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High prevalence of thalassemia in migrant populations in Guangdong Province, China

BMC Public Health201414:905

https://doi.org/10.1186/1471-2458-14-905

Received: 7 March 2014

Accepted: 26 August 2014

Published: 2 September 2014

Abstract

Background

The objectives of this study were to estimate the prevalence of thalassemia and to analyze the need for public health services for migrant populations in different cities in Guangdong Province, China.

Methods

A cross-sectional survey was conducted in 21 cities of Guangdong Province. Twenty-three types of a- and β-globin gene mutations were detected in a total of 14,230 pregnant women and 14,249 husbands.

Results

There was a 16.45% prevalence of thalassemia among the 28,479 individuals, and the prevalences of α-, β-, and combined α-/β- thalassemia were 12.03%, 3.80%, and 0.63%, respectively. Compared with the native city residents in the province, the migrants from within the province and the immigrants from outside the province had lower prevalences of thalassemia, but the prevalence values were >11%.

Conclusions

The prevalence values for thalassemia gene mutations were high in all three population groups studied in Guangdong Province. The results indicate that all segments of the Guangdong population should be screened for thalassemia.

Keywords

Thalassemia Globin gene mutation Prevention Migrant population Public health service

Background

Thalassemia is the most commonly inherited, recessive single gene disease. Globally, approximately 7% of pregnant women carry β- or α zero-thalassemia, or other hemoglobin disorders [1, 2], which imposes an enormous burden on families and society [3, 4]. Thalassemia has become a public health problem in Guangdong Province, China. High prevalences of thalassemia are present in Guangdong populations; 17.70% of pregnant women, 15.94% of their husbands, and 16.03% of neonates are thalassemia carriers [5]. To prevent and control thalassemia major, the government of Guangdong has implemented the Thalassemia Prenatal Prevention and Control Program (TPPCP), which has been supported by annual funding of 35 million RMB since 2011. In 2012, we used data obtained from this program and conducted a baseline survey on the epidemiological status of globin gene mutations in Guangdong.

As a developed area in China, Guangdong Province has a large amount of immigration between cities and between provinces, which imposes significant challenges for the public health services. Most public health services are only offered to native city residents who have a registered household as part of the household registry system. Little is known about the thalassemia prevalence in this and in other types of registered household populations in different cities in Guandong Province. We analyzed the α- and β-thalassemia prevalence in these populations.

Methods

The tested individuals were from one of three populations. The first population consisted of native city residents who were recorded in the local city household register. They had primary social and health insurance coverage and could obtain aid from the public health program. The second population consisted of migrants from within the province, and who were registered as residing in a household in another city in Guangdong Province. These residents had no primary social and health insurance coverage from the cities in which they were currently residing, and had non-transferable health insurance coverage from the cities or counties in which they were registered. They also could not obtain aid from the public health programs of the cities in which they were currently residing. The third population consisted of the immigrants from outside the province. These individuals were not registered as living in a household in Guangdong Province. They had no primary social and health insurance coverage in Guangdong, did not have transferable health coverage in the province in which they were registered, and could not obtain aid from the public health program in Guangdong.

This study used a cross-sectional survey design and was performed using data from the baseline TPPCP survey of Guangdong. The survey was conducted in the 21 cities of Guangdong Province. One district or county was randomly sampled from each city, and a total of 91 hospitals were selected according to the newborn delivery numbers in the sampled districts or counties. After informed consent was obtained, 3 mL peripheral vein blood (collected in an EDTA tube) was sampled from each pregnant woman and her husband during the delivery period. The samples were temporarily placed into a refrigerator at 4°C, and then mailed on ice by express delivery to the genetics and metabolic diseases laboratory of Guangdong Women and Children Hospital for further analysis. They arrived at the laboratory within 3 days, where they were analyzed for the globin gene mutation. A total of 8,479 eligible blood samples were tested, which included 14,230 pregnant women and 14,249 husbands. The results for the number of samples from each city are presented in Table 1.
Table 1

The prevalence (%) of thalassemia carriers among different household register population of cities of Guangdong, China

Sampled cites of Guangdong

Native city residents in the province

Migrants from within the province

Immigrants from outside the province

Total

Statistic values

Tested individuals

Thalassemia carriers

Prevalence (%95 CI)

Tested individuals

Thalassemia carriers

Prevalence (%95 CI)

Tested individuals

Thalassemia carriers

Prevalence (%95 CI)

Tested individuals

Thalassemia carriers

Prevalence (%95 CI)

East Area

            

Chaozhou

737

84

11.40

48

4

8.33

202

15

7.43

987

103

10.44

χ2 = 2.91,

Raoping

(9.11, 13.68)

(0.55, 16.11)

(3.83, 11.02)

(8.54, 12.33)

P > 0.05

Jieyang

1318

135

10.24

108

12

11.11

54

5

9.26

1480

152

10.27

χ2 = 0.14,

Puning

(8.61, 11.87)

(5.21, 17.01)

(1.57, 16.95)

(8.73, 11.81)

P > 0.05

Shantou

620

46

7.42

800

76

9.50

81

9

11.11

1501

131

8.73

χ2 = 2.51,

Jinping

(5.37, 9.47)

(7.48, 11.52)

(4.30, 17.92)

(7.31, 10.15)

P > 0.05

Shanwei

1118

123

11.00

60

9

15.00

51

4

7.84

1229

136

11.07

χ2 = 1.49,

Haifeng

(9.18, 12.83)

(6.01, 23.99)

(0.50, 15.18)

(9.32, 12.81)

P > 0.05

Total

3793

388

10.23

1016

101

9.94

388

33

8.51

5197

522

10.04

χ2 = 1.17,

(9.27, 11.19)

(8.11, 11.77)

(5.74, 11.27)

(9.23, 10.86)

P > 0.05

Montain Area

            

Heyuan

1346

265

19.69

136

29

21.32

91

15

16.48

1573

309

19.64

χ2 = 0.82,

District

(17.57, 21.80)

(14.47, 28.17)

(8.90, 24.07)

(17.69, 21.60)

P > 0.05

Meizhou

934

199

21.31

26

5

19.23

42

8

19.05

1002

212

21.16

χ2 = 0.18,

Xingning

(18.69, 23.92)

(4.16, 34.30)

(7.23, 30.86)

(18.64, 23.67)

P > 0.05

Qingyuan

1165

237

20.34

88

15

17.05

92

16

17.39

1345

268

19.93

χ2 = 0.96,

Yingde

(18.04, 22.64)

(9.23, 24.86)

(9.69, 25.10)

(17.80, 22.05)

P > 0.05

Shaoguan

981

185

18.86

164

20

12.20

139

17

12.23

1284

222

17.29

χ2 = 7.15,

District

(16.42, 21.29)

(7.21, 17.18)

(6.81, 17.65)

(15.23, 19.35)

P < 0.05

Yunfu

1048

265

25.29

295

67

22.71

95

11

11.58

1438

343

23.85

χ2 = 9.28,

Luoding

(22.67, 27.90)

(17.96, 27.47)

(5.18, 17.98)

(21.66, 26.04)

P < 0.01

Total

5474

1151

21.03

709

136

19.18

459

67

14.60

6642

1354

20.39

χ2 = 11.50,

(19.95, 22.10)

(16.30, 22.07)

(11.38, 17.81)

(19.42, 21.35)

P < 0.05

The Pearl River Delta

            

Dongguan

959

130

13.56

412

76

18.45

111

6

5.41

1482

212

14.30

χ2 = 13.38,

District

(11.40, 15.71)

(14.72, 22.17)

(1.22, 9.59)

(12.53, 16.08)

P < 0.01

Foshan

847

123

14.52

466

93

19.96

100

11

11.00

1413

227

16.07

χ2 = 8.63,

(16.35, 23.57)

(4.90, 17.10)

(14.16, 17.97)

P < 0.05

Nanhai

(12.16, 16.88)

Guangzhou

756

93

12.30

375

64

17.07

96

9

9.38

1227

166

13.53

χ2 = 6.40,

Panyu

(9.97, 14.63)

(13.28, 20.86)

(3.57, 15.18)

(11.62, 15.43)

P < 0.05

Huizhou

854

170

19.91

502

69

13.75

118

9

7.63

1474

248

16.82

χ2 = 16.33,

District

(17.24, 22.57)

(10.75, 16.74)

(2.86, 12.39)

(14.92, 18.72)

P < 0.001

Jiangmen

1282

231

18.02

121

20

16.53

47

5

10.64

1450

256

17.66

χ2 = 1.81,

Xinhui

(15.93, 20.11)

(9.94, 23.11)

(1.87, 19.41)

(15.70, 19.61)

P > 0.05

Shenzhen

194

29

14.95

913

149

16.32

174

14

8.05

1281

192

14.99

χ2 = 7.85,

Baoan

(9.96, 19.94)

(13.93, 18.70)

(4.02, 12.07)

(13.04, 16.93)

P < 0.05

Zhaoqing

1143

215

18.81

191

46

24.08

85

15

17.65

1419

276

19.45

χ2 = 3.09,

Sihui

(16.56, 21.06)

(18.05, 30.12)

(9.58, 25.71)

(17.40, 21.50)

P > 0.05

Zhongshan

705

85

12.06

174

32

18.39

569

65

11.42

1448

182

12.57

χ2 = 6.21,

District

(9.67, 14.45)

(12.66, 24.12)

(8.82, 14.02)

(10.87, 14.27)

P < 0.05

Zhuhai

675

115

17.04

382

72

18.85

106

15

14.15

1163

202

17.37

χ2 = 1.40,

Doumen

(14.22, 19.86)

(14.95, 22.75)

(7.55, 20.75)

(15.20, 19.54)

P > 0.05

Total

7415

1191

16.06

3536

621

17.56

1406

149

10.60

12357

1961

15.87

χ2 = 37.06,

(15.23, 16.89)

(16.31, 18.81)

(9.00, 12.20)

(15.23, 16.51)

P < 0.001

West Area

             

Maoming

1292

240

18.58

47

5

10.64

75

10

13.33

1414

255

18.03

χ2 = 3.1,

Huazhou

(16.47, 20.69)

(1.87, 19.41)

(5.68, 20.99)

(16.04, 20.03)

P > 0.05

Yangjiang

1393

355

25.48

74

4

5.41

54

8

14.81

1521

367

24.13

χ2 = 18.13,

Yangchun

(23.21, 27.76)

(0.28, 10.53)

(5.39, 24.24)

(21.99, 26.27)

P < 0.001

Zhanjiang

982

166

16.90

265

39

14.72

101

22

21.78

1348

227

16.84

χ2 = 2.62,

Lianjiang

(14.57, 19.24)

(10.47, 18.96)

(13.77, 29.79)

(14.85, 18.83)

P > 0.05

Total

3667

761

20.75

386

48

12.44

230

40

17.39

4283

849

19.82

χ2 = 16.11,

(19.45, 22.06)

(9.16, 15.71)

(12.52, 22.26)

(18.63, 21.01)

P < 0.001

All Guangdong

20349

3491

17.16

5647

906

16.04

2483

289

11.64

28479

4686

16.45

χ2 = 49.85,

(16.64, 17.67)

(15.09, 17.00)

(10.38, 12.89)

(16.03, 16.88)

P < 0.001

Note: CI is Confidence Interval.

Detection of α- and β-globin gene mutations

Genomic DNA was extracted from all blood samples using a Lab-Aid 820 automation system (Zee San Biotech Company, Xiamen, Fujian, China). Twenty-three mutations of the a- and β-globin genes were identified using a Luminex 200 liquichip array system (R & D Systems Inc., Minneapolis, MN, USA) [6, 7]. The system was used throughout the process of probe design, the multiplex PCR, the attachment of probes to microspheres, and hybridization and analysis. The 23 thalassemia mutations included three α-globin gene deletions (i.e., the Southeast Asian deletion [-SEA], the rightward deletion [-α3.7], and the leftward deletion [-α4.2]). Three α-globin gene point mutations were also analyzed (i.e., Hb Constant Spring, Hb Quong Sze, and Hb Westmead). The 17 β-globin gene point mutations were on codons 41/42 (-TCTT), 654, -29 (A > G), -28 (A > G), codons 71/72 (+A), codon 17 (A > T), codon 43 (G > T), Hb E (β26[B8] Glu → Lys, GAG > AAG or codon 26 [G > A]), codons 27/28 (+C), codon 31 (-C), -32 (C > A), -30 (T > C), codons 14/15 (+G), IVS-I-1 (G > T), IVS-I-5 (G > T), Int, and Cap.

Statistical analysis

We used the “vcd” and “car” program packages of R Version 3.0.1 statistical software (May 16, 2013, copyright 2013, R Foundation for Statistical Computing, Vienna, Austria) to analyze the data. We calculated the values for thalassemia carrier prevalence, with 95% confidence intervals (95% CIs), for the different household registry-based populations for all of the cities in Guangdong. The differences between prevalence values were compared using the chi-square test or the Mantel–Haenszel chi-square test. A thalassemia carrier was defined as an individual who carried any one of the 23 types of α- and/or β-globin gene mutations.

Results

Blood samples were collected from a total of 28,479 individuals; 71.45% (20,349/28,479) were native residents of the city in which they resided, 19.83% (5,647/28,479) of them were migrants from another city within the province, and 8.72% (2,483/28,479) of them were immigrants from other provinces.

The results for the prevalence values for the different thalassemia genotypes are presented in Table 2. The overall prevalence of thalassemia carriers was 16.45%. The prevalence of α-, β-, and combined α-/β- thalassemia carriers was 12.03%, 3.80%, and 0.63%, respectively. The specific prevalence values for the different clinical forms of the disease were also calculated. The prevalence of α+-thalassemia was 5.71%, α0-thalassemia was 6.12%, hemoglobin H (HbH) disease was 0.20%, β-thalassemia minor (β0N or β+N) was 3.78%, β-thalassemia intermedia was 0.01%, α0- or α+-thalassemia with β-thalassemia minor was 0.60%, HbH disease with β-thalassemia minor was 0.02%, α0-thalassemia with β-thalassemia intermedia carrier was 0.004%. The top three genotypes of α-thalassemia were --SEA/αα, α3.7α/αα, and α4.2α/αα. The top three genotypes of β-thalassemia were β41–42N, β654N, and β-28N.
Table 2

The prevalence (%) of different genotypes of thalassemia among pregnant coupes of Guangdong, China (n = 28479)

Individuals only with α-thalassemia

Individuals only with β-thalassemia

Individuals combined α-/β- thalassemia carriers

Genotypes

Frequency

Prevalence (%95 CI)

Genotypes (clinic forms)

Frequency

Prevalence (%95 CI)

Genotypes (clinic forms)

Frequency

Prevalence (%95 CI)

Genotypes (clinic forms)

Frequency

Prevalence (%95 CI)

α+-thalassemia

1626

5.71% (5.44, 5.98)

β-thalassemia minor

1077

3.78 (3.56, 4.00)

--SEA/αα, β41–42N0, β0N)

34

0.12 (0.08,0.16)

--SEA3.7, β41–42N (HbH, β0N)

1

0.00 (0.00,0.01)

α3.7α/αα

911

3.20 (3.00, 3.40)

β41–42N0N)

415

1.46 (1.32, 1.60)

--SEA/αα, β654N0, β0N)

25

0.09 (0.05,0.12)

--SEA/αα, β-28IVS-10, β+0)

1

0.00 (0.00,0.01)

α4.2α/αα

313

1.10 (0.98, 1.22)

β654N0N)

281

0.99 (0.87, 1.10)

α3.7/αα, β41–42N+, β0N)

20

0.07 (0.04,0.10)

--SEA/αα, β-29N0, β+N)

1

0.00 (0.00,0.01)

αWSα/αα

239

0.84 (0.73, 0.94)

β17N0N)

95

0.33 (0.27, 0.40)

α3.7/αα, β-28N+, β+N)

11

0.04 (0.02,0.06)

--SEA/αα, βIVS-5N

0, β+N)

1

0.00 (0.00,0.01)

αCSα/αα

83

0.29 (0.23, 0.35)

β71–72N0N)

24

0.08 (0.05, 0.12)

--SEA/αα, β-28N0, β+N)

9

0.03 (0.01,0.05)

α3.7CSα, β41–42N

0, β0N)

1

0.00 (0.00,0.01)

αQSα/αα

47

0.17 (0.12, 0.21)

β27–28N0N)

19

0.07 (0.04, 0.10)

α3.7/αα, β654N+, β0N)

8

0.03 (0.01,0.05)

α3.7/αα, β-29N

+, β+N)

1

0.00 (0.00,0.01)

α3.7α/α4.2α

9

0.03 (0.01, 0.05)

β14–15N0N)

10

0.04 (0.01, 0.06)

αWSα/αα, β41–42N+, β0N)

7

0.02 (0.01,0.04)

α3.7/αα, βIVS-1N

+, β0N)

1

0.00 (0.00,0.01)

α3.7α/α3.7α

8

0.03 (0.01, 0.05)

β43N0N)

6

0.02 (0.00, 0.04)

α4.2/αα, β41–42N+, β0N)

6

0.02 (0.00,0.04)

αCSα/αα, β17N+, β0N)

2

0.01 (0.00,0.02)

α3.7α/αWSα

5

0.02 (0.00, 0.03)

βIVS-1N0N)

6

0.02 (0.00, 0.04)

--SEA/αα, β17N0, β0N)

4

0.01 (0.00,0.03)

αCSα/αα, β654N+, β0N)

2

0.01 (0.00,0.02)

α3.7α/αCSα

3

0.01 (0.00, 0.02)

βIntN0N)

1

0.00 (0.00, 0.01)

--SEA/αα, βEN0, β+N)

4

0.01 (0.00,0.03)

α3.7/αα, βIVS-5N+, β+N)

1

0.00 (0.00,0.01)

α3.7α/αQSα

3

0.01 (0.00, 0.02)

β-28N+N)

155

0.54 (0.46, 0.63)

α3.7/αα, β17N+, β0N)

4

0.01 (0.00,0.03)

α4.2/αα, β71–72N

+, β0N)

1

0.00

(0.00,0.01)

α4.2α/αWSα

3

0.01 (0.00, 0.02)

βE/ βN+N)

24

0.08 (0.05, 0.12)

α4.2/αα, β-28N+, β+N)

4

0.01 (0.00,0.03)

α4.2/αα, βCapN

+, β+N)

1

0.00

(0.00,0.01)

α4.2α/αCSα

1

0.00 (0.00, 0.01)

βCapN+N)

23

0.08 (0.05, 0.11)

αCSα/αα, β41–42N+, β0N)

4

0.01 (0.00,0.03)

αCSα/αα, β-28N

+, β+N)

1

0.00

(0.00,0.01)

α4.2α/αQSα

1

0.00 (0.00, 0.01)

β-29N+N)

17

0.06 (0.03, 0.09)

α3.7/αα, β71–72N+, β0N)

3

0.01 (0.00,0.02)

αWSα/αα, β71–72N

+, β0N)

1

0.00

(0.00,0.01)

α0-thalassemia

1743

6.12 (5.84, 6.40)

βIVS-5N+N)

1

0.00 (0.00, 0.01)

α4.2/αα, β17N+, β0N)

3

0.01 (0.00,0.02)

αWSα/αα, βEN

+, β+N)

1

0.00

(0.00,0.01)

--SEA/αα

1743

6.12 (5.84, 6.40)

β-thalassemia intermedia

4

0.01 (0.00, 0.03)

α4.2/αα, β654/βN+, β0N)

3

0.01 (0.00,0.02)

αWSα/αα, βIVS-1N+, β0N)

1

0.00 (0.00,0.01)

HbH disease

58

0.20 (0.15, 0.26)

β-28E++)

1

0.00 (0.00, 0.01)

--SEA3.7, β654N (HbH, β0N)

2

0.01 (0.00,0.02)

   

--SEA3.7

33

0.12 (0.08, 0.16)

β41–42Cap0+)

1

0.00 (0.00, 0.01)

--SEACSα, β41–42N (HbH, β0N)

2

0.01 (0.00,0.02)

   

--SEA4.2

15

0.05 (0.03, 0.08)

β41–42E0+)

1

0.00 (0.00, 0.01)

--SEA/αα, β71–72N0, β0N)

2

0.01 (0.00,0.02)

   

--SEAWSα

5

0.02 (0.00, 0.03)

β-2817+0)

1

0.00 (0.00, 0.01)

α4.2/αα, βEN+, β+N)

2

0.01 (0.00,0.02)

   

--SEACSα

3

0.01 (0.00, 0.02)

   

αWSα/αα, β654N+, β0N)

2

0.01 (0.00,0.02)

   

--SEAQSα

2

0.01 (0.00, 0.02)

   

--SEA3.7, β17N (HbH, β0N)

1

0.00 (0.00,0.01)

   

Total

3427

12.03 (11.66, 12.41)

Total

1081

3.80 (3.57,4.02)

Total

178

0.63 (0.53,0.72)

Notes: 1. CI is Confidence Interval. 2. Hb H disease means Hemoglobin H (HbH) disease. 3. βN means normal β-globin allele gene.

The results for thalassemia carrier prevalence in different population groups are presented in Table 1. The values for thalassemia carrier prevalence for the native city residents, the migrants from within the province, and the immigrants from outside the province were 17.16% (3491/20349), 16.04% (906/5647), and 11.64% (289/2483), respectively. Compared with the native city residents, the migrants from within the province and the immigrants from outside the province had a lower prevalence of thalassemia carriers, but the prevalence was >11%. The difference between these prevalence values was significant (χ2 = 49.85, P < 0.001).

For thalassemia carrier prevalence in the different areas of Guangdong Province, the differences between the different household registry populations were variable. Prevalence values were not significantly different (P > 0.05) between the four cities in the east area. In the mountain area, two of five cities had a significantly different prevalence (P < 0.05). In the Pearl River delta area, six of nine cities had a significantly different prevalence (P < 0.05), and in seven cities migrants from within the province had a higher prevalence of thalassemia carriers. In the west area, one of three cities had a significantly different prevalence value (P < 0.05).

Discussion

Our results indicated that thalassemia is a serious public health problem in Guangdong. The average prevalence of thalassemia in the Guangdong population was 16.45%, and the prevalence of α-, β-, and combined α-/β- thalassemia was 12.03%, 3.80%, and 0.63%, respectively. These values were higher than values previously reported for prevalence for Guangdong Province [8, 9]. Our data also indicated that the native city resident population in the province, the migrant population from within the province, and the immigrant population from outside the province also have had a high prevalence of thalassemia. In some surveyed cities, the thalassemia prevalence in the migrant population from within the province was higher compared with the prevalence in native city residents in the province. In all targeted populations, the native city residents and the immigrants from other cities of the same or other provinces belong to the same ethnic group, and the finding that there were similar prevalences of thalassemia mutations supports this observation.

Worldwide, 56,000 conceptions per year have a major thalassemia disorder. Approximately 30,000 of these are affected by β-thalassemia major, and 3,500 succumb from hydrops fetalis syndrome during the perinatal period [1]. Interestingly, in Guangdong, thalassemia also causes a significant economic and disease burden. Thalassemias were originally characteristic of the tropics and subtropics, but are now common worldwide because of migration [10, 11]. Because thalassemia can be controlled in a cost-effective manner using programs that integrate treatment with carrier detection and genetic counseling, the World Health Organization has recommended global development of these services [12]. Many countries and areas have implemented antenatal or premarital thalassemia screening programs [13, 14]. Since the 1990s, some hospitals have delivered voluntary antenatal thalassemia screening and counseling services in Guangdong Province [14]. In 2011, the Guangdong government initiated an antenatal thalassemia prevention and control program, which includes 35 million RMB per year in financial support.

Because of the household registry arrangement and resource limitations, public health services for thalassemia prevention have only been offered to native city residents in the province. However, our results indicate that all segments of the Guangdong population should be screened for thalassemia. The migrants from within the province and the immigrants from outside the province accounted for nearly 30% of the total population in many cities in Guandong, which could affect the outcomes of thalassemia prevention programs and challenge the public health service system of Guangdong. The results of a Thalassemia International Federation study indicated that countries with a strong prevention and treatment program are well prepared to face the problem of hemoglobinopathy gene migration into the population [14].

Previously, the thalassemia prevalence reported for Guangdong Province was approximately 5–11% [9, 10]. The differences between these figures and our results were mainly owing to differences in areas selected for sampling, the populations examined, the detection methods, and the spectra of globin gene mutations examined. We sampled a greater number of cities and populations. We used the more sensitive liquichip array system for detection of globin gene mutation and found 23 types of globin gene mutations. A higher prevalence of thalassemia carriers (24.51%) has been reported for Guangxi Province [15]. Bangalore et al. reported that the prevalence of the β-thalassemia trait among pregnant women was 8.5%, [16] which was also higher than that of Guangdong, but these results were estimated from data from an antenatal care clinic.

The analysis of our data revealed that 0.22% (64/28479) of individuals were carriers of HbH disease, which could be a serious health problem for pregnant couples. The incidence of HbH disease has been reported to be 0.43% in Guangxi Province [15]. HbH disease is predominantly seen in South East Asia, the Middle East, and the Mediterranean [17].

There are some limitations that must be taken into consideration in our study. We only sampled one county or district in each city, so the results might not represent the true prevalence of thalassemia carriers in the population of that city. We also did not consider the duration of residence of the migrant populations.

Conclusion

The prevalence of thalassemia gene mutations was high in native city resident populations in Guangdong Province, the migrant populations from within the province, and the immigrant populations from outside the province. The results indicate that all segments of the Guangdong population should be screened for thalassemia. The effectiveness of thalassemia prevention programs might be improved if the entire population in Guangdong Province were included. Policy makers should establish a strategy that allows affordable thalassemia prevention public health programs to be provided to inter-city and inter-province migrant populations in Guangdong Province.

Ethical consideration

Ethical approval was obtained from Guangdong Women and Children Hospital Ethics Committee.

Declarations

Acknowledgments

The authors would like to thank all the members of Guangdong thalassemia prevention and control program management team, and all the workers of data collection in all sampled hospitals.

The study was the program of the medical scientific research fund of Guangdong, the number were C2012009 and C2012010.

Authors’ Affiliations

(1)
Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University
(2)
Department of Healthcare, Guangdong Women and Children Hospital
(3)
Department of the Office of the Dean, Guangdong Women and Children Hospital
(4)
Center of Prenatal Diagnosis, Guangdong Women and Children Hospital

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  18. Pre-publication history

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© Li et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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