Résumé :
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[BDSP. Notice produite par INIST-CNRS qmR0x88F. Diffusion soumise à autorisation]. The objective of this study is to conduct a meta-analysis of published and unpublished studies that examine the association between Agent Orange (AO) exposure and the risk of spina bifida. Relevant studies were identified through a computerized literature search of Medline and Embase from 1966 to 2008 ; a review of the reference list of retrieved articles and conference proceedings ; and by contacting researchers for unpublished studies. Both fixed-effects and random-effects models were used to pool the results of individual studies. The Cochrane Q test and index of heterogeneity (I2) were used to evaluate heterogeneity, and a funnel plot and Egger's test were used to evaluate publication bias. Seven studies, including two Vietnamese and five non-Vietnamese studies, involving 330 cases and 134,884 non-cases were included in the meta-analysis. The overall relative risk (RR) for spina bifida associated with paternal exposure to AO was 2.02 (95% confidence interval [CI] : 1.48-2.74), with no statistical evidence of heterogeneity across studies. Non-Vietnamese studies showed a slightly higher summary RR (RR=2.22 ; 95% CI : 1.38-3.56) than Vietnamese studies (RR=1.92 95% CI : 1.29-2.86). When analyzed separately, the overall association was statistically significant for the three case-control studies (Summary Odds Ratio=2.25,95% CI : 1.31-3.86) and the cross sectional study (RR=1.97,95% CI : 1.31-2.96), but not for the three cohort studies (RR : 2.11 ; 95% CI : 0.78-5.73). Paternal exposure to AO appears to be associated with a statistically increased risk of spina bifida.
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