Congenital Abnormalities in Greece

1
Congenital Abnormalitiesin Greece

• Functional evaluation of statistical data

Emmanuel Brilakis, Medical Doctor Evangelos
Fousteris, Medical Doctor Jannis Papadopulos,
Ass. Professor Medical School of Athens
University
2
Epidemiology

• Affects 3 4 of all live births
• Causes many elective or spontaneous abortions
• 15 30 of all pediatric hospitalizations
• Significant burden to families society

3
Causal Factors

• Genetic factors
• Environmental factors
• Lifestyle factors
• 50 60 cannot be attributed in known causes

Multifactorial Etiology
4
Objective

• To record the regional distribution of mortality
  and hospitalization caused by congenital
  abnormalities in Greece
• To compare the mortality and infantile mortality
  by congenital abnormalities between Greece and
  other countries
• To evaluate the existence of local factors that
  may be involved in the generation of the problem

5
Material and Methods

• National Statistical Service of Greece

• Monthly Statistical Bulletin

• Statistics of Populations Physical Movement

• Annual Statistical Yearbook of Greece

• World Health Organization

• Annuals

6
Specific infantile mortality index by congenital
abnormalities per 1.000 live births
Year Greece U.S.A. Bulgaria France Italy The Nether- lands Portugal Sweden Japan
1981 4,84  
1982 4,77  
1983 4,65 3,09  
1984 4,44 2,33 3,04  
1985 4,57 2,28 3,80 1,79 2,71 2,67  
1986 3,37 2,19 3,50 1,67 2,45 2,52 3,08 1,68
1987 3,66 2,07 3,60 1,73 2,61 2,74 3,35 2,23 1,65
1988 3,49 2,08 3,60 1,54 2,46 2,34 2,89 1,95 1,68
1989 3,26 2,01 3,73 1,53 2,36 2,15 3,10 2,16 1,65
1990 4,83 1,98 1,48 2,04 2,40 2,83 2,04 1,66
1991 4,46 1,87 1,36 1,97 2,26 2,71 2,16 1,60
1992 4,81 1,83 1,25 2,00 2,40 2,60 1,82 1,69
1993 3,40 1,78 1,42 2,17 2,30 2,58 1,66 1,54
1994 3,19 1,73 1,32 1,94 2,11 2,55 1,67 1,47
1995 3,03         1,85 2,22    
7
Specific infantile mortality index by congenital
abnormalities per 1.000 live births
Year Greece U.S.A. Bulgaria France Italy The Nether- lands Portugal Sweden Japan
1981 4,84  
1982 4,77  
1983 4,65 3,09  
1984 4,44 2,33 3,04  
1985 4,57 2,28 3,80 1,79 2,71 2,67  
1986 3,37 2,19 3,50 1,67 2,45 2,52 3,08 1,68
1987 3,66 2,07 3,60 1,73 2,61 2,74 3,35 2,23 1,65
1988 3,49 2,08 3,60 1,54 2,46 2,34 2,89 1,95 1,68
1989 3,26 2,01 3,73 1,53 2,36 2,15 3,10 2,16 1,65
1990 4,83 1,98 1,48 2,04 2,40 2,83 2,04 1,66
1991 4,46 1,87 1,36 1,97 2,26 2,71 2,16 1,60
1992 4,81 1,83 1,25 2,00 2,40 2,60 1,82 1,69
1993 3,40 1,78 1,42 2,17 2,30 2,58 1,66 1,54
1994 3,19 1,73 1,32 1,94 2,11 2,55 1,67 1,47
1995 3,03         1,85 2,22    
8
Specific infantile mortality index by congenital
abnormalities per 1.000 live births
Year Greece U.S.A. Bulgaria France Italy The Nether- lands Portugal Sweden Japan
1981 4,84  
1982 4,77  
1983 4,65 3,09  
1984 4,44 2,33 3,04  
1985 4,57 2,28 3,80 1,79 2,71 2,67  
1986 3,37 2,19 3,50 1,67 2,45 2,52 3,08 1,68
1987 3,66 2,07 3,60 1,73 2,61 2,74 3,35 2,23 1,65
1988 3,49 2,08 3,60 1,54 2,46 2,34 2,89 1,95 1,68
1989 3,26 2,01 3,73 1,53 2,36 2,15 3,10 2,16 1,65
1990 4,83 1,98 1,48 2,04 2,40 2,83 2,04 1,66
1991 4,46 1,87 1,36 1,97 2,26 2,71 2,16 1,60
1992 4,81 1,83 1,25 2,00 2,40 2,60 1,82 1,69
1993 3,40 1,78 1,42 2,17 2,30 2,58 1,66 1,54
1994 3,19 1,73 1,32 1,94 2,11 2,55 1,67 1,47
1995 3,03         1,85 2,22    
9
Specific infantile mortality index by congenital
abnormalities per 1.000 live births
GREECE
GREECE
BULGARIA
ITALY
U.S.A.
FRANCE
GREECE
GREECE
PORTUGAL
SWEDEN
THE NETHERLANDS
JAPAN
10
Specific infantile mortality index by congenital
abnormalities per 1.000 live births
GREECE
GREECE
BULGARIA
ITALY
U.S.A.
FRANCE
GREECE
GREECE
PORTUGAL
SWEDEN
THE NETHERLANDS
JAPAN
11
Specific infantile mortality index by congenital
abnormalities per 1.000 live births
GREECE
GREECE
BULGARIA
ITALY
U.S.A.
FRANCE
GREECE
GREECE
PORTUGAL
SWEDEN
THE NETHERLANDS
JAPAN
12
Percentage of decrease of specific infantile
mortality index by congenital abnormalities per
1.000 live births for each country between 1987
and 1994
Percentage of decrease

Data not available for all this period
13
Percentage of decrease of specific infantile
mortality index by congenital abnormalities per
1.000 live births for each country between 1987
and 1994
Percentage of decrease

Data not available for all this period
14
MAP OF GREECE
You are here
15
Specific infantile mortality index by congenital
abnormalities per 1.000 live birthsin Greece
Specific mortality index by congenital
abnormalities per 100.000 of population in Greece
Specific infantile mortality index per 1.000 live
births
16
Specific infantile mortality index by congenital
abnormalities per 1.000 live birthsin Greece
Specific mortality index by congenital
abnormalities per 100.000 of population in Greece
Specific mortality index per 100.000 of population
Specific infantile mortality index per 1.000 live
births
17
Percentage of deaths by congenital abnormalities
in Greece from 1981 to 1995 per age of death
80
19811987 1989-1995

10
4
3
2
1
gt50 years old
12 years old
34 years old
519 years old
till 365 days old
2049 years old
18
Congenital abnormalities in Greece from 1981 to
1995 per category of congenital 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
19
Specific mortality index by congenital
abnormalities per 100.000 of population per
geographic department of Greece from 1981 to 1995
Year Greater Athens Rest of central Greece Evia Pelopon-nesus Ionian sea islands Ipiros Thessaly Macedonia Thrace Aegean sea islands Crete
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 5,09 10,54
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 11,93 10,88
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
20
Specific mortality index by congenital
abnormalities per 100.000 of population per
geographic department of Greece from 1981 to 1995
Year Greater Athens Rest of central Greece Evia Pelopon-nesus Ionian sea islands Ipiros Thessaly Macedonia Thrace Aegean sea islands Crete
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 5,09 10,54
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 11,93 10,88
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
21
Specific mortality index by congenital
abnormalities per 100.000 of population per
geographic department of Greece from 1981 to 1995
Year Greater Athens Rest of central Greece Evia Pelopon-nesus Ionian sea islands Ipiros Thessaly Macedonia Thrace Aegean sea islands Crete
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 5,09 10,54
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 11,93 10,88
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
22
Specific mortality index by congenital
abnormalities per 100.000 of population per
geographic department of Greece from 1981 to 1995
Year Greater Athens Rest of central Greece Evia Pelopon-nesus Ionian sea islands Ipiros Thessaly Macedonia Thrace Aegean sea islands Crete
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 5,09 10,54
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 11,93 10,88
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
23
Discharged patients with congenital abnormalities
per 100.000 of population per geographic
department of Greece from 1981 to 1995
Year Greater Athens Rest of central Greece Evia Pelopon-nesus Ionian sea islands Ipiros 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
24
Discharged patients with congenital abnormalities
per 100.000 of population per geographic
department of Greece from 1981 to 1995
Year Greater Athens Rest of central Greece Evia Pelopon-nesus Ionian sea islands Ipiros 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
25
Discharged patients with congenital abnormalities
per 100.000 of population per geographic
department of Greece from 1981 to 1995
Year Greater Athens Rest of central Greece Evia Pelopon-nesus Ionian sea islands Ipiros 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
26
Problematic areas

• Thrace
• greater Athens
• Crete

27
Deaths and discharged patients due to congenital
abnormalities in ATHENS from 1981 to 1995
DEATHS
10
ATHENS
GREECE
6
2
95
81
83
85
87
89
91
93
DISCHARGED PATIENTS
ATHENS
140
GREECE
80
20
81
83
85
87
89
91
93
95
28
Deaths and discharged patients due to congenital
abnormalities in CRETE from 1981 to 1995
DEATHS
10
6
CRETE
GREECE
2
95
81
83
85
87
89
91
93
DISCHARGED PATIENTS
CRETE
140
GREECE
80
20
81
83
85
87
89
91
93
95
29
Deaths and discharged patients due to congenital
abnormalities in THRACE from 1981 to 1995
DEATHS
THRACE
10
6
GREECE
2
95
81
83
85
87
89
91
93
DISCHARGED PATIENTS
140
GREECE
GREECE
THRACE
80
20
81
83
85
87
89
91
93
95
30
Average annual specific mortality index by
congenital abnormalities per 100.000 of
population in geographic regions of Greece for
time period 1981 1995
Crete
Greater Athens
Thrace
Ipiros
Thessaly
Macedonia
Peloponnesus
Rest of central Greece and Evia
Greeces average
Aegean sea islands
Ionian sea islands
31
Average annual specific mortality index by
congenital abnormalities per 100.000 of
population in geographic regions of Greece for
time period 1981 1995
Crete
Greater Athens
Thrace
Ipiros
Thessaly
Macedonia
Peloponnesus
Rest of central Greece and Evia
Greeces average
Aegean sea islands
Ionian sea islands
32
Average annual specific index of discharged
patients with congenital abnormalities per
100.000 of population in geographic regions of
Greece for time period 1981 1995
Crete
Greater Athens
Thrace
Ipiros
Thessaly
Macedonia
Peloponnesus
Rest of central Greece and Evia
Greeces average
Ionian sea islands
Aegean sea islands
33
Average annual specific index of discharged
patients with congenital abnormalities per
100.000 of population in geographic regions of
Greece for time period 1981 1995
Crete
Greater Athens
Thrace
Ipiros
Thessaly
Macedonia
Peloponnesus
Rest of central Greece and Evia
Greeces average
Ionian sea islands
Aegean sea islands
34
Percentage of deaths/ discharged patients with
congenital abnormalities in geographic regions of
Greece for time period 1981 1995
Greater Athens
Crete
Ipiros
Thrace
Thessaly
Macedonia
Rest of central Greece and Evia
Peloponnesus
Ionian sea islands
Aegean sea islands
Greeces average
35
Percentage of deaths/ discharged patients with
congenital abnormalities in geographic regions of
Greece for time period 1981 1995
Greater Athens
Crete
Ipiros
Thrace
Thessaly
Macedonia
Rest of central Greece and Evia
Peloponnesus
Ionian sea islands
Aegean sea islands
Greeces average
36
Conclusions
More deaths by congenital abnormalities are
registered in Greece than in U.S.A., France,
Italy, The Netherlands, Portugal, Sweden and
Japan.

Greeces 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.

37
Conclusions
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.

38
Thank You !!!