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166 TIME-PLACE CLUSTERS ANALYSIS FOR SELECTED CONGENITAL MALFORMATION IN SOUTHERN POLAND

During the period of 1096 days (Jan. 1,87 through Dec. 31,89) 2508 children with: Neural tube defects NTD (217), congenital heart defects CHD (1076), cleft lip +/- palate CL+/-P (275), and limbs malformations LM (940) were ascertained. Three sources of selection were used: 1. Birth defects registry, 2. Death registry, 3. Institute of Pediatrics records. The major goal of the study was to asses the existence of time-place clusters of the above mentioned anomalies. For analysis of Ho hypothesis of random malformations' distribution, K-means algorithm implemented by Kamea package was used. The highest contribution for clusters formation was shown by LM (35%) and CHD (28%) and the lowest one for CL+/-P (12%) Significant clusters were characterized by: mean time per cluster 8.5, wks range: 7.7 wks(LM) - 12.2 wks(CL+/-P); mean surface area: 186 km2, range: 133 km2 (LM) - 290 km2 (CHD). The mean malformation count per cluster was 7.3 and varied from 5.7 (CL+/-P) to 6.1 (NTD, LM). The most frequent time clusters were observed in March and June'87; May and December'88; January'89, whereas place clusters predominated in two industrial districts of Kraków (n = 43).Conclusions: 1. Different ability for birth defects clusters formation suggests different contribution of environmental factors to their etiology. 2. Cluster analysis may offer the rationale for future intervention study aiming at birth defects prevention.