Center for Clinical Big Data and Statistics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
Center for Clinical Big Data and Statistics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; School of Public Health, Zhejiang University School of Medicine, Hangzhou, China; International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China.
Lancet Child Adolesc Health. 2024 Dec;8(12):872-881. doi: 10.1016/S2352-4642(24)00260-8. Epub 2024 Oct 30.
Childhood hypertension is a growing health concern in China. Accurate estimation of prevalence is essential but challenging due to the variability of blood pressure and the need for multiple occasions for confirmation. This study aimed to estimate the national, regional, and provincial prevalence of childhood hypertension in China in 2020.
For this systematic review and modelling study, we did a comprehensive literature search of epidemiological studies reporting the prevalence of elevated blood pressure (EBP) or hypertension among Chinese children (aged 18 years or younger) that were published between Jan 1, 1990 and June 20, 2024 in PubMed, Embase, MEDLINE, China National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database. EBP was defined as blood pressure greater than or equal to the 95th percentile on a single occasion, and childhood hypertension as blood pressure greater than or equal to the 95th percentile consistently across three occasions. First, we estimated the prevalence of childhood EBP using a multi-level mixed-effects meta-regression and the pooled odds ratios (ORs) for factors associated with childhood EBP through random-effects meta-analysis. Second, the ratio of childhood EBP to childhood hypertension was calculated via random-effects meta-analysis, based on which the national and regional prevalence of childhood hypertension was imputed. Finally, we derived the provincial prevalence of childhood hypertension using an associated factor-based model. The review protocol was registered in PROSPERO (CRD42024537570).
We identified 8872 records, of which 134 articles covering 22 431 861 children were included. In 2020, the overall prevalence of hypertension among Chinese children aged 6-18 years was 3·11% (95% CI 2·35-4·04), equivalent to 6·80 million (5·13-8·83) affected children. The prevalence of childhood hypertension ranged from 2·25% (1·54-2·75) for children aged 6 years to 2·01% (1·36-3·37) for those aged 18 years, peaking at 3·84% (2·97-4·94) for those aged 14 years. The overall prevalence was higher in boys (3·34% [2·53-4·35]) than in girls (2·85% [2·13-3·69]). Associations between four factors (overweight, obesity, salted food intake, and family history of hypertension) and childhood EBP were graded as highly suggestive evidence.
This study reveals substantial regional and provincial variations in the prevalence of childhood hypertension in China. Our findings could inform targeted public health initiatives and optimise resource allocation to address this public health concern.
This study was supported by the National Natural Science Foundation of China (72104211 and 82273654) and the Chao Kuang Piu High-tech Development Fund (2022RC019).
For the Chinese translation of the abstract see Supplementary Materials section.
儿童高血压是中国日益严重的健康问题。准确估计患病率至关重要，但由于血压的可变性和多次确认的需要，这具有挑战性。本研究旨在估计 2020 年中国儿童高血压的全国、地区和省级患病率。
本系统评价和建模研究对 1990 年 1 月 1 日至 2024 年 6 月 20 日期间在 PubMed、Embase、MEDLINE、中国国家知识基础设施、万方数据和中国科技期刊数据库中发表的报道中国儿童（年龄 18 岁以下）血压升高（EBP）或高血压患病率的流行病学研究进行了全面文献检索。EBP 定义为单次血压大于或等于第 95 百分位数，而儿童高血压则定义为连续三次血压大于或等于第 95 百分位数。首先，我们使用多水平混合效应荟萃回归估计儿童 EBP 的患病率，并通过随机效应荟萃分析计算与儿童 EBP 相关的因素的汇总比值比（OR）。其次，基于随机效应荟萃分析计算 EBP 与高血压的比值，根据该比值推断儿童高血压的全国和地区患病率。最后，我们使用相关因素模型推导出儿童高血压的省级患病率。该综述方案已在 PROSPERO（CRD42024537570）中注册。
我们共确定了 8872 条记录，其中纳入了 134 篇文章，涵盖了 22431861 名儿童。2020 年，中国 6-18 岁儿童高血压总患病率为 3.11%（95%CI 2.35-4.04），相当于 680 万（513-883）名患病儿童。儿童高血压患病率从 6 岁儿童的 2.25%（1.54-2.75）到 18 岁儿童的 2.01%（1.36-3.37）不等，14 岁儿童的患病率最高，为 3.84%（2.97-4.94）。男孩（3.34%[2.53-4.35]）的总患病率高于女孩（2.85%[2.13-3.69]）。超重、肥胖、摄入咸食和高血压家族史等四个因素与儿童 EBP 的关联被归类为高度提示性证据。
本研究揭示了中国儿童高血压患病率存在显著的地区和省级差异。我们的研究结果可以为有针对性的公共卫生措施提供信息，并优化资源配置，以应对这一公共卫生问题。
本研究得到了国家自然科学基金（72104211 和 82273654）和赵匡彪高科技发展基金（2022RC019）的支持。
