Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, China; The Third Affiliated Hospital of Harbin Medical University, China.
Int J Cardiol. 2013 Sep 30;168(2):1121-6. doi: 10.1016/j.ijcard.2012.11.046. Epub 2012 Dec 4.
Sentinel surveillance of Keshan disease (KD) is limited by unable to give the prevalence rates and their estimates. This study was to find the national KD prevalence and the estimated patient numbers to provide evidence toward modifying the policy of KD prevention and control.
Using a probability proportional to population size, randomized, multistage, and cluster sampling, we surveyed 101,127, measured grain selenium levels; and surveyed household income with pre-designed questionnaires.
The national prevalence rates of KD, chronic KD and latent KD were 2.21%, 0.50%, and 1.71% respectively. Chronic KD patients are mainly in the provinces where KD had been seriously epidemic. The KD prevalence rate was higher in females (2.20%) than in males (1.98%). These were also higher in older age groups. The cases younger than 30 years accounted for 13.6%, indicating the possibility that KD is still occurring. Nationally, the estimated numbers of KD and chronic KD patients are 1,675,500 (95% CI, 1,608,500-1,747,300) and 379,800 (95% CI, 346,700-412,800) respectively. Multiple logistic regression analysis indicated that family income was a significant dependent variable (OR: -0.258, 95% CI: -0.332 to -0.185, p<0.001). More than 2000 chronic KD patients found in the study were treated in 2009-2011. The limitation of this study was that sampling size was determined at national level.
KD is still a public health issue among the people of the historically severe endemic areas. Selenium supplementation, self-management program for chronic KD patients and translation epidemiology of KD surveillance should be strengthened.
克山病（KD）哨点监测的局限性在于无法给出患病率及其估计值。本研究旨在确定全国 KD 患病率和估计患者人数，为修改 KD 防治政策提供依据。
采用按人口规模大小成比例概率抽样、多阶段、整群随机抽样方法，对 101127 人进行抽样调查，检测粮食硒水平；采用设计好的调查问卷对家庭收入进行调查。
全国 KD、慢性 KD 和潜在 KD 的患病率分别为 2.21%、0.50%和 1.71%。慢性 KD 患者主要集中在 KD 曾严重流行的省份。女性 KD 患病率（2.20%）高于男性（1.98%），且随年龄增长而升高。30 岁以下患者占 13.6%，提示 KD 仍有发生。全国 KD 和慢性 KD 患者估计人数分别为 167.55 万（95%CI：160.85 万174.73 万）和 37.98 万（95%CI：34.67 万41.28 万）。多因素 logistic 回归分析表明，家庭收入是一个显著的依赖变量（OR：-0.258，95%CI：-0.332~-0.185，p<0.001）。研究中发现的 2000 多名慢性 KD 患者在 2009-2011 年得到了治疗。本研究的局限性在于采样规模是在全国层面确定的。
历史重病区人群 KD 仍是一个公共卫生问题。应加强硒补充、慢性 KD 患者自我管理方案和 KD 监测转化流行病学。
