Lee Joyce M, Davis Matthew M, Menon Ram K, Freed Gary L
Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, Michigan, USA.
J Pediatr. 2008 Mar;152(3):331-6. doi: 10.1016/j.jpeds.2007.08.037. Epub 2007 Nov 5.
To determine the geographic distribution of childhood diabetes and obesity relative to the supply of US pediatric endocrinologists.
Estimation of observed and "index" ratios of children with diabetes (by region and division) and obesity (body mass index >/=95th % for age and sex) (by region and state) to board-certified pediatric endocrinologists.
At the national level, the ratio of children with diabetes to pediatric endocrinologists is 290:1, and the ratio of obese children to pediatric endocrinologists is 17,741:1. Ratios of children with diabetes to pediatric endocrinologists in the Midwest (370:1), South (335:1), and West (367:1) are twice as high as in the Northeast (144:1). Across states, there is up to a 19-fold difference in the observed ratios of obese children to pediatric endocrinologists. Under conditions of equitably distributed endocrinologist supply, variation across states would be mitigated considerably.
The distribution of children with diabetes and obesity does not parallel the distribution of pediatric endocrinologists in the United States, due largely to geographic disparities in endocrinologist supply. Given the large burden of obese children to endocrinologists, multidisciplinary models of care delivery are essential for the US health care system to address the needs of children with diabetes and obesity.
确定美国儿童糖尿病和肥胖症的地理分布与儿科内分泌专家供应情况的关系。
估算糖尿病患儿（按地区和分区）以及肥胖症患儿（体重指数≥年龄和性别的第95百分位数）（按地区和州）与获得委员会认证的儿科内分泌专家的观察比率和“指数”比率。
在国家层面，糖尿病患儿与儿科内分泌专家的比率为290:1，肥胖儿童与儿科内分泌专家的比率为17741:1。中西部地区（370:1）、南部地区（335:1）和西部地区（367:1）糖尿病患儿与儿科内分泌专家的比率是东北地区（144:1）的两倍。在各州之间，肥胖儿童与儿科内分泌专家的观察比率相差高达19倍。在内分泌专家供应公平分布的情况下，各州之间的差异将大大减轻。
美国糖尿病和肥胖症患儿的分布与儿科内分泌专家的分布并不平行，这在很大程度上是由于内分泌专家供应的地理差异所致。鉴于肥胖儿童给内分泌专家带来的巨大负担，多学科护理模式对于美国医疗保健系统满足糖尿病和肥胖症患儿的需求至关重要。
