Int. J. Environ. Res. Public Health 2013, 10(4), 1312-1323; doi:10.3390/ijerph10041312
Article

Food Fortification and Decline in the Prevalence of Neural Tube Defects: Does Public Intervention Reduce the Socioeconomic Gap in Prevalence?

1,2,3,4,* email, 1,2,4,5,6,7email, 1,2,5email, 7,8,9email and 1,7,8,9email
1 Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada 2 Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, M5B 1W8, Canada 3 Pediatric Oncology Group of Ontario, Toronto, ON M5G 1V2, Canada 4 Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada 5 Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada 6 Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON M5G 1V7, Canada 7 Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON M5T 3M6, Canada 8 Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada 9 Division of Paediatric Medicine, the Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
* Author to whom correspondence should be addressed.
Received: 5 February 2013; in revised form: 18 March 2013 / Accepted: 21 March 2013 / Published: 28 March 2013
(This article belongs to the Special Issue Birth Defect Prevention)
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Abstract: Objective: A significant decline in the prevalence of neural tube defects (NTD) through food fortification has been reported. Questions remain, however, about the effectiveness of this intervention in reducing the gap in prevalence across socioeconomic status (SES). Study Design: Using health number and through record linkage, children born in Ontario hospitals between 1994 and 2009 were followed for the diagnosis of congenital anomalies. SES quintiles were assigned to each child using census information at the time of birth. Adjusted rates and multivariate models were used to compare trends among children born in different SES groups. Results: Children born in low SES areas had significantly higher rates of NTDs (RR = 1.25, CI: 1.14–1.37). Prevalence of NTDs among children born in low and high SES areas declined since food fortification began in 1999 although has started rising again since 2006. While the crude decline was greater in low SES areas, after adjustment for maternal age, the slope of decline and SES gap in prevalence rates remained unchanged overtime. Conclusions: While food fortification is successful in reducing the prevalence of NTDs, it was not associated with removing the gap between high and low SES groups.
Keywords: neural tube defects; food fortification; socioeconomic status; health disparities

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MDPI and ACS Style

Agha, M.M.; Glazier, R.H.; Moineddin, R.; Moore, A.M.; Guttmann, A. Food Fortification and Decline in the Prevalence of Neural Tube Defects: Does Public Intervention Reduce the Socioeconomic Gap in Prevalence? Int. J. Environ. Res. Public Health 2013, 10, 1312-1323.

AMA Style

Agha MM, Glazier RH, Moineddin R, Moore AM, Guttmann A. Food Fortification and Decline in the Prevalence of Neural Tube Defects: Does Public Intervention Reduce the Socioeconomic Gap in Prevalence? International Journal of Environmental Research and Public Health. 2013; 10(4):1312-1323.

Chicago/Turabian Style

Agha, Mohammad M.; Glazier, Richard H.; Moineddin, Rahim; Moore, Aideen M.; Guttmann, Astrid. 2013. "Food Fortification and Decline in the Prevalence of Neural Tube Defects: Does Public Intervention Reduce the Socioeconomic Gap in Prevalence?" Int. J. Environ. Res. Public Health 10, no. 4: 1312-1323.

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