Open Access Open Badges Research article

Assessing local determinants of neural tube defects in the Heshun Region, Shanxi Province, China

Jin-Feng Wang1*, Xin Liu1, George Christakos2, Yi-Lan Liao1, Xue Gu3 and Xiao-Ying Zheng4*

Author Affiliations

1 Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China

2 Department of Geography, San Diego State University, San Diego, California 92182-4493, USA

3 Beijing Institute of Pediatrics, Beijing, 100012, China

4 Institute of Population Science, Peking University, Beijing 100871, China

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BMC Public Health 2010, 10:52  doi:10.1186/1471-2458-10-52

Published: 2 February 2010



Neural tube defect (NTD) prevalence in northern China is among the highest worldwide. Dealing with the NTD situation is ranked as the number one task in China's scientific development plan in population and health 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 that play a significant role in NTD occurrence may be buried by global statistics analysis to a pooled dataset over the entire study area. This study aims at identification of the local determinants of NTD across the study area and exploration of the epidemiological implications of the findings.


NTD prevalence rate is represented in terms of the random field theory, and Rushton's circle method is used to stabilize NTD rate estimation across the geographical area of interest; NTD determinants are represented by their measurable proxy variables and the geographical weighted regression (GWR) technique is used to represent the spatial heterogeneity of the NTD determinants.


Informative maps of the NTD rates and the statistically significant proxy variables are generated and rigorously assessed in quantitative terms.


The NTD determinants in the study area are investigated and interpreted on the basis of the maps of the proxy variables and the relationships between the proxy variables and the NTD determinants. No single determinant was found to dominate the NTD occurrence in the study area. Villages where NTD rates are significantly linked to environmental determinants are identified (some places are more closely linked to certain environmental factors than others). The results improve current understanding of NTD spread in China and provide valuable information for adequate disease intervention planning.