Few spatial ecological studies on hair selenium (Se) and Keshan disease (KD) have been reported. To investigate the relationships of hair Se with KD and economic indicators and to visualize the evidence for KD precise prevention. An ecological study design was employed. The levels of hair Se of 636 adult men (≥ 18 years old) living in rural, general cities and developed cities in 15 KD endemic provinces and 11 KD non-endemic provinces in mainland China were measured using hydride generation atomic fluorescence spectrometry. Spatial description and spatial analysis of hair Se were conducted. The subjects were adults aged. The hair Se level of the residents of KD endemic areas was 0.30 mg/kg, statistically significantly lower than that of non-endemic areas 0.34 mg/kg (Mann-Whitney U test, p = 0.007). The hair Se level of the 636 people was 0.33 mg/kg. The hair Se levels of the residents of the developed cities, general cities, and rural were 0.35 mg/kg, 0.33 mg/kg, and 0.32 mg/kg, respectively, with statistical significance (Kruskal-Wallis H test, P = 0.032). Spatial regression analysis showed that the spatial distribution of hair Se was positively correlated with per capita GDP. Selenium deficiency may still exist among residents living in the KD endemic areas. The results of spatial description and analysis of hair Se provided visualized evidence for targeting key provinces for precise prevention of Keshan disease, including assessment of KD elimination. The hair Se level of the mainland Chinese males was probably between 0.31 and 0.33 μg/g in 2015.

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The small-scale survey methodology for assessing KD elimination at township level was feasible. KD among the people living in Yuanbao township has not been eliminated.