Family and neighborhood socioeconomic inequality in cryptorchidism and hypospadias: A nationwide study from Sweden

Objectives: To examine whether there is an association between neighborhood deprivation and incidence of cryptorchidism and hypospadias, after accounting for family-level and individual-level sociodemographic characteristics. Methods: All boys born in Sweden between January 1, 2001 and December 31, 2010 were followed. Data were analyzed by multilevel logistic regression, with family-level and individual-level characteristics at the first level and level of neighborhood deprivation at the second level. Results: During the study period, among a total of 497,584 boys, 8,584 (1.7%) and 3,704 (0.7%) were diagnosed with cryptorchidism and hypospadias, respectively. Cumulative rates for cryptorchidism and hypospadias increased with increasing levels of neighborhood deprivation. In the study population, 1.5 per 100 and 2.0 per 100 boys, in the least and most deprived neighborhoods were diagnosed with cryptorchidism and 0.7 per 100 and 0.9 per 100 boys were diagnosed with hypospadias. Incidence of hospitalization for cryptorchidism and hypospadias increased with increasing neighborhood-level deprivation across all family-level and individual-level sociodemographic categories. The odds ratio (OR) for cryptorchidism and hypospadias for those living in high-deprivation neighborhoods versus those living in low-deprivation neighborhoods was 1.13 (95% confidence interval [CI] = 1.05–1.21) and 1.24 (95% CI = 1.12–1.37). High neighborhood deprivation remained significantly associated with higher odds of hypospadias after adjustment for family-level and individual-level sociodemographic characteristics (OR = 1.20, 95% CI = 1.08–1.35). Conclusions: This study is the largest so far on neighborhood influences on cryptorchidism and hypospadias. Our results suggest that neighborhood deprivation is associated with a moderate incidence of hypospadias independent of family-level and individual-level sociodemographic characteristics.