Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies

Yingjuan Liu, Sen Chen, Liesl Zühlke, Graeme C Black, Mun-Kit Choy, Ningxiu Li, Bernard D Keavney, Yingjuan Liu, Sen Chen, Liesl Zühlke, Graeme C Black, Mun-Kit Choy, Ningxiu Li, Bernard D Keavney

Abstract

Background: Globally, access to healthcare and diagnostic technologies are known to substantially impact the reported birth prevalence of congenital heart disease (CHD). Previous studies have shown marked heterogeneity between different regions, with a suggestion that CHD prevalence is rising globally, but the degree to which this reflects differences due to environmental or genetic risk factors, as opposed to improved detection, is uncertain. We performed an updated systematic review to address these issues.

Methods: Studies reporting the birth prevalence of CHD between the years 1970-2017 were identified from searches of PubMed, EMBASE, Web of Science and Google Scholar. Data on the prevalence of total CHD and 27 anatomical subtypes of CHD were collected. Data were combined using random-effect models. Subgroup and meta-regression analyses were conducted, focused on geographical regions and levels of national income.

Results: Two hundred and sixty studies met the inclusion criteria, encompassing 130 758 851 live births. The birth prevalence of CHD from 1970-2017 progressively increased to a maximum in the period 2010-17 of 9.410/1000 [95% CI (confidence interval) 8.602-10.253]. This represented a significant increase over the fifteen prior years (P = 0.031). The change in prevalence of mild CHD lesions (ventricular septal defect, atrial septal defect and patent ductus arteriosus) together explained 93.4% of the increased overall prevalence, consistent with a major role of improved postnatal detection of less severe lesions. In contrast the prevalence of lesions grouped together as left ventricular outflow tract obstruction (which includes hypoplastic left heart syndrome) decreased from 0.689/1000 (95% CI 0.607-0.776) in 1995-99, to 0.475/1000 (95% CI 0.392-0.565; P = 0.004) in 2010-17, which would be consistent with improved prenatal detection and consequent termination of pregnancy when these very severe lesions are discovered. There was marked heterogeneity among geographical regions, with Africa reporting the lowest prevalence [2.315/1000 (95% CI 0.429-5.696)] and Asia the highest [9.342/1000 (95% CI 8.072-10.704)].

Conclusions: The reported prevalence of CHD globally continues to increase, with evidence of severe unmet diagnostic need in Africa. The recent prevalence of CHD in Asia for the first time appears higher than in Europe and America, where disease ascertainment is likely to be near-complete, suggesting higher genetic or environmental susceptibility to CHD among Asian people.

Keywords: Congenital heart disease; geographical region; meta-analysis; national income; prevalence; systematic review.

© The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for review.
Figure 2.
Figure 2.
The number of included studies on the birth prevalence of CHD in five-year bands from 1970 to June 2017. Year-bands are defined according to the publication time of included studies.
Figure 3.
Figure 3.
Changes in the birth prevalence of CHD 1970–2017. The thick line is the estimated overall prevalence of CHD, thin lines represent the 95% CI.
Figure 4.
Figure 4.
The birth prevalence of CHD subtypes and their changes over time. (A) The prevalence of mild and severe CHD lesions during 1970–2017. Thick lines are the estimated prevalence of CHD lesions, thin lines represent the 95% CI. (B) The birth prevalence of the five most frequent CHD subtypes during 1970–2017. PS, pulmonary stenosis; TOF, tetralogy of fallot.
Figure 5.
Figure 5.
The changes in birth prevalence of CHD categories (except septal defects) from 1970 to 2017. RVOTO, right ventricular outflow tract obstruction; LVOTO, left ventricular outflow tract obstruction; AVSD, atrioventricular septal defect; APVR, anomalous pulmonary venous return.
Figure 6.
Figure 6.
CHD prevalence in different geographic regions 1970–2017. (A) The prevalence of overall CHD in six geographic regions. (B) The prevalence of mild lesions in six geographic regions. The number of studies for each region was: Africa 4 (69 304 births), Asia 74 (12 975 858 births), Europe 110 (56 272 142 births), North America 58 (59 498 436 births), South America 9 (667 353 births) and Oceania 5 (1 275 758 births). Data for (A) and (B) are presented as Mean ± SE. *, P < 0.05, compared with Africa, #, P < 0.05, compared with Asia.
Figure 7.
Figure 7.
CHD prevalence and income levels. (A) The prevalence of CHD in countries of different income levels. (B) The linear correlation between the prevalence of ASD and GNI (per capita). (C) The linear correlation between the prevalence of LVOTO and GNI (per capita).

References

    1. van der Linde D, Konings EE, Slager MA et al. . Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011;58:2241–7.
    1. Blue GM, Kirk EP, Sholler GF, Harvey RP, Winlaw DS. Congenital heart disease: current knowledge about causes and inheritance. Med J Aust 2012;197:155–9.
    1. Moss AJ, Gussoni CC, Isabel-Jones J. Echocardiography in congenital heart disease. West J Med 1976;124:102–21.
    1. Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: advantages and limitations of the Newcastle Ottawa Scale. World J Metaanal 2017;5:80–4.
    1. Bae J-M. A suggestion for quality assessment in systematic reviews of observational studies in nutritional epidemiology. Epidemiol Health 2016;38:e2016014.
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Chichester: Wiley-Blackwell, 2008.
    1. Botto LD, Lin AE, Riehle-Colarusso T, Malik S, Correa A. Seeking causes: classifying and evaluating congenital heart defects in etiologic studies. Birth Defects Res Part A Clin Mol Teratol 2007;79:714–27.
    1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002;39:1890–900.
    1. Egbe A, Uppu S, Lee S, Ho D, Srivastava S. Changing prevalence of severe congenital heart disease: a population-based study. Pediatr Cardiol 2014;35:1232–8.
    1. Ionescu-Ittu R, Marelli AJ, Mackie AS, Pilote L. Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. Br Med J 2009;338:b1673.
    1. The World Bank. World Bank Country and Lending Groups. 2017. (4 August 2017, date last accessed).
    1. Oyen N, Poulsen G, Boyd HA, Wohlfahrt J, Jensen PK, Melbye M. National time trends in congenital heart defects, Denmark, 1977–2005. Am Heart J 2009;157:467–73.e1.
    1. Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric ultrasonographers. Heart 2000;84:294–8.
    1. United Nations. World Economic Situation and Prospects. New York: United Nations, UN, 2014.
    1. Moller A-B, Petzold M, Chou D, Say L. Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013. Lancet Glob Health 2017;5:e977–83.
    1. Du Y, Xu X, Chu M, Guo Y, Wang J. Air particulate matter and cardiovascular disease: the epidemiological, biomedical and clinical evidence. J Thorac Dis 2016;8:E8–19.
    1. Zhang B, Liang S, Zhao J et al. . Maternal exposure to air pollutant PM2.5 and PM10 during pregnancy and risk of congenital heart defects. J Expo Sci Environ Epidemiol 2016;26:422–7.
    1. Vrijheid M, Martinez D, Manzanares S et al. . Ambient air pollution and risk of congenital anomalies: a systematic review and meta-analysis. Environ Health Perspect 2011;119:598–606.
    1. Hwang B-F, Lee YL, Jaakkola JJK. Air pollution and the risk of cardiac defects: a population-based case-control study. Medicine 2015;94:e1883.
    1. Beghetti M, Galiè N. Eisenmenger syndrome: a clinical perspective in a new therapeutic era of pulmonary arterial hypertension. J Am Coll Cardiol 2009;53:733–40.
    1. Zaidi S, Brueckner M. Genetics and genomics of congenital heart disease. Circ Res. 2017;120: 923–40.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir