Abstract
To assess the birth prevalence and spatial distribution of congenital heart disease (CHD) in China by conducting a complete overview and using spatial epidemiological methods. Unrestricted searches were conducted on seven electronic databases, with an end-date parameter of May 2019. Data on the birth prevalence of CHD and its subtypes were collected and combined using either the random-effect model or fixed-effect model. Subgroup sensitivity analyses were performed to explore potential heterogeneity moderators. The three-dimensional trend analysis and a visualization of CHD birth prevalence among different provinces were performed to describe the spatial distribution characteristics. Total 617 studies involving 76,961,354 births and 201,934 CHD individuals were included. Overall, total CHD birth prevalence increased continuously over time, from 0.201‰ in 1980–1984 to 4.905‰ in 2015–2019. The study on the high-income provinces, population-based monitoring model, male births, and urban regions reported a significantly higher prevalence of total CHD compared with upper-middle-income provinces, hospital-based monitoring model, female births, and rural regions, respectively. National CHD birth prevalence increased gradually from western region to eastern region, but decreased gradually from southern to northern region. Relevant heterogeneity moderators including gender, geographic region, income levels, and monitoring models have been identified by subgroup analyses. Sensitivity analysis yielded consistent results. Total CHD birth prevalence in China increases continuously in the past 40 years. Significant differences in gender, geographical regions, income levels, and monitoring models were found. In the future, population wide prospective birth defect registries covering the entire Chinese population need to determine the exact birth prevalence.
Highlights
Congenital heart disease (CHD) is typically defined as clinically significant structural heart and/or great vessels disease present at birth [1]
All included studies belonged to high quality studies, and monitored the occurrence of CHD according to the requirement of China Birth Defect Monitoring Scheme (CBDMS)
The included studies involved in 32 provinces, autonomous regions or municipalities of China; of these, 325 studies (50.23%) were conducted in eastern region, 154 (23.80%) in western region, 385 (59.51%) in southern region, 260 (40.19%) in northern region, 116 (17.93%) in central region, and 50 (7.73%) in northeastern region
Summary
Congenital heart disease (CHD) is typically defined as clinically significant structural heart and/or great vessels disease present at birth [1]. CHD is the most common congenital anomalies worldwide, accounting for nearly one-third of all major congenital anomalies, and resulting in a huge health, social, and economic burden [2]. The prognosis and life quality of children with CHD continues to improve with innovative medical techniques, the effects of CHD on children are still lifelong. In order to effectively reduce the burden of CHD and to guide policy and advocacy efforts, accurate data on the CHD birth prevalence are needed. According to the statistics from Ministry of Health of China in 2012, CHD accounts for 40.95% of all birth defects in China [3]. There may be a significant disease burden of CHD in China.
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