Increasing prevalence of cerebral palsy among children and adolescents in China 1988-2020: A systematic review and meta-analysis.
Shengyi Yang, Jiayue Xia, Jing Gao and 1 others
PMID 33961057WHAT IT FOUND
Cerebral palsy prevalence in China was 2.07 per 1,000 people and rose continuously from 1988 to 2020, with higher rates in rural areas, males, and birthweight under 2.5 kg.
Key findings
01The pooled prevalence of cerebral palsy was 2.07 per 1,000 persons, with study estimates ranging from 1.02 to 7.59 per 1,000 persons.
02The modelled prevalence trend increased continuously over time, with mean annual increases of approximately 9.14% from 1988 to 1996, approximately 9% from 1996 to 2008, and approximately 38.13% from 2008 to 2019.
03Pooled prevalence was 2.25 per 1,000 live births in males and 1.59 per 1,000 live births in females; rural prevalence was 2.75 per 1,000 and urban prevalence was 1.90 per 1,000; prevalence was 20.55 per 1,000 for birthweight under 2.5 kg and 1.82 per 1,000 for 2.5 to 4 kg.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The studies varied widely in estimates, with very high heterogeneity (I2 = 99.4%), so the pooled prevalence should be read as an average across many different settings rather than a single stable rate. Egger's test showed publication bias (t = -4.6, p-value < 0.05), and the authors say selection, information, sample representativeness, diagnostic tool specificity and missing data could affect the estimates. China lacks a population-based cerebral palsy registration system, so the review covered only part of mainland China rather than a national register. The early trend from 1988 to 1996 rested on only 3 studies, and the denominators changed from children under 14 years to children under 13 years, which may distort the apparent rise. The included studies used different denominators, study designs and diagnostic criteria, which limits direct comparison.
The easy way to misread this
Do not read the increasing prevalence trend as proof that cerebral palsy is becoming more common in every child group. The trend came from 43 studies with very high heterogeneity, possible publication bias and only 3 studies before 1996, so some of the rise may reflect different study methods or denominators.