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Abstract Objective To conduct a detailed epidemiological exploration of the relative contributions of cannabis and ethnicity to US atrial septal defect (ASD) rates (ASDR). Study design State-based ASDR data from the US National Births Defects Prevention Network, substance use, income and ethnicity data analyzed in RStudio. Results Ethnic effects were significant with relative risks amongst African Americans and American Indians and Alaskan Natives of 2·40 (95%C.I. 2·27, 2·54) and 2·31 (2·19, 21·43), Cohen’s D of 1·44 and 1·46 and P values of 2·94 × 10 −168 and 3·01 × 10 −172 compared to others, respectively. In general, additive models inclusion of ethnicity:cannabinoid and ethnicity:tobacco interactions were significant down to P=zero for cannabis, Δ9THC and cannabidiol. Sequentially doubly robust targeted multiple likelihood estimations confirmed epidemiologically causal relationships under standard assumptions. ASDR amongst Asians and Pacific Islanders in Nevada showed an exponential doubling time of 2.83 years. Conclusions Cannabinoid and cannabinoid:ethnicity interactions drive ASDR and meet epidemiological causal criteria.
Reece et al. (Wed,) studied this question.