr
ease
Perc
en
tage o
f decr
ease
* * Data not available for all this periodData not available for all this period
**
Percentage of decrease of specific infantile Percentage of decrease of specific infantile mortality index by congenital abnormalities per mortality index by congenital abnormalities per
1.000 live births for each country between 1987 and 1.000 live births for each country between 1987 and 19941994
13%
16%
24%26%
23%24%
25%
11%
Gre
ece
U.S
.A.
Bu
lgari
a
Fra
nce
Italy
Th
e N
eth
erl
an
ds
Port
ugal
Sw
eden
Japan
Perc
en
tage o
f decr
ease
Perc
en
tage o
f decr
ease
**
* * Data not available for all this periodData not available for all this period
MAP OF GREECEMAP OF GREECE
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Specific infantile mortality index by congenital Specific infantile mortality index by congenital abnormalities per 1.000 live birthsabnormalities per 1.000 live births
in Greece in Greece &&
Specific mortality index by congenital abnormalities Specific mortality index by congenital abnormalities per 100.000 of population in Greeceper 100.000 of population in Greece
0
2
4
6
8
10
12
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
Specific infantile mortality indexper 1.000 live births
0
2
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1981
1982
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Specific infantile mortality index by congenital Specific infantile mortality index by congenital abnormalities per 1.000 live birthsabnormalities per 1.000 live births
in Greece in Greece &&
Specific mortality index by congenital abnormalities Specific mortality index by congenital abnormalities per 100.000 of population in Greeceper 100.000 of population in Greece
Specific infantile mortality indexper 1.000 live births
Specific mortality indexper 100.000 of population
Percentage of deaths by congenital Percentage of deaths by congenital abnormalities in Greece from 1981 to 1995 abnormalities in Greece from 1981 to 1995
per age of deathper age of death
till 365days old
1–2 yearsold
3–4yearsold
5–19yearsold
20–49yearsold
>50yearsold
80%
3% 4%
10%
2% 1%
1981–1987 & 1989-1995
1988
Congenital abnormalities in Greece Congenital abnormalities in Greece from 1981 to 1995 per category of from 1981 to 1995 per category of
congenital abnormalitycongenital abnormality
Congenital abnormalities of heart & circulatory system 46.075 25%
Undescended testicles 29.826 16%
Other congenital abnormalities of musculoskeletal system 22.033 12%
Other deformities of digestive system 13.747 7%
Congenital dislocation of hip 9.200 5%
Spina bifida & hydrocephalus 4.591 3%
Cleft palate & cleft lip 4.358 2%
Other deformities of C.N.S. 2.971 2%
Other congenital abnormalities 50.516 28%
Specific mortality index by congenital Specific mortality index by congenital abnormalities per 100.000 of population per abnormalities per 100.000 of population per
geographic department of Greece from 1981 to geographic department of Greece from 1981 to 19951995
YearGreate
r Athens
Rest of central Greece & Evia
Pelopon-nesus
Ionian sea
islandsIpiros
Thessaly
Macedonia
Thrace
Aegean sea
islandsCrete
1981
10,65 7,45 6,31 6,58 6,48 7,62 7,70 9,97 7,48 4,38
1982
11,11 5,48 6,74 6,01 5,54 8,39 5,97 10,96 4,42 6,72
1983
8,70 5,95 6,58 4,36 9,82 5,07 6,79 9,88 7,66 8,84
1984
8,08 6,06 5,85 3,80 6,43 6,98 6,72 6,66 5,0910,5
4
1985
8,58 5,05 5,71 6,50 5,80 6,78 6,32 8,88 7,63 2,72
1986
6,52 4,41 4,36 3,79 4,27 2,48 4,26 7,69 5,54 4,06
1987
7,47 3,43 4,92 3,24 4,57 3,98 3,88 7,06 5,52 5,96
1988
10,68 7,94 10,30 12,95 7,90 6,31 9,56 10,09 11,9310,8
8
1989
5,10 2,54 4,16 2,68 3,65 4,66 4,02 7,32 2,73 5,29
1990
7,03 4,68 4,58 3,19 3,30 6,02 6,42 10,07 5,20 5,42
1991
6,96 4,07 4,21 4,19 6,15 3,67 4,96 6,73 4,49 6,10
1992
7,23 3,98 5,12 4,14 5,73 5,01 5,75 9,52 5,14 5,50
1993
4,96 2,88 4,06 2,56 5,05 4,05 4,42 6,79 2,90 5,83
1994
4,37 3,43 3,84 2,54 3,60 2,56 4,09 9,27 3,78 3,45
1995
3,75 2,90 3,19 3,54 4,39 3,91 3,12 7,43 5,32 4,86
Diff. -65% -61% -49% -46% -32% -49% -59% -25% -29% 11%
Specific mortality index by congenital Specific mortality index by congenital abnormalities per 100.000 of population per abnormalities per 100.000 of population per
geographic department of Greece from 1981 to geographic department of Greece from 1981 to 19951995
YearGreate
r Athens
Rest of central Greece & Evia
Pelopon-nesus
Ionian sea
islandsIpiros
Thessaly
Macedonia
Thrace
Aegean sea
islandsCrete
1981
10,65 7,45 6,31 6,58 6,48 7,62 7,70 9,97 7,48 4,38
1982
11,11 5,48 6,74 6,01 5,54 8,39 5,97 10,96 4,42 6,72
1983
8,70 5,95 6,58 4,36 9,82 5,07 6,79 9,88 7,66 8,84
1984
8,08 6,06 5,85 3,80 6,43 6,98 6,72 6,66 5,0910,5
4
1985
8,58 5,05 5,71 6,50 5,80 6,78 6,32 8,88 7,63 2,72
1986
6,52 4,41 4,36 3,79 4,27 2,48 4,26 7,69 5,54 4,06
1987
7,47 3,43 4,92 3,24 4,57 3,98 3,88 7,06 5,52 5,96
1988
10,68 7,94 10,30 12,95 7,90 6,31 9,56 10,09 11,9310,8
8
1989
5,10 2,54 4,16 2,68 3,65 4,66 4,02 7,32 2,73 5,29
1990
7,03 4,68 4,58 3,19 3,30 6,02 6,42 10,07 5,20 5,42
1991
6,96 4,07 4,21 4,19 6,15 3,67 4,96 6,73 4,49 6,10
1992
7,23 3,98 5,12 4,14 5,73 5,01 5,75 9,52 5,14 5,50
1993
4,96 2,88 4,06 2,56 5,05 4,05 4,42 6,79 2,90 5,83
1994
4,37 3,43 3,84 2,54 3,60 2,56 4,09 9,27 3,78 3,45
1995
3,75 2,90 3,19 3,54 4,39 3,91 3,12 7,43 5,32 4,86
Diff. -65% -61% -49% -46% -32% -49% -59% -25% -29% 11%
Specific mortality index by congenital Specific mortality index by congenital abnormalities per 100.000 of population per abnormalities per 100.000 of population per
geographic department of Greece from 1981 to geographic department of Greece from 1981 to 19951995
YearGreate
r Athens
Rest of central Greece & Evia
Pelopon-nesus
Ionian sea
islandsIpiros
Thessaly
Macedonia
Thrace
Aegean sea
islandsCrete
1981
10,65 7,45 6,31 6,58 6,48 7,62 7,70 9,97 7,48 4,38
1982
11,11 5,48 6,74 6,01 5,54 8,39 5,97 10,96 4,42 6,72
1983
8,70 5,95 6,58 4,36 9,82 5,07 6,79 9,88 7,66 8,84
1984
8,08 6,06 5,85 3,80 6,43 6,98 6,72 6,66 5,0910,5
4
1985
8,58 5,05 5,71 6,50 5,80 6,78 6,32 8,88 7,63 2,72
1986
6,52 4,41 4,36 3,79 4,27 2,48 4,26 7,69 5,54 4,06
1987
7,47 3,43 4,92 3,24 4,57 3,98 3,88 7,06 5,52 5,96
1988
10,68 7,94 10,30 12,95 7,90 6,31 9,56 10,09 11,9310,8
8
1989
5,10 2,54 4,16 2,68 3,65 4,66 4,02 7,32 2,73 5,29
1990
7,03 4,68 4,58 3,19 3,30 6,02 6,42 10,07 5,20 5,42
1991
6,96 4,07 4,21 4,19 6,15 3,67 4,96 6,73 4,49 6,10
1992
7,23 3,98 5,12 4,14 5,73 5,01 5,75 9,52 5,14 5,50
1993
4,96 2,88 4,06 2,56 5,05 4,05 4,42 6,79 2,90 5,83
1994
4,37 3,43 3,84 2,54 3,60 2,56 4,09 9,27 3,78 3,45
1995
3,75 2,90 3,19 3,54 4,39 3,91 3,12 7,43 5,32 4,86
Diff. -65% -61% -49% -46% -32% -49% -59% -25% -29% 11%
Specific mortality index by congenital Specific mortality index by congenital abnormalities per 100.000 of population per abnormalities per 100.000 of population per
geographic department of Greece from 1981 to geographic department of Greece from 1981 to 19951995
YearGreate
r Athens
Rest of central Greece & Evia
Pelopon-nesus
Ionian sea
islandsIpiros
Thessaly
Macedonia
Thrace
Aegean sea
islandsCrete
1981
10,65 7,45 6,31 6,58 6,48 7,62 7,70 9,97 7,48 4,38
1982
11,11 5,48 6,74 6,01 5,54 8,39 5,97 10,96 4,42 6,72
1983
8,70 5,95 6,58 4,36 9,82 5,07 6,79 9,88 7,66 8,84
1984
8,08 6,06 5,85 3,80 6,43 6,98 6,72 6,66 5,0910,5
4
1985
8,58 5,05 5,71 6,50 5,80 6,78 6,32 8,88 7,63 2,72
1986
6,52 4,41 4,36 3,79 4,27 2,48 4,26 7,69 5,54 4,06
1987
7,47 3,43 4,92 3,24 4,57 3,98 3,88 7,06 5,52 5,96
1988
10,68 7,94 10,30 12,95 7,90 6,31 9,56 10,09 11,9310,8
8
1989
5,10 2,54 4,16 2,68 3,65 4,66 4,02 7,32 2,73 5,29
1990
7,03 4,68 4,58 3,19 3,30 6,02 6,42 10,07 5,20 5,42
1991
6,96 4,07 4,21 4,19 6,15 3,67 4,96 6,73 4,49 6,10
1992
7,23 3,98 5,12 4,14 5,73 5,01 5,75 9,52 5,14 5,50
1993
4,96 2,88 4,06 2,56 5,05 4,05 4,42 6,79 2,90 5,83
1994
4,37 3,43 3,84 2,54 3,60 2,56 4,09 9,27 3,78 3,45
1995
3,75 2,90 3,19 3,54 4,39 3,91 3,12 7,43 5,32 4,86
Diff. -65% -61% -49% -46% -32% -49% -59% -25% -29% 11%
Discharged patients with congenital abnormalities Discharged patients with congenital abnormalities per 100.000 of population per geographic per 100.000 of population per geographic department of Greece from 1981 to 1995department of Greece from 1981 to 1995
YearGreater Athens
Rest of central Greece & Evia
Pelopon-nesus
Ionian sea
islandsIpiros
Thessaly
Macedonia
Thrace
Aegean sea
islands
Crete
1981
142 98 101 89 75 93 92 77 97 116
1982
151 91 111 83 96 102 95 83 87 125
1983
133 108 104 142 103 104 99 91 130 129
1984
122 81 91 81 93 87 94 95 84 102
1985
117 86 96 82 86 85 98 93 93 99
1986
139 88 95 87 108 95 96 92 95 121
1987
132 82 94 101 108 74 95 94 84 139
1988
119 85 86 86 115 91 93 98 88 124
1989
117 92 105 96 109 93 112 114 93 144
1990
115 96 100 102 109 96 106 110 99 113
1991
116 79 95 101 103 89 114 98 91 118
1992
124 86 94 90 85 94 118 102 100 123
1993
131 82 92 112 70 91 115 117 100 129
1994
127 85 95 111 98 92 115 117 102 138
1995
128 68 79 84 77 82 110 93 85 112
Diff. -10% -31% -22% -5% 3% -11% 20% 21% -12% -4%
Discharged patients with congenital abnormalities Discharged patients with congenital abnormalities per 100.000 of population per geographic per 100.000 of population per geographic department of Greece from 1981 to 1995department of Greece from 1981 to 1995
YearGreater Athens
Rest of central Greece & Evia
Pelopon-nesus
Ionian sea
islandsIpiros
Thessaly
Macedonia
Thrace
Aegean sea
islands
Crete
1981
142 98 101 89 75 93 92 77 97 116
1982
151 91 111 83 96 102 95 83 87 125
1983
133 108 104 142 103 104 99 91 130 129
1984
122 81 91 81 93 87 94 95 84 102
1985
117 86 96 82 86 85 98 93 93 99
1986
139 88 95 87 108 95 96 92 95 121
1987
132 82 94 101 108 74 95 94 84 139
1988
119 85 86 86 115 91 93 98 88 124
1989
117 92 105 96 109 93 112 114 93 144
1990
115 96 100 102 109 96 106 110 99 113
1991
116 79 95 101 103 89 114 98 91 118
1992
124 86 94 90 85 94 118 102 100 123
1993
131 82 92 112 70 91 115 117 100 129
1994
127 85 95 111 98 92 115 117 102 138
1995
128 68 79 84 77 82 110 93 85 112
Diff. -10% -31% -22% -5% 3% -11% 20% 21% -12% -4%
Discharged patients with congenital abnormalities Discharged patients with congenital abnormalities per 100.000 of population per geographic per 100.000 of population per geographic department of Greece from 1981 to 1995department of Greece from 1981 to 1995
YearGreater Athens
Rest of central Greece & Evia
Pelopon-nesus
Ionian sea
islandsIpiros
Thessaly
Macedonia
Thrace
Aegean sea
islands
Crete
1981
142 98 101 89 75 93 92 77 97 116
1982
151 91 111 83 96 102 95 83 87 125
1983
133 108 104 142 103 104 99 91 130 129
1984
122 81 91 81 93 87 94 95 84 102
1985
117 86 96 82 86 85 98 93 93 99
1986
139 88 95 87 108 95 96 92 95 121
1987
132 82 94 101 108 74 95 94 84 139
1988
119 85 86 86 115 91 93 98 88 124
1989
117 92 105 96 109 93 112 114 93 144
1990
115 96 100 102 109 96 106 110 99 113
1991
116 79 95 101 103 89 114 98 91 118
1992
124 86 94 90 85 94 118 102 100 123
1993
131 82 92 112 70 91 115 117 100 129
1994
127 85 95 111 98 92 115 117 102 138
1995
128 68 79 84 77 82 110 93 85 112
Diff. -10% -31% -22% -5% 3% -11% 20% 21% -12% -4%
Problematic areasProblematic areas
ThraceThrace
greater greater AthensAthens
CreteCrete
Deaths and discharged patients due to Deaths and discharged patients due to congenital abnormalities in congenital abnormalities in ATHENSATHENS from from
1981 to 19951981 to 1995
ATHENSATHENS
81 83 85 87 89 91 93 95
2
6
10
GREECEGREECE
DEATHSDEATHS
DISCHARGED PATIENTSDISCHARGED PATIENTS
81 83 85 87 89 91 93 95
20
80
140
GREECEGREECE
ATHENSATHENS
Deaths and discharged patients due to Deaths and discharged patients due to congenital abnormalities in congenital abnormalities in CRETECRETE from from
1981 to 19951981 to 1995
81 83 85 87 89 91 93
DEATHSDEATHS
DISCHARGED PATIENTSDISCHARGED PATIENTS
81 83 85 87 89 91 93 95
GREECEGREECE
CRETECRETE
20
80
140
95
2
6
10
CRETECRETE GREECEGREECE
Deaths and discharged patients due to Deaths and discharged patients due to congenital abnormalities in congenital abnormalities in THRACETHRACE from from
1981 to 19951981 to 1995
81 83 85 87 89 91 93
DEATHSDEATHS
DISCHARGED PATIENTSDISCHARGED PATIENTS
81 83 85 87 89 91 93 95
GREECEGREECETHRACETHRACE
20
80
140
95
2
6
10
GREECEGREECE
THRACETHRACE
GREECEGREECE
Average annual specific mortality index by Average annual specific mortality index by congenital abnormalities per 100.000 of congenital abnormalities per 100.000 of
population in geographic regions of Greece population in geographic regions of Greece for time period 1981 – 1995for time period 1981 – 1995
7,30
4,80
5,37
4,71
5,61
5,12
5,63
8,61
5,67 6,06 6,09
0
1
2
3
4
5
6
7
8
9
Gre
ate
rG
reate
rA
then
sA
then
s
Rest
of
cen
tral
Rest
of
cen
tral
Gre
ece a
nd
Evia
Gre
ece a
nd
Evia
Pelo
pon
nesu
sP
elo
pon
nesu
s
Ion
ian
sea isla
nd
sIo
nia
n s
ea isla
nd
s
Ipir
os
Ipir
os
Th
essaly
Th
essaly
Maced
on
iaM
aced
on
ia
Th
race
Th
race
Aeg
ean
sea isla
nd
sA
eg
ean
sea isla
nd
s
Gre
ece’s
avera
ge
Gre
ece’s
avera
ge
Cre
teC
rete
Average annual specific mortality index by Average annual specific mortality index by congenital abnormalities per 100.000 of congenital abnormalities per 100.000 of
population in geographic regions of Greece population in geographic regions of Greece for time period 1981 – 1995for time period 1981 – 1995
7,30
4,80
5,37
4,71
5,61
5,12
5,63
8,61
5,67 6,06 6,09
0
1
2
3
4
5
6
7
8
9
Gre
ate
rG
reate
rA
then
sA
then
s
Rest
of
cen
tral
Rest
of
cen
tral
Gre
ece a
nd
Evia
Gre
ece a
nd
Evia
Pelo
pon
nesu
sP
elo
pon
nesu
s
Ion
ian
sea isla
nd
sIo
nia
n s
ea isla
nd
s
Ipir
os
Ipir
os
Th
essaly
Th
essaly
Maced
on
iaM
aced
on
ia
Th
race
Th
race
Aeg
ean
sea isla
nd
sA
eg
ean
sea isla
nd
s
Gre
ece’s
avera
ge
Gre
ece’s
avera
ge
Cre
teC
rete
““Average annual specific index” of Average annual specific index” of discharged patients with congenital discharged patients with congenital
abnormalities per 100.000 of population in abnormalities per 100.000 of population in geographic regions of Greece for time geographic regions of Greece for time
period 1981 – 1995period 1981 – 1995
126
9097 97
97
91
104
9795
122
107
0
20
40
60
80
100
120
140
Gre
ate
rG
reate
rA
then
sA
then
s
Rest
of
cen
tral
Rest
of
cen
tral
Gre
ece a
nd
Evia
Gre
ece a
nd
Evia
Pelo
pon
nesu
sP
elo
pon
nesu
s
Ion
ian
sea isla
nd
sIo
nia
n s
ea isla
nd
s
Ipir
os
Ipir
os
Th
essaly
Th
essaly
Maced
on
iaM
aced
on
ia
Th
race
Th
race
Aeg
ean
sea isla
nd
sA
eg
ean
sea isla
nd
s
Gre
ece’s
avera
ge
Gre
ece’s
avera
ge
Cre
teC
rete
126
9097 97
97
91
104
9795
122
107
0
20
40
60
80
100
120
140
Gre
ate
rG
reate
rA
then
sA
then
s
Rest
of
cen
tral
Rest
of
cen
tral
Gre
ece a
nd
Evia
Gre
ece a
nd
Evia
Pelo
pon
nesu
sP
elo
pon
nesu
s
Ion
ian
sea isla
nd
sIo
nia
n s
ea isla
nd
s
Ipir
os
Ipir
os
Th
essaly
Th
essaly
Maced
on
iaM
aced
on
ia
Th
race
Th
race
Aeg
ean
sea isla
nd
sA
eg
ean
sea isla
nd
s
Gre
ece’s
avera
ge
Gre
ece’s
avera
ge
Cre
teC
rete
““Average annual specific index” of Average annual specific index” of discharged patients with congenital discharged patients with congenital
abnormalities per 100.000 of population in abnormalities per 100.000 of population in geographic regions of Greece for time geographic regions of Greece for time
period 1981 – 1995period 1981 – 1995
““Percentage of deaths/ discharged Percentage of deaths/ discharged patients” with congenital abnormalities in patients” with congenital abnormalities in
geographic regions of Greece for time geographic regions of Greece for time period 1981 – 1995period 1981 – 1995
5,83%
5,30% 5,53% 4,81%
5,76%5,63%
5,37%
8,74%
5,92%
4,92% 5,37%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Gre
ate
rG
reate
rA
then
sA
then
s
Rest
of
cen
tral
Rest
of
cen
tral
Gre
ece a
nd
Evia
Gre
ece a
nd
Evia
Pelo
pon
nesu
sP
elo
pon
nesu
s
Ion
ian
sea isla
nd
sIo
nia
n s
ea isla
nd
s
Ipir
os
Ipir
os
Th
essaly
Th
essaly
Maced
on
iaM
aced
on
ia
Th
race
Th
race
Aeg
ean
sea isla
nd
sA
eg
ean
sea isla
nd
s
Gre
ece’s
avera
ge
Gre
ece’s
avera
ge
Cre
teC
rete
““Percentage of deaths/ discharged Percentage of deaths/ discharged patients” with congenital abnormalities in patients” with congenital abnormalities in
geographic regions of Greece for time geographic regions of Greece for time period 1981 – 1995period 1981 – 1995
5,83%
5,30% 5,53% 4,81%
5,76%5,63%
5,37%
8,74%
5,92%
4,92% 5,37%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Gre
ate
rG
reate
rA
then
sA
then
s
Rest
of
cen
tral
Rest
of
cen
tral
Gre
ece a
nd
Evia
Gre
ece a
nd
Evia
Pelo
pon
nesu
sP
elo
pon
nesu
s
Ion
ian
sea isla
nd
sIo
nia
n s
ea isla
nd
s
Ipir
os
Ipir
os
Th
essaly
Th
essaly
Maced
on
iaM
aced
on
ia
Th
race
Th
race
Aeg
ean
sea isla
nd
sA
eg
ean
sea isla
nd
s
Gre
ece’s
avera
ge
Gre
ece’s
avera
ge
Cre
teC
rete
ConclusionsConclusions
More deaths by congenital abnormalities are registered in Greece than in U.S.A., France, Italy, The Netherlands, Portugal, Sweden and Japan.
Greece’s infantile mortality index by congenital abnormalities presents the second lowest reduction between the selected countries in the under study period.
Many fluctuations are observed in the course of indexes concerning in mortality and hospitalization in Greece during 1981 to 1995. Significant disproportions are also revealed among the geographic departments of Greece. There are lots of peaks that need further investigation.
ConclusionsConclusions
We tried to isolate concrete factors responsible for the problem but the data available is not sufficient. Thus, we avoided to name causal factors because we only would be hypothetical. We should mention the need of planning specific epidemiological studies (perspective and retrospective) in order to approach the possible causes.
We propose the establishment of birth defects registration centres to evaluate genetic and environmental factors associated with the occurrence of congenital diseases.
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