中国五省中小学生社区筛查先心病患病率与海拔及民族关系

Associations of altitude and ethnic groups with congenital heart disease prevalence in primary and secondary school students in five provinces of China: a screening data analysis

目的了解中国五省中小学生社区筛查先天性心脏病(先心病)患病率与海拔及民族关系,为社区筛查及防控提供参考依据。方法于2017年4月—2019年12月采用整群抽样方法在云南、西藏、河北、山西、贵州五省16个市、6个州抽取5443所中小学共1952919名6~16岁中小学生进行先心病社区筛查,分析先心病患病率与不同海拔和民族的关系。结果中国五省筛查的1952919名中小学生中,确诊先心病者2874例,先心病患病率为1.47‰;云南、西藏、河北、山西和贵州省中小学生先心病患病率分别为1.49‰、7.64‰、0.77‰、0.69‰和1.02‰,差异有统计学意义(χ2=160.981,P<0.001);海拔<1000、1000~1499、1500~1999和≥2000 m中小学生先心病患病率分别为0.69‰、1.57‰、1.45‰和1.37‰,差异有统计学意义(χ2=26.081,P<0.001);海拔1000~1499 m中景颇族/傣族、哈尼族/彝族和汉族中小学生先心病患病率分别为2.06‰、1.93‰和1.34‰,海拔1500~1999 m中壮族/苗族、彝族、白族和汉族中小学生先心病患病率分别为0.62‰、1.45‰、1.00‰和1.68‰,海拔≥2000 m中傈僳族、藏族和侗族中小学生先心病患病率分别为0.69‰、1.54‰和1.87‰,各海拔中不同民族中小学生先心病患病率差异均有统计学意义(均P<0.05)。结论中国不同地区不同海拔中小学生先心病患病率不同,相同海拔不同民族中小学生先心病患病率亦不同。

Objective To investigate the prevalence of congenital heart disease(CHD) among primary and secondary school students of various ethnic groups and living in regions with different altitude in five provinces of China and to provide evidences for screening and prevention of CHD in communities. Methods Using cluster sampling, We recruited 1 952 919 primary and secondary school students aged 6 – 16 years in 16 municipalities and 6 prefectures of Tibet Autonomous Region(Tibet) and Yunnan, Hebei, Shanxi, Guizhou province and carried out community screenings on CHD among the students from April 2017 through December 2019. CHD cases were diagnosed based on oxyhemoglobin saturation detection and B-mode cardiac ultrasound examination. Results Totally 2 874 CHD cases were diagnosed and the CHD prevalence rate was 1.47‰ for all the students. The highest CHD prevalence rate of 7.64‰ was observed among the students in Tibet,followed by the rates among the students in Yunnan(1.49‰), Guizhou(1.02‰), Hebei(0.77‰), and Shanxi(0.69‰), with a significant difference(χ2 = 160.981, P < 0.001). The CHD prevalence rate differed significantly among the students living in regions at various altitude, with the rates of 0.69‰, 1.57‰, 1.45‰, and 1.37‰ for the students living in regions at the altitudes of < 1 000 m, 1 000 – 1 499 m, 1 500 – 1 999 m, and ≥ 2 000 m, respectively(χ2 = 26.081, P < 0.001). The CHD prevalence rate was also significantly different among the students of various ethnic groups and living in a same regions at a specific altitude;the CHD prevalence rates were 2.06‰, 1.93‰, and 1.34‰ for the students of Jingpo/Dai, Hani/Ni, and Han ethnics living in regions at the altitude of 1 000 – 1 499 m;the CHD prevalence rates were 1.68‰, 1.45‰, 1.00‰, and0.62‰ for the students of Han, Ni, Bai, and Zhuang/Miao ethnics living in regions at the altitude of 1 500 – 1 999 m;and the CHD prevalence rates were 1.87‰, 1.54‰, and 0.69‰ for the students of Dong, Tibetan, and Lisu ethnics living in regions at the altitude of ≥ 2 000 m;all the differences were statistically significant(P < 0.05 for all). Conclusion In China, the prevalence rate of congenital heart disease is different among the primary and secondary school students living in various regions at different altitude;while for the students living in regions with the same altitude, the congenital heart disease prevalence rate differs by ethnic groups.