Prevalence of Keshan disease at the township level in China: a cross-sectional study
Abstract
Keshan disease (KD), an endemic myocardiopathy with unclear etiology, lacks primary preventive measures. This study aimed to assess the prevalence of KD at the township level using spatial epidemiology, elucidate its distribution characteristics for further precision classifications, and propose strategies for its control and elimination. This cross-sectional study covered 2,351 endemic townships in 16 provinces of China, including all the endemic townships determined by the Delimitation and Classification of KD-endemic areas. Global autocorrelation analyses were conducted for KD prevalence. The clustering patterns and regions were determined by Getis-Ord General G , Getis-Ord Gi* , and Anselin Local Moran’s I. The ordinary least squares regression was used to analyze the relationship between per capita disposable income (PCDI) and KD. Multiple testing in local spatial statistics was controlled using the Benjamini-Hochberg False Discovery Rate (FDR) correction. Additionally, the Geographically Weighted Regression(GWR) model was utilized to illustrate the spatial distribution characteristics of PCDI and KD. The prevalence of KD was 0.70 (95%CI 0.68–0.72) per 10,000 persons, and 613 KD-endemic townships had a prevalence higher than the national average. High prevalence areas exhibited significant spatial clustering, mainly in Shaanxi, Jilin, Inner Mongolia, and Gansu provinces in northern China. GWR identified spatial heterogeneity in the association between KD prevalence and PCDI, with negative associations in Jilin, Heilongjiang, Gansu, and Shaanxi, but a positive association in Inner Mongolia. Townships with a higher KD prevalence were spatially clustered and heterogeneous in terms of economic factors. Hence, geographic patterns should be integrated with clinical surveillance, diagnostic capacity, nutritional indicators, socioeconomic factors, and healthcare accessibility to develop comprehensive strategies for the prevention and control of KD.
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Authors: Xin Zhang, Zidan Guo, Zhifeng Xing, Jinshu Li, Xiuhong Wang, Xiaoyan Wan, Yanling Wang, Zhengjun Yang, Anwei Wang, Jinming Liu, Shuang Zhou, Jing Ma, Jingyang He, Zhongyuan Kan, Xiangdong Zhang, Xin Dai, Suolang Zhaxi, Demei Zhou, Dianjun Sun, Bo Yu, Jie Hou
Institutions: Harbin Medical University, Second Affiliated Hospital of Harbin Medical University, Guiyang Medical University, Chinese Center For Disease Control and Prevention, Taiwan Centers for Disease Control, Hubei Provincial Center for Disease Control and Prevention, Yunnan Institute of Endemic Diseases Control and Prevention, Hebei Provincial Center for Disease Control and Prevention, National Health and Family Planning Commission, Sichuan Center for Disease Control and Prevention, Shanxi Institute of Endemic Diseases, Heilongjiang Center for Tuberculosis Control and Prevention, Shandong Center for Disease Control and Prevention, Institute of Endemic Disease Control in Shandong Province, Gansu Provincial Center for Disease Control and Prevention, Xian Center for Disease Control and Prevention, Inner Mongolia Comprehensive Disease Prevention and Control Center, Henan Provincial Center for Disease Control and Prevention, Shenyang Center for Disease Control and Prevention, Guizhou Center for Disease Control and Prevention