Assessing Local Determinants of Neural Tube Defects in the Heshun Region, Shanxi Province, China

Abstract

AbstractBackground: Neural tube defect (NTD) prevalence in northern China is among the highest worldwide. Dealingwith the NTD situation is ranked as the number one task in China’s scientific development plan in population andhealth field for the next decade. Physical and social environments account for much of the disease’s occurrence.The environmental determinants and their effects on NTD vary across geographical regions, whereas factors thatplay a significant role in NTD occurrence may be buried by global statistics analysis to a pooled dataset over theentire study area. This study aims at identification of the local determinants of NTD across the study area andexploration of the epidemiological implications of the findings.Methods: NTD prevalence rate is represented in terms of the random field theory, and Rushton’s circle method isused to stabilize NTD rate estimation across the geographical area of interest; NTD determinants are representedby their measurable proxy variables and the geographical weighted regression (GWR) technique is used torepresent the spatial heterogeneity of the NTD determinants.Results: Informative maps of the NTD rates and the statistically significant proxy variables are generated andrigorously assessed in quantitative terms.Conclusions: The NTD determinants in the study area are investigated and interpreted on the basis of the mapsof the proxy variables and the relationships between the proxy variables and the NTD determinants. No singledeterminant was found to dominate the NTD occurrence in the study area. Villages where NTD rates aresignificantly linked to environmental determinants are identified (some places are more closely linked to certainenvironmental factors than others). The results improve current understanding of NTD spread in China and providevaluable information for adequate disease intervention planning.