Child Skeletal Fluorosis from Indoor Burning of Coal in Southwestern China

OBJECTIVES We assess the prevalence and pathogenic stage of skeletal fluorosis among children and adolescents residing in a severe coal-burning endemic fluorosis area of southwest China. METHODS We used a cross-sectional design. A total of 1,616 students aged between 7 and 16 years in Zhijin County, Guizhou, China in late 2004 were selected via a cluster sampling of all 9-year compulsory education schools to complete the study questionnaire. Any student lived in a household that burned coal, used an open-burning stove, or baked foodstuffs over a coal stove was deemed high-risk for skeletal fluorosis. About 23% (370) of students (188 boys, 182 girls) were identified as high-risk and further examined by X-ray. RESULTS One-third of the 370 high-risk participants were diagnosed with skeletal fluorosis. Overall prevalence of child skeletal fluorosis due to indoor burning of coal was 7.5%. Children aged 12-16 years were significantly more likely to be diagnosed with skeletal fluorosis than children aged 7-11 years (OR = 1.84, 95% CI: 1.17-2.90; P = .0082). Four types of skeletal fluorosis were identified: constrictive (60.7%), raritas (15.6%), mixed (16.4%), and soft (7.4%). Most diagnosed cases (91%) were mild or moderate in severity. In addition, about 97% of 370 high-risk children were identified with dental fluorosis. Dental fluorosis was highly correlated with skeletal fluorosis in this study. CONCLUSIONS Skeletal fluorosis among children may contribute to poor health and reduced productivity when they reach adulthood. Further efforts to reduce fluoride exposure among children in southwestern of China where coal is burned indoors are desperately needed.