Spatial Clusters of Low Serum Selenium: the Priorities of Selenium Supplementation to Residents of Keshan Disease Endemic Areas

Qingyu Zeng; Guijin Li; Ruixiang Wang; Cunqi Lv; Shuxiu Hao; Jiacheng Li; Huixin Sun; Linlin Du; Cheng Wang; Yu Zhang; Xinshu Wang; Yuehui Jia; Qi Li; Tong Wang

doi:10.1007/s12011-025-04547-8

Spatial Clusters of Low Serum Selenium: the Priorities of Selenium Supplementation to Residents of Keshan Disease Endemic Areas

Biol Trace Elem Res. 2025 Feb 14. doi: 10.1007/s12011-025-04547-8. Online ahead of print.

Authors

Qingyu Zeng^#^{1

2

3}, Guijin Li^#^{1

2

3}, Ruixiang Wang^{1

2

3}, Cunqi Lv^{1

2

3}, Shuxiu Hao^{1

2

3}, Jiacheng Li^{1

2

3}, Huixin Sun^{1

2

3}, Linlin Du^{1

2

3}, Cheng Wang^{1

2

3}, Yu Zhang^{1

2

3}, Xinshu Wang⁴, Yuehui Jia^{5

6}, Qi Li⁷, Tong Wang^{8

9

10}

Affiliations

¹ Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin, 150081, China.
² NHC Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, 150081, China.
³ Joint Key Laboratory of Endemic Diseases, Harbin Medical University, Guizhou Medical University, Xi'an Jiaotong University, Harbin, 150081, China.
⁴ Nanchang University Queen Mary School, Nanchang, 330000, China.
⁵ Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin, 150081, China. 202001070@hrbmu.edu.cn.
⁶ School of Public Health, Qiqihar Medical University, Qiqihar , Heilongjiang, 161003, China. 202001070@hrbmu.edu.cn.
⁷ Department of Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, 150081, China. liqi@ems.hrbmu.edu.cn.
⁸ Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin, 150081, China. wangtong@ems.hrbmu.edu.cn.
⁹ NHC Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, 150081, China. wangtong@ems.hrbmu.edu.cn.
¹⁰ Joint Key Laboratory of Endemic Diseases, Harbin Medical University, Guizhou Medical University, Xi'an Jiaotong University, Harbin, 150081, China. wangtong@ems.hrbmu.edu.cn.

^# Contributed equally.

PMID: 39951187
DOI: 10.1007/s12011-025-04547-8

Abstract

Selenium deficiency is strongly associated with Keshan disease (KD). It is essential to investigate serum selenium levels from the perspective of etiological surveillance and evaluation of the populations at-risk. This research aims to identify areas at high risk of selenium deficiency using spatial epidemiological methods and to provide a scientific basis for targeted selenium supplementation. This cross-sectional study measured serum selenium levels using an atomic fluorescence spectrometer among 6,643 residents in KD endemic and non-endemic counties across China, applying spatial epidemiological methods, including global autocorrelation and local Moran's I analysis, to identify spatial clustering. Additionally, ordinary least squares regression was used to assess the correlation between serum selenium levels and per capita disposable income. The median serum selenium level among participants was 66.69 μg/L. Serum selenium levels of residents in KD endemic areas were significantly lower than those in non-endemic areas. A total of 72 counties were classified as selenium-deficient, 638 as selenium-marginal, and 967 as selenium-sufficient. Spatial clustering analysis identified 375 clusters of low selenium levels. Regression analysis revealed a positive correlation between serum selenium levels and per capita disposable income. The geographical distribution of serum selenium levels exhibits significant spatial clustering. The low-low clustering areas in provinces such as Sichuan, Shaanxi, Gansu and Yunnan should be prioritized for selenium nutrition interventions and surveillance. Furthermore, areas with low incomes may need enhanced strategies for selenium supplementation.

Keywords: Keshan disease; Selenium nutrition; Serum selenium; Spatial clustering; Spatial regression.