Spatial pattern and variations in the prevalence of congenital heart disease in children aged 4-18 years in the Qinghai-Tibetan Plateau

Sci Total Environ. 2018 Jun 15;627:158-165. doi: 10.1016/j.scitotenv.2018.01.194. Epub 2018 Feb 3.


Purpose: This study aimed to investigate the spatial distribution pattern of the prevalence of congenital heart disease (CHD) in children in Qinghai-Tibetan Plateau (QTP), a high-altitude region in China.

Methods: Epidemiological data from a survey on the prevalence of CHD in Qinghai Province including 288,066 children (4-18 years) were used in this study. The prevalence and distribution pattern of CHD was determined by sex, CHD subtype, and nationality and altitude. Spatial pattern analysis using Getis-Ord Gi was used to identify the spatial distribution of CHD. Bayesian spatial binomial regression was performed to examine the relationship between the prevalence of CHD and environmental risk factors in the QTP.

Results: The prevalence of CHD showed a significant spatial clustering pattern. The Tibetan autonomous prefecture of Yushu (average altitude > 4000 m) and the Mongolian autonomous county of Henan (average altitude > 3600 m) in Huangnan had the highest prevalence of CHD. Univariate analysis showed that with ascending altitude, the total prevalence of CHD, that in girls and boys with CHD, and that of the subtypes PDA and ASD increasing accordingly. Thus, environmental factors greatly contributed to the prevalence of CHD.

Conclusions: The prevalence of CHD shows significant spatial clustering pattern in the QTP. The CHD subtype prevalence clustering pattern has statistical regularity which would provide convenient clues of environmental risk factors. Our results may provide support to make strategies of CHD prevention, to reduce the incidence of CHD in high altitude regions of China.

Keywords: Congenital heart disease; Environmental risk factor; Qinghai-Tibetan Plateau; Spatial pattern and distribution.

MeSH terms

  • Adolescent
  • Altitude
  • Bayes Theorem
  • Child
  • Child, Preschool
  • China / epidemiology
  • Environmental Exposure / statistics & numerical data
  • Female
  • Heart Diseases / congenital
  • Heart Diseases / epidemiology*
  • Humans
  • Male
  • Prevalence
  • Tibet