RACIAL AND ETHNIC DISPARITIES IN NEURAL TUBE DEFECTS IN TEXAS: A CASE-CONTROL STUDY

Purpose: Several investigators have reported Hispanics to be at elevated risk for neural tube defects (anencephaly and spina bifida). Factors contributing to this risk have not been established. Neural tube defects (NTDs) are preventable through pre-and peri-conceptional folic acid intake. The main purpose of our study is to investigate the association between maternal demography and NTDs. Methods: We analyzed data on NTDs births using Texas birth defects registry data from 1999 thru 2009 in five Texas counties (Bexar, Dallas, Harris, Tarrant, and Travis). The study employed case-control design with randomly matched controls (1:2 ratio) by county, birth year, child's gender, maternal race/ethnicity, and age with live birth cases (N= 1030) and controls (N=2010). We used univariate for descriptive, bivariate to assess associations, and logistic regression analysis with BMI as our main risk factor to estimate the adjusted odds with 95% confidence intervals (at p-value Results: A significant bi-variate association was found between mother's ethnicity (p= 0.004), mother's educational status and NTDs (p= 0.003). After simultaneous adjustment for other confounders (obese) in multivariate analysis, having a Hispanic (versus non-Hispanic) mother remained a strong risk factor for NTDs (Odds ratio=1.4, 95% confidence intervals 1.16, 1.64). Overall Bexar County has the highest rate per 1,000 live births across this time period which is explained by the high Hispanic population in that area Also, low maternal education had greater odds of developing NTDs (Odds ratio 1.33, 95% confidence intervals 1.11, 1.6). No compelling association was found between obese status and NTDs in this population. Conclusions: Our findings on the Hispanic association with NTDs were also supported by previous studies. An increased risk of NTDs among Hispanics remained after controlling for other factors. This risk might be partially explained by economic, dietary and cultural differences between Hispanics and non-Hispanics. Public health programs must find means to ensure all women, especially those from lower socioeconomic backgrounds and/or with a low level of education, have an adequate folic acid intake. Access to early prenatal care, diet supplementation with a folic acid-containing multivitamin or high dose of folic acid alone in the peri-conception period may reduce the incidence of NTDs.