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Gansu, Hebei, Heilongjiang, Henan, Inner Mongolia, Jilin, Liaoning, Qinghai, Shaanxi, Shandong, Shanxi, Sichuan, and Xizang are KBD provinces, forming a narrow strip from northeast to southwest China. More than 16,000 KBD villages are distributed across the 13 provinces. Figure 2 showed the KBD villages in 13 provinces of China. Gansu, Shaanxi, and Jilin provinces have the highest number of villages affected by the disease, all exceeding 3,000; followed by Inner Mongolia and Heilongjiang, with the number of affected villages over 1,000; next in line are Shanxi, Liaoning, Henan, and Sichuan, each with more than 300 affected villages; Hebei, Shandong, Qinghai and Xizang provinces have the least, all with fewer than 100 affected villages.
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During this decade, a total of 21,928 X-ray images were taken, with 175–375 individuals underwentb examination annually. Statistics were prepared according to the metaphyseal, epiphyseal, and carpal parts, respectively, and the positive rate was summarized. At the national level, the KBD X-ray detection rate decreased from 21.01% in 1990 to 7.75% in 1999.
Changes in the monitoring results can be summarized into four cases: 1) the X-ray detection rate among children in Beijing and Henan stayed very low, under 2% throughout the study period; 2) in Hebei and Jilin, the X-ray detection rate was under 10% in 1990, and decreased to under 2% in 1999; 3) in the Heilongjiang, Inner Mongolia, and Shaanxi provinces, areas severely affected by KBD, the detection rates were above 30% in 1990, but dropped significantly with time; 4) and in active areas found in the Sichuan and Qinghai provinces in the west of China, the X-ray detection rate remained above 10% (above 30% in Sichuan). Detailed information about the prevalence of KBD endemic provinces in different years is shown in Table 1.
Province 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Beijing − − − − − − − − − 1.71 Gansu 22.69 20.85 18.89 10.13 5.24 3.85 4.02 1.05 1.02 0.84 Hebei 5.48 2.85 2.84 2.88 1.83 1.35 1.12 1.12 0 0.98 Heilongjiang 30.04 21.65 22.12 19.03 12.58 8.64 5.53 4.76 3.23 3.54 Henan − − − − 2.13 0.81 0.74 0.75 1.36 1.45 Inner Mongolia 45.82 44.12 65.27 31.27 27.05 32.26 9.59 12.57 10.39 12.81 Jilin 1.79 1.54 4.46 1.74 1.20 0.94 0.49 1.45 0.92 0.47 Qinghai − − − − 27.59 30.08 26.82 15.10 13.84 12.62 Shaanxi 54.86 38.73 44.59 21.68 23.35 3.08 0.75 0.68 0 1.02 Shanxi 1.69 4.24 2.058 1.15 0.84 5.23 11.09 6.83 4.51 5.35 Sichuan 4.72 5.36 5.75 1.48 11.35 37.31 39.53 31.45 25.59 35.16 Total (n/N) 21.01
(375/1,782)17.67
(334/1,890)21.84
(382/1,749)12.21
(217/1,777)13.75
(357/2,579)14.93
(336/2,251)12.39
(324/2,614)9.25
(211/2,282)7.51
(175/2,329)7.75
(206/2,657)Note. −: there is no data; n/N: number of X-ray positive children/number of children examined. Table 1. X-ray detectable rate of children in all provinces from 1990 to 1999 (%)
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During this 8-year period, the national KBD X-ray detection rate decreased from 12.61% to 4.21%, achieving the control standards at the national level (5%). In 2000, the Qinghai province had a detection rate above 30% (36.78%). The X-ray detection rates in inner Mongolia, Shaanxi, and Xizang were 21.43%, 28.26%, and 21.19, respectively, which were all above 20%. By 2007, the X-ray detection rate of all the other provinces, except Qinghai (19.89%) and Inner Mongolia (7.33%), was below 5%. Detailed information about the year-wise prevalence of KBD in the 13 endemic provinces is shown in Table 2.
Province 2000 2001 2002 2003 2004 2005 2006 2007 Beijing − 0 2.51 0 1.67 2.46 4.95 2.19 Gansu 13.11 24.76 17.43 10.55 6.30 15.87 8.82 4.41 Hebei 0.95 0 0.42 0 0 0.50 1.97 0.42 Heilongjiang 2.19 3.13 2.43 3.98 5.22 1.46 3.67 3.45 Henan 0 0 0 0 0 0 3.79 1.37 Inner Mongolia 21.43 5.43 3.47 6.48 7.08 4.69 9.95 7.33 Jilin 1.45 0 2.53 2.44 1.28 1.50 1.83 1.00 Liaoning − − − 0 − − 0 1.50 Qinghai 36.78 26.01 34.32 29.79 26.76 18.33 24.51 19.89 Shaanxi 28.26 23.83 17.49 17.41 12.92 5.76 4.13 3.32 Shandong 0.57 − − 2.69 1.53 1.89 2.06 − Shanxi 0.93 0 0 0.30 2.48 0.48 3.53 2.45 Sichuan 5.63 3.17 2.48 3.94 2.40 3.14 3.24 4.05 Xizang 29.19 40.87 33.86 27.33 20.08 − − − Total (n/N) 12.61
(374/2,965)10.05
(250/2,488)11.47
(218/2,772)6.89
(202/2,931)6.94
(196/2,823)5.21
(119/2,284)5.53
(146/2,642)4.21
(108/2,566)Note. −: there is no data; n/N: number of X-ray positive children/number of children examined. Table 2. X-ray detectable rate of children in all provinces from 2000 to 2007 (%)
The monitoring results can be summarized as follows: 1) when monitoring began, the detection rate which was 10% or less in the ward did not change, and remained at control levels, e.g., Beijing and Hebei; 2) the serious, moderate illness areas at the beginning of monitoring, such as Gansu, Shaanxi, Inner Mongolia, and Heilongjiang, achieved the controlled levels (5%); 3) Qinghai, with seriously affected areas in the 1990s, and Xizang, with the additional wards in 2000, became moderately affected areas.
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The prevalence of KBD in Inner Mongolia (8.23%), Xizang (5.40%), and Qinghai (7.14%) reduced in 2008; however, it was higher than that specified by the controlled criteria (5%). By 2010, the prevalence in all KBD provinces was less than 5% but higher than 1% in Inner Mongolia (2.23%), Liaoning (2.49%), Sichuan (1.07%), Xizang (4.51%), Gansu (1.17%), and Qinghai (4.67%). The prevalence has been less than 1% in the other KBD provinces except for Xizang and Qinghai since 2011. Detailed information about the year-wise prevalence of KBD in the 13 endemic provinces is shown in Table 3.
Province 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Gansu 3.66 1.17 0.40 0.61 0.14 0.22 0.16 0.22 0.06 0.24 0.25 Hebei 1.05 0 0.91 0 0.12 − 0.03 − 0 0 0 Heilongjiang 2.11 0 0.05 0.07 0.01 0.11 0.07 0.13 0.04 0.01 0.03 Henan 0.99 0 0 0 0.16 − 0.15 − 0.08 0 0 Inner Mongolia 8.23 2.23 0.92 0 0.57 0.90 0.46 0.51 0.59 0.57 0.05 Jilin 1.89 0.74 0.47 0.19 0.22 0.27 0.28 0.25 0 0.13 0.06 Liaoning 1.53 2.49 0.26 0 0 − 0 − 0 0 0 Qinghai 7.14 4.67 0.85 0.91 1.32 1.68 1.39 1.28 0.97 0 0 Shaanxi 0.23 0.53 0.45 0 0.01 0 0 0.01 0.05 0.08 0.08 Shandong 0.94 − − − 0.93 − 0.69 − 0.22 − 0 Shanxi 0.83 0.25 0 0 0.06 0.05 0 0 0 0 0 Sichuan 2.69 1.07 0.47 0.69 0.09 0.23 0.27 0 0 0.12 0 Xizang 5.40 4.51 - 0.75 1.70 0.67 2.31 0.03 0.01 0.07 0 Total (n/N) 3.32
(516/
1,5551)1.64
(224/
13,364)0.38
(36/
9,536)0.36
(45/
12,580)0.17 (191/
115,529)0.22 (185/
83,080)0.21 (217/
104,561)0.13 (140/
103,822)0.07
(49/
67,461)0.12
(70/
57,838)0.06
(39/
63,635)Note. −: there is no data; n/N: number of X-ray positive children/number of children examined. Table 3. X-ray detectable rate of children in all provinces from 2008 to 2018 (%)
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From 2019 to 2023, 13 provinces in the country conducted clinical examinations of children aged 7–12 in all KBD villages. Suspicious cases of children with clinical positive signs of suspected KBD were subjected to bilateral hand X-ray examination. In 2019, clinical examinations were conducted on 823,000 children, among whom 869 children showed signs of KBD such as thickening of bones and joint deformation, but all cases were ruled out through x-ray examination. Therefore, starting from 2019, the detection rate of KBD in children in all village nationwide has been zero and no cases were detected in the next 3 years.
Number of KBD examined children in all provinces from 2019 to 2023 shown in Table 4.
Province 2019 2020 2021 2022 2023 Nc Nx N Nc Nx N Nc Nx N Nc Nx N Nc Nx N Gansu 241,738 301 0 263,805 0 0 257,786 262 0 250,130 0 0 234,997 28 0 Hebei 3,754 0 0 2,516 4 0 2,113 0 0 1,835 0 0 1,714 0 0 Heilongjiang 76,062 13 0 69,437 0 0 60,994 0 0 56,046 0 0 48,902 0 0 Henan 11,644 5 0 12,588 0 0 13,349 0 0 12,806 0 0 10,499 0 0 Inner Mongolia 70,535 0 0 58,197 17 0 69,536 4 0 65,872 0 0 49,527 0 0 Jilin 117,204 486 0 115,230 80 0 102,749 35 0 95,588 41 0 88,690 51 0 Liaoning 32,683 30 0 31,629 67 0 31,838 95 0 30,317 56 0 27,286 42 0 Qinghai 1,025 0 0 1,028 0 0 927 0 0 1,583 32 0 1,128 0 0 Shaanxi 213,904 34 0 201,688 0 0 195,630 0 0 195,850 0 0 187,834 0 0 Shandong 319 0 0 273 0 0 228 0 0 295 0 0 287 0 0 Shanxi 16,966 0 0 15,645 0 0 13,174 0 0 11,843 0 0 11,251 0 0 Sichuan 22,693 0 0 22,521 21 0 17,689 2 0 17,553 1 0 18,190 7 0 Xizang 14,838 0 0 24,429 14 0 20,154 0 0 8,083 0 0 28,565 0 0 Total 823,365 869 0 827,986 203 0 786,167 398 0 747,801 130 0 708,870 128 0 Note. Nc: Number of clinically examined children; Nx: Number of X-ray examined children; N: Number of KBD children. KBD, Kashin-Beck disease. Table 4. Number of KBD examined children in all provinces from 2019 to 2023
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The detected rate of KBD in the western region of China is consistently higher than that in the eastern region (Eastern China: Hebei, Heilongjiang, Henan, Jilin, Liaoning, Shandong, Shanxi; Western China: Gansu, Inner Mongolia, Qinghai, Shaanxi, Sichuan, Xizang) (Figure 3). The detection rate of KBD in the eastern region has been reduced to less than 10% since 1994 and has remained below 5% since 1995. While the rate in western provinces dropped to less than 10% in 2005 and to less than 5% in 2008, at present, the detection rate in both the eastern and western regions is 0.
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We used the number of adult KBD patients in each county in 2023 divided by the population of the epidemic village to calculate the prevalence rate for further analysis. The results of global spatial autocorrelation analysis indicated a spatial clustering of adult patients prevalence rate in the KBD areas. Moran’s I was 0.106 (Z = 10.038, P < 0.001) indicated a positive spatial correlation, with larger values indicating clearer spatial correlation.
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Local spatial autocorrelation analysis Getis-Ord Gi* was used for local spatial autocorrelation analysis (Z = 8.341, P < 0.001). In 2023, there was one hot spot and one cold spots (Figure 4). The hotspots are clustered in the southwest region of China, mainly including some districts in province Xizang, Sichuan, Qinghai, Gansu, Shaanxi, indicating a wider range of hot spots and higher KBD prevalence rate. The cold pots are clustered in the northeast region of China, including some districts in province Heilongjiang, Jilin, Liaoning, indicating a wider range of cold spots and lower KBD prevalence rate.
Summary Analysis of National Surveillance on Kashin-Beck Disease from 1990 to 2023
doi: 10.3967/bes2024.109
- Received Date: 2023-11-28
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Key words:
- Kashin-Beck disease /
- Geographic Information System /
- National surveillance /
- X-ray detective rate
Abstract:
&These authors contributed equally to this work.
Citation: | Silu Cui, Hui Liu, Junrui Pei, Jiaxin Li, Zhe Jiao, Qing Deng, Ning Liu, Yanhong Cao, Jun Yu. Summary Analysis of National Surveillance on Kashin-Beck Disease from 1990 to 2023[J]. Biomedical and Environmental Sciences, 2024, 37(9): 1056-1066. doi: 10.3967/bes2024.109 |