Woodruff Tracey J, Axelrad Daniel A, Kyle Amy D, Nweke Onyemaechi, Miller Gregory G, Hurley Bradford J
United States Environmental Protection Agency, San Francisco, California 94105, USA.
Pediatrics. 2004 Apr;113(4 Suppl):1133-40.
Tracking incidence or prevalence of diseases and using that information to target interventions is a well-established strategy for improving public health. The need to track environmentally mediated chronic diseases is increasingly recognized. Trends in childhood illnesses are 1 element of a framework for children's environmental health indicators, which also includes trends in contaminants in the environment and in concentrations of contaminants in bodies of children and their mothers. This article presents data on 3 groups of important childhood diseases or disorders that seem to be caused or exacerbated, at least in part, by exposure to environmental agents and for which nationally representative data are available. They are asthma, childhood cancers, and neurodevelopmental disorders. Data were used from the National Health Interview Survey for asthma and neurodevelopmental disorders; the Surveillance, Epidemiology, and End Results Program for childhood cancer incidence; and the National Vital Statistics System for childhood cancer mortality. The prevalence of children with asthma doubled between 1980 and 1995, from 3.6% in 1980 to 7.5% in 1995. The annual incidence of childhood cancer increased from 1975 until approximately 1990 and seems to have become fairly stable since. Childhood cancer mortality has declined substantially during the past 25 years. Incidence of certain types of cancers has increased since 1974, including acute lymphoblastic leukemia, central nervous system tumors, and non-Hodgkin's lymphoma. Approximately 6.7% of children aged 5 to 17 were reported to have attention-deficit/hyperactivity disorder in 1997-2000, and approximately 6 of every 1000 children were reported to have received a diagnosis of mental retardation during the same period.
追踪疾病的发病率或患病率，并利用这些信息来确定干预措施的目标，是改善公众健康的一项既定策略。追踪由环境介导的慢性病的必要性日益得到认可。儿童疾病的趋势是儿童环境健康指标框架的一个要素，该框架还包括环境中的污染物以及儿童及其母亲体内污染物浓度的趋势。本文提供了关于三组重要儿童疾病或病症的数据，这些疾病或病症似乎至少部分是由接触环境因素引起或加剧的，并且有全国代表性的数据可用。它们是哮喘、儿童癌症和神经发育障碍。哮喘和神经发育障碍的数据来自国家健康访谈调查；儿童癌症发病率的数据来自监测、流行病学和最终结果计划；儿童癌症死亡率的数据来自国家生命统计系统。1980年至1995年间，哮喘儿童的患病率翻了一番，从1980年的3.6%升至1995年的7.5%。儿童癌症的年发病率从1975年至大约1990年呈上升趋势，此后似乎已趋于稳定。在过去25年中，儿童癌症死亡率大幅下降。自1974年以来，某些类型癌症的发病率有所上升，包括急性淋巴细胞白血病、中枢神经系统肿瘤和非霍奇金淋巴瘤。据报告，1997 - 2000年期间，5至17岁的儿童中有约6.7%患有注意力缺陷/多动障碍，同期每1000名儿童中约有6名被诊断为智力迟钝。
