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Llamosas-Falcón L, Bermejo-Sánchez E, Sánchez-Díaz G, Villaverde-Hueso A, Posada de la Paz M, Alonso-Ferreira V. Tetralogy of Fallot in Spain: a nationwide registry-based mortality study across 36 years. Orphanet J Rare Dis 2019; 14:79. [PMID: 30961612 PMCID: PMC6454694 DOI: 10.1186/s13023-019-1056-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart defect. TOF mortality has fallen remarkably in recent years due to therapeutic advances. Accordingly, the aim of this study was to assess temporal and spatial variability in TOF-related mortality in Spain across the period 1981-2016, using data drawn from the nationwide population-based registry. METHODS Annual deaths due to TOF were sourced from the Spanish National Institute of Statistics database by reference to International Classification of Diseases (ICD), 9th and 10th Revision codes, namely, ICD-9 code 745.2 (period 1981-1998) and ICD-10 code Q21.3 (period 1999-2016). Age-specific and age-adjusted mortality rates were calculated, as were standardised mortality ratios (SMRs) by province, district and municipality for the period 1999-2016. RESULTS A total of 1035 deaths were attributed to TOF (57.78% of them were men and 42.22% were women). The age-adjusted mortality rate ranged from 0.75 per 1,000,000 inhabitants (95% confidence interval [CI]: 0-1.36) in 1981 to 0.03 per 1,000,000 (95% CI: 0.01-0.06) in 2016 for both sexes. In 2011, there was a change in the mortality trend, with a significant decrease of 49.22% per year (p < 0.001). In terms of geographical analysis, some areas with a significantly higher risk of TOF mortality were identified in the south of Spain, though no specific spatial pattern was in evidence. CONCLUSION The decrease in TOF mortality may be related to improvements in diagnostic and treatment techniques. More studies are needed to analyse regions with a higher mortality risk, in order to improve medical planning and resource allocation, and identify risk factors and preventive measures.
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Affiliation(s)
- Laura Llamosas-Falcón
- Preventive Medicine and Public Health, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Eva Bermejo-Sánchez
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Germán Sánchez-Díaz
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
- Department of Geology, Geography and Environmental Sciences, University of Alcala, 28801 Alcalá de Henares, Spain
| | - Ana Villaverde-Hueso
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
| | - Manuel Posada de la Paz
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
| | - Verónica Alonso-Ferreira
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
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Pérez-Lescure Picarzo J, Mosquera González M, Latasa Zamalloa P, Crespo Marcos D. Incidence and evolution of congenital heart disease in Spain from 2003 until 2012. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ma LG, Chen QH, Wang YY, Wang J, Ren ZP, Cao ZF, Cao YR, Ma X, Wang BB. Spatial pattern and variations in the prevalence of congenital heart disease in children aged 4-18 years in the Qinghai-Tibetan Plateau. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 627:158-165. [PMID: 29426137 DOI: 10.1016/j.scitotenv.2018.01.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/19/2018] [Accepted: 01/19/2018] [Indexed: 05/28/2023]
Abstract
PURPOSE This study aimed to investigate the spatial distribution pattern of the prevalence of congenital heart disease (CHD) in children in Qinghai-Tibetan Plateau (QTP), a high-altitude region in China. METHODS Epidemiological data from a survey on the prevalence of CHD in Qinghai Province including 288,066 children (4-18 years) were used in this study. The prevalence and distribution pattern of CHD was determined by sex, CHD subtype, and nationality and altitude. Spatial pattern analysis using Getis-Ord Gi⁎ was used to identify the spatial distribution of CHD. Bayesian spatial binomial regression was performed to examine the relationship between the prevalence of CHD and environmental risk factors in the QTP. RESULTS The prevalence of CHD showed a significant spatial clustering pattern. The Tibetan autonomous prefecture of Yushu (average altitude > 4000 m) and the Mongolian autonomous county of Henan (average altitude > 3600 m) in Huangnan had the highest prevalence of CHD. Univariate analysis showed that with ascending altitude, the total prevalence of CHD, that in girls and boys with CHD, and that of the subtypes PDA and ASD increasing accordingly. Thus, environmental factors greatly contributed to the prevalence of CHD. CONCLUSIONS The prevalence of CHD shows significant spatial clustering pattern in the QTP. The CHD subtype prevalence clustering pattern has statistical regularity which would provide convenient clues of environmental risk factors. Our results may provide support to make strategies of CHD prevention, to reduce the incidence of CHD in high altitude regions of China.
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Affiliation(s)
- Li-Guang Ma
- National Research Institute for Family Planning, Beijing 100081, PR China; Beijing GIStone Information Technology Co Ltd., Beijing 100101,PR China
| | - Qiu-Hong Chen
- Central Laboratory, Qinghai Cardiovascular Diseases Vocational Hospital, Xining, Qinghai 810012, PR China.
| | - Yuan-Yuan Wang
- National Research Institute for Family Planning, Beijing 100081, PR China
| | - Jing Wang
- Department of Medical Genetics and Developmental Biology, School of Medical Basic, Capital Medical University, Beijing 100069, PR China
| | - Zhou-Peng Ren
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, PR China
| | - Zong-Fu Cao
- National Research Institute for Family Planning, Beijing 100081, PR China
| | - Yan-Rong Cao
- Beijing GIStone Information Technology Co Ltd., Beijing 100101,PR China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing 100081, PR China; Peking Union Medical College, Beijing 100730, PR China.
| | - Bin-Bin Wang
- National Research Institute for Family Planning, Beijing 100081, PR China; Peking Union Medical College, Beijing 100730, PR China.
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Pérez-Lescure Picarzo J, Mosquera González M, Latasa Zamalloa P, Crespo Marcos D. [Incidence and evolution of congenital heart disease in Spain from 2003 until 2012]. An Pediatr (Barc) 2018; 89:294-301. [PMID: 29605620 DOI: 10.1016/j.anpedi.2017.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Congenital heart disease (CHD) represents the most common congenital malformation. The objective of this study was to analyse the incidence of CHD in Spain, and it is the first nationwide study so far. METHODS A retrospective observational study was performed in order to evaluate the incidence of CHD in Spain. The administrative database (minimum basic data set) from 2003 to 2012 was analysed in children less than one year old admitted to hospital with codes of CHD (International Classification of Diseases, 9th Revision, clinical modification). Cumulative incidence, Incidence relative risk, and standardised incidence ratio were calculated to study geographic variations. RESULTS There were 64,831 infants with CHD among the 4,766,325 births analysed during the period studied, with an incidence of 13.6‰. The incidence excluding atrial septal defect was 7.29 ‰.The most frequent CHD were atrial septal defect (6.31‰), ventricular septal defect (3.48‰), patent ductus arteriosus (2.71‰), coarctation of the aorta (0.55‰), pulmonary stenosis (0.50‰), transposition of the great arteries (0.49‰), atrioventricular septal defect (0.45‰), and tetralogy of Fallot (0.41‰). Castilla and Leon, together with Extremadura, showed the highest risks for severe and very severe CHD, while Madrid and Cantabria showed the lowest. CONCLUSIONS An increase of mild CHD was observed during the period analysed. This could have been influenced by improvements in diagnostic techniques, extended use of echocardiography, and the International Classification of Diseases, 9th Revision, clinical modification coding system, and to a decrease in very severe CHD, which is less influenced by external factors. Significant geographical differences were found in the incidence of severe and very severe CHD.
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Affiliation(s)
- Javier Pérez-Lescure Picarzo
- Cardiología Infantil, Área de Pediatría y Neonatología, Hospital Universitario Fundación Alcorcón, Madrid, España.
| | | | - Pello Latasa Zamalloa
- Subdirección de Epidemiología, Dirección General de Salud Pública, Departamento de Salud, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - David Crespo Marcos
- Cardiología Infantil, Área de Pediatría y Neonatología, Hospital Universitario Fundación Alcorcón, Madrid, España
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Cavero-Carbonell C, Gimeno-Martos S, Páramo-Rodríguez L, Rabanaque-Hernández MJ, Martos-Jiménez C, Zurriaga Ó. Drugs use in pregnancy in the Valencia Region and the risk of congenital anomalies. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2016.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Consumo de medicamentos en el embarazo y riesgo de anomalías congénitas en la Comunitat Valenciana. An Pediatr (Barc) 2017; 87:135-142. [DOI: 10.1016/j.anpedi.2016.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/30/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022] Open
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Gimeno-Martos S, Cavero-Carbonell C, López-Maside A, Bosch-Sánchez S, Martos-Jiménez C, Zurriaga O. Chromosomal anomalies: The experience of the Congenital Anomalies Registry of the Valencia Region. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Páramo-Rodríguez L, Mas Pons R, Cavero-Carbonell C, Martos-Jiménez C, Zurriaga Ó, Barona Vilar C. A corazón abierto: vivencias de madres y padres de menores con anomalías congénitas cardiacas. GACETA SANITARIA 2015; 29:445-50. [DOI: 10.1016/j.gaceta.2015.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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[Chromosomal anomalies: The experience of the Congenital Anomalies Registry of the Valencia Region]. An Pediatr (Barc) 2015; 84:203-10. [PMID: 26526828 DOI: 10.1016/j.anpedi.2015.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the temporal trend and distribution of chromosomal congenital abnormalities (CA) in the Valencia Region, in less than one year olds, during the period 2007-2011. METHODOLOGY Live births, still births and termination of pregnancy due to foetal anomaly between 2007 and 2011 with chromosomal CA (Q90-Q99.9 codes of the 10th International Classification of Diseases -British Paediatric Association) were selected from the CA population-based Registry of Valencia Region The prevalence per 10,000 births for the chromosomal CA and for the different types of chromosomal syndromes with 95% confidence intervals was calculated. The analysis was performed by calculating prevalences and data were compared using Pearson Chi-squared test. RESULTS A total of 895 cases were found, representing a prevalence of 33.5 per 10,000 births (95% CI: 31.0-35.9), highlighting five syndromes: Down's, Edward's, Patau, Turner and Klinefelter. The prevalence of chromosomal CA and Down's syndrome were stable over the period, except in 2010. Down's was the most frequent chromosomal CA (67% of the cases), and the most frequent termination of pregnancy type was for foetal anomaly (69%). Cardiac heart defects represented 70.3% of the associated congenital anomalies. Mothers of children with chromosomal CA were mainly Spanish (73.3%). The age group of mothers over 39 years had a higher prevalence (133.0 per 10,000 births). The province of Castellón had the highest prevalence, 39.1 per 10,000 births. CONCLUSIONS The prevalence has remained stable over the five years, excluding the significant decline in 2010, for chromosomal CA detected and two of the major syndromes. The chromosomal CA are an important public health problem as they represent 15% of all CA identified in the Valencia Region, and agrees with the European data.
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Ma LG, Zhao J, Ren ZP, Wang YY, Peng ZQ, Wang JF, Ma X. Spatial patterns of the congenital heart disease prevalence among 0- to 14-year-old children in Sichuan Basin, P. R China, from 2004 to 2009. BMC Public Health 2014; 14:595. [PMID: 24924350 PMCID: PMC4073187 DOI: 10.1186/1471-2458-14-595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 05/15/2014] [Indexed: 01/21/2023] Open
Abstract
Background Congenital heart disease (CHD) is the most common type of major birth defects in Sichuan, the most populous province in China. The detailed etiology of CHD is unknown but some environmental factors are suspected as the cause of this disease. However, the geographical variations in CHD prevalence would be highly valuable in providing a clue on the role of the environment in CHD etiology. Here, we investigate the spatial patterns and geographic differences in CHD prevalence among 0- to 14-year-old children, discuss the possible environmental risk factors that might be associated with CHD prevalence in Sichuan Basin from 2004 to 2009. Methods The hierarchical Bayesian model was used to estimate CHD prevalence at the township level. Spatial autocorrelation statistics were performed, and a hot-spot analysis with different distance thresholds was used to identify the spatial pattern of CHD prevalence. Distribution and clustering maps were drawn using geographic information system tools. Results CHD prevalence was significantly clustered in Sichuan Basin in different spatial scale. Typical hot/cold clusters were identified, and possible CHD causes were discussed. The association between selected hypothetical environmental factors of maternal exposure and CHD prevalence was evaluated. Conclusions The largest hot-spot clustering phenomena and the CHD prevalence clustering trend among 0- to 14-year-old children in the study area showed a plausibly close similarity with those observed in the Tuojiang River Basin. The high ecological risk of heavy metal(Cd, As, and Pb)sediments in the middle and lower streams of the Tuojiang River watershed and ammonia–nitrogen pollution may have contribution to the high prevalence of CHD in this area.
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Affiliation(s)
| | | | | | | | | | | | - Xu Ma
- National Research Institute for Family Planning, Beijing 100081, People's Republic of China.
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