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      Changing trends in the prevalence of anencephaly in Liaoning province of Northeast China from 2006–2015: data from a population-based birth defects registry

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          Abstract

          The goal of this study was to assess the prevalence and trends of anencephaly on the basis of a large population-based cases identified by the Liaoning Birth Defects Registry, which included 14 cities over a 10-year period. Anencephaly prevalence, percent change, average changeand the contribution rates of each city were calculated. Statistical analysis was undertaken on the basis of a Poisson regression model. A total of 1600 anencephaly cases were collected during the observational period (4.92/10,000 live births). On average, the prevalence decreased 10.15% each year; this overall time trend was statistically significant (P<0.01). The top three leading cities were Huludao (10.33 per 10,000 live births), Chaoyang (8.56 per 10,000 live births) and Fuxin (6.36 per 10,000 live births). In contrast, Anshan (2.64 per 10,000 live births), Dalian (2.79 per 10,000 live births) and Yingkou (3.46 per 10,000 live births) were the cities with the lowest prevalence. Of note, significantly decreasing trends were observed in half of these cities (n=7). Additionally, Benxi, Yingkou and Dalian were the major cities contributing to over one third of the decreasing trend in Liaoning province. In conclusion, this study provided evidence of the decreasing prevalence of anencephaly from 2006 to 2015 in Liaoning province. In the future, prevention efforts should be strengthened to further reduce the risk of anencephaly in areas with high rates.

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          Partitioning linear trends in age-adjusted rates.

          Surveillance of chronic diseases includes monitoring trends in age-adjusted rates in the general population. Statistics that are calculated to describe and compare trends include the annual percent change and the percent change for a specified time period. However, it is also of interest to determine the contribution specific diseases make to an overall trend in order to better understand the impact of interventions and changes in the prevalence of risk factors. The objective here is to provide a method for partitioning a linear trend in age-adjusted rates into disease-specific components. The method presented is based on linear regression. The decreasing trend in age-adjusted cancer mortality rates for the total United States during the period 1991-96 is analyzed to illustrate the method. Trends in mortality for cancers of the colon/rectum, breast, lung/bronchus, and prostate are found to be responsible for 75% of the decreasing trend in cancer mortality. It is possible to partition an overall trend in age-adjusted rates under the assumption that it and the trends for all mutually exclusive and exhaustive subgroups of interest are linear.
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            Prevalence and trend of neural tube defects in five counties in Shanxi province of Northern China, 2000 to 2014.

            The prevalence of neural tube defects (NTDs) in northern China is among the highest in the world. A massive folic acid supplementation program as a specific countermeasure was introduced in 2009. Examining trends in NTD prevalence may provide evidence for future intervention.
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              Prevention of neural tube defects with folic acid: The Chinese experience.

              Ai-guo Ren (2015)
              Neural tube defects (NTDs) are a group of congenital malformations of the central nervous system that are caused by the closure failure of the embryonic neural tube by the 28(th) day of conception. Anencephaly and spina bifida are the two major subtypes. Fetuses with anencephaly are often stillborn or electively aborted due to prenatal diagnosis, or they die shortly after birth. Most infants with spina bifida are live-born and, with proper surgical treatment, can survive into adulthood. However, these children often have life-long physical disabilities. China has one of the highest prevalence of NTDs in the world. Inadequate dietary folate intake is believed to be the main cause of the cluster. Unlike many other countries that use staple fortification with folic acid as the public health strategy to prevent NTDs, the Chinese government provides all women who have a rural household registration and who plan to become pregnant with folic acid supplements, free of charge, through a nation-wide program started in 2009. Two to three years after the initiation of the program, the folic acid supplementation rate increased to 85% in the areas of the highest NTD prevalence. The mean plasma folate level of women during early and mid-pregnancy doubled the level before the program was introduced. However, most women began taking folic acid supplements when they knew that they were pregnant. This is too late for the protection of the embryonic neural tube. In a post-program survey of the women who reported folic acid supplementation, less than a quarter of the women began taking supplements prior to pregnancy, indicating that the remaining three quarters of the fetuses remained unprotected during the time of neural tube formation. Therefore, staple food fortification with folic acid should be considered as a priority in the prevention of NTDs.
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                Author and article information

                Journal
                Oncotarget
                Oncotarget
                Oncotarget
                ImpactJ
                Oncotarget
                Impact Journals LLC
                1949-2553
                8 August 2017
                26 April 2017
                : 8
                : 32
                : 52846-52853
                Affiliations
                1 Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
                2 Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
                3 Liaoning Women and Children’s Health Hospital, Shenyang, China
                4 School of Environmental and Chemical Engineering, Shenyang Ligong University, Shenyang, China
                5 Department of Science and Education, Shenyang Women and Children Health Care Centre, Shenyang, China
                6 Department of Children’s Health Prevention, Shenyang Women and Children Health Care Centre, Shenyang, China
                7 Department of Information Statistics, Shenyang Women and Children Health Care Centre, Shenyang, China
                Author notes
                Correspondence to: Qi-Jun Wu, wuqj@ 123456sj-hospital.org
                Article
                17423
                10.18632/oncotarget.17423
                5581075
                28881776
                675ef1dc-120e-4a89-8914-1bbe55f65556
                Copyright: © 2017 Gong et al.

                This article is distributed under the terms of the Creative Commons Attribution License (CC-BY), which permits unrestricted use and redistribution provided that the original author and source are credited.

                History
                : 4 November 2016
                : 22 February 2017
                Categories
                Research Paper

                Oncology & Radiotherapy
                anencephaly,liaoning province,prevalence,time trend
                Oncology & Radiotherapy
                anencephaly, liaoning province, prevalence, time trend

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