| International Trends in Rates of Hypospadias and Cryptorchidism Leonard J. Paulozzi National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724 USA Abstract
Researchers from seven European nations and the United States have published reports of increasing rates of hypospadias during the 1960s, 1970s, and 1980s. Reports of increasing rates of cryptorchidism have come primarily from England. In recent years, these reports have become one focus of the debate over endocrine disruption. This study examines more recent data from a larger number of countries participating in the International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS) to address the questions of whether such increases are worldwide and continuing and whether there are geographic patterns to any observed increases. The ICBDMS headquarters and individual systems provided the data. Systems were categorized into five groups based on gross domestic product in 1984. Hypospadias increases were most marked in two American systems and in Scandinavia and Japan. The increases leveled off in many systems after 1985. Increases were not seen in less affluent nations. Cryptorchidism rates were available for 10 systems. Clear increases in this anomaly were seen in two U.S. systems and in the South American system, but not elsewhere. Since 1985, rates declined in most systems. Numerous artifacts may contribute to or cause upward trends in hypospadias. Possible "real" causes include demographic changes and endocrine disruption, among others. Key words: abnormality, cryptorchidism, endocrine, genital, hypospadias, testicle. Environ Health Perspect 107:297-302 (1999) . [Online 11 March 1999] http://ehpnet1.niehs.nih.gov/docs/1999/107p297-302paulozzi/ abstract.html Address correspondence to L.J. Paulozzi, Division of Birth Defects and Pediatric Genetics, National Center for Environmental Health, Centers for Disease Control and Prevention, Mailstop F-45, 4770 Buford Highway NE, Atlanta, GA 30341-3724 USA. I thank the ICBDMS scientists making individual contributions to the data and its interpretation: P. Lancaster, S.W. Wen, B. Sibbald, W. Yanqiao, Z. Jun, A. Sipek, K. Helweg-Larsen, B. Botting, A. Ritvanen, E. Robert, J. Goujard, C. Siffel, Z. Johnson, P. Merlog, G. Cocchi, P. Mastroiacovo, R. Tenconi, Y. Sumiyoshi, O. Mutchinick, B. Borman, M. Cornel, A. Daltveit, M. da Graça Dutra, M.L. Martinez-Frias, B. Källén, and C. Torfs. Received 29 October 1998 ; accepted 29 December 1998.
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