| Long-term epidemiological insights into rickets: a nationwide population-based retrospective study |
Chun-Hao Chu1,2,3 
, Ying-Chuan Chen4
, Pei-Yao Liu4
, Chun-Chieh Hu1
, Yu-Lung Lin5,6
, Feng-Chih Kuo7
, Chieh-Hua Lu7
, Tzu-Ju Hsu8
, Yu-Tung Hung8,9
, Fuu-Jen Tsai10,11,12,1
, Chien-Ming Lin1
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1Department of Pediatrics, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan
2Department of Pediatrics, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan
3Master of Public Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
4Department of Physiology & Biophysics, National Defense Medical University, Taipei, Taiwan
5The Ph.D. Program for Translational Medicine, College for Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
6International Ph.D. Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
7Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan
8Management Office for Health Data, Clinical Trial Research Center, China Medical University Hospital, Taichung, Taiwan
9College of Medicine, China Medical University, Taichung, Taiwan;
10School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
11Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
12Division of Medical Genetics, China Medical University Children's Hospital, Taichung, Taiwan
13Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan |
Correspondence:
Chien-Ming Lin, Email: ming.sandra@msa.hinet.net
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Received: 28 April 2025 • Revised: 29 June 2025 • Accepted: 5 July 2025 |
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| Abstract |
Background
Rickets is a growth disorder that imposes a global health burden and causes disability in affected children. However, issues related to the clinical epidemiology and mortality risk of nutritional versus hereditary rickets have not been fully investigated in large population studies, particularly in Asia.
Purpose
This study aimed to investigate the nationwide incidence, demographic characteristics, and mortality-related risk factors of pediatric rickets stratified by nutritional and hereditary subtypes.
Methods
This study utilized data of subjects aged 0–18 years taken from Taiwan’s National Health Insurance Research Database. The database includes records of 31,488,321 individuals from January 1, 2008, to December 31, 2018. We analyzed all cases and conducted subgroup analyses of nutritional and hereditary rickets to examine how different etiologies affect the risk of mortality (ROM).
Results
Among the 1,551 patients with rickets, nutritional rickets accounted for twice as many cases as hereditary rickets. Nutritional rickets primarily affects preschoolers without sex-based differences, whereas hereditary rickets is often diagnosed later with a male predominance. ROM in rickets is associated with a low household income, anemia, chronic kidney disease (CKD), hyperparathyroidism secondary to renal tubulopathy, and a prolonged length of hospital stay (LOS). Between 2012 and 2018, the overall incidence of rickets increased and the mortality rates decreased.
Conclusion
Increasing incidence and decreasing mortality rates of rickets were noted, suggesting improvements in clinical awareness and disease management.influencing ROM, such as family income, anemia, CKD, hyperparathyroidism secondary to renal tubulopathy, and LOS are important considerations in the clinical care of rickets. |
| Key Words:
Nutritional rickets, Hereditary rickets, Incidence, Mortality rate |
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