Changes in the prevalence of polycystic ovary syndrome in China over the past decade

Rui Yang; Qin Li; Zehong Zhou; Weiping Qian; Jian Zhang; Ze Wu; Lei Jin; Xueqing Wu; Cuilian Zhang; Beihong Zheng; Jichun Tan; Guimin Hao; Shangwei Li; Tian Tian; Yongxiu Hao; Danni Zheng; Yuanyuan Wang; Robert J Norman; Rong Li; Ping Liu; Jie Qiao

doi:10.1016/j.lanwpc.2022.100494

Changes in the prevalence of polycystic ovary syndrome in China over the past decade

Lancet Reg Health West Pac. 2022 May 31:25:100494. doi: 10.1016/j.lanwpc.2022.100494. eCollection 2022 Aug.

Authors

Rui Yang^{1

2

3

4}, Qin Li^{1

2

3

4}, Zehong Zhou^{5

6}, Weiping Qian⁷, Jian Zhang⁸, Ze Wu⁹, Lei Jin¹⁰, Xueqing Wu¹¹, Cuilian Zhang¹², Beihong Zheng¹³, Jichun Tan¹⁴, Guimin Hao¹⁵, Shangwei Li¹⁶, Tian Tian^{1

2

3

4}, Yongxiu Hao^{1

2

3

4}, Danni Zheng^{1

2

3

4}, Yuanyuan Wang^{1

2

3

4}, Robert J Norman¹⁷, Rong Li^{1

2

3

4}, Ping Liu^{1

2

3

4}, Jie Qiao^{1

2

3

4}

Affiliations

¹ Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
² National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China.
³ Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China.
⁴ Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China.
⁵ Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China.
⁶ Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China.
⁷ Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen 518036, China.
⁸ Department of Pathophysiology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Shanghai Jiao Tong University, School of Medicine, Shanghai 200240, China.
⁹ Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming 650021, China.
¹⁰ Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
¹¹ Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated Hospital of Shanxi Medical University, Taiyuan 030000, China.
¹² Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou 450003, China.
¹³ Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China.
¹⁴ Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110022, China.
¹⁵ Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
¹⁶ Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu 610041, China.
¹⁷ Discipline of Obstetrics/Gynecology, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia.

Abstract

Background: Polycystic ovary syndrome (PCOS) has become a major international public health concern. However, because of controversy about the diagnostic criteria and patient selection, estimates of its absolute prevalence and change with time vary greatly.

Methods: We conducted two consecutive nationwide epidemiological surveys of the prevalence of PCOS in representative samples of reproductive-aged women in China in 2010 and 2020. Face-to-face interviews were performed by trained interviewers in each survey. All participants completed a questionnaire and underwent a physical examination, blood sampling, and transvaginal pelvic ultrasound. We assessed hyperandrogenism (H), chronic anovulation (O), and polycystic ovaries (P) to classify the presence of PCOS using the Rotterdam criteria. The prevalence of PCOS among reproductive-aged women was estimated after consideration of differential probabilities of selection and population distribution. We conducted a logistic regression analysis by using the probability of PCOS as a function of the survey year to acquire the trend information across the years.

Findings: 28,739 respondents completed the survey, including 15,924 in the previously published 2010 survey and 12,815 in the new 2020 survey. In 2020, 826 participants could be diagnosed as having PCOS, with a weighted prevalence of 7.8% (95%CI: 7.0%, 9.0%) among women aged 20-49 years, leading to an estimate of 24.0 million women of reproductive age affected by this condition in China as a whole. The estimated prevalence in 2020 was higher than that of a decade ago despite identical research methods suggesting a two-thirds increase over the study period. Women with PCOS in 2020 also appeared to have a more severe phenotype overall than those of a decade ago, possibly reflecting a significantly higher prevalence of obesity, hyperandrogenism, and infertility.

Interpretation: The prevalence of PCOS in Chinese women has increased significantly over the past 10 years. PCOS is a significant public health problem in women of reproductive age in China and national policy and guidelines should be re-examined in the light of the current data.

Funding: National Key R&D Program of China and the National Natural Science Foundation of China.

Keywords: Polycystic ovary syndrome; Prevalence; Trend; Ultrasound.