Grimberg Adda, Stewart Elizabeth, Wajnrajch Michael P
Division of Pediatric Endocrinology, The Children's Hospital of Philadelphia, Abramson Research Center, 3615 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA.
J Clin Endocrinol Metab. 2008 Jun;93(6):2050-6. doi: 10.1210/jc.2007-2617. Epub 2008 Mar 11.
Gender disparities were found in reports of early pediatric recombinant human GH (rhGH) use in the United States. With rhGH entering its third decade, we sought to examine U.S. gender-based treatment patterns and how these patterns compare with that of other countries.
All children entered in the Pfizer International Growth Study, a database designed to document long-term outcomes and safety of Genotropin (Pfizer, New York, NY), were categorized by gender, location, date and age of therapy initiation, and diagnosis. Measures of national health status, health care expenditure, general economic indices, and mean adult heights were also compared.
Throughout the past 20 yr, the United States had an almost 2:1 male to female ratio overall. The gender ratio depended on the specific indication and age. There was no consistent relation to geographical region, pediatric population size, or density of pediatric endocrinologists. Male predominance was seen in Asia (mostly Japan), the United States, and Europe/Australia/New Zealand (65, 64, and 55%, respectively), but not the rest of the world (47%), where rhGH was prescribed less frequently. In the countries with the greatest rhGH use, the gender ratios depended on the specific indications but did not correlate with mean adult height, national health care measures, or general economic indices.
Male predominance among U.S. pediatric rhGH recipients persists, especially for indications without a clear organic etiology. Global differences in gender ratios suggest that factors other than biology are at play. We speculate that social and cultural pressures and the health care systems' permissiveness toward paying for rhGH therapy contribute to these international differences.
在美国，早期儿科使用重组人生长激素（rhGH）的报告中发现了性别差异。随着rhGH进入第三个十年，我们试图研究美国基于性别的治疗模式，以及这些模式与其他国家的模式相比如何。
辉瑞国际生长研究纳入的所有儿童，该数据库旨在记录健高素（辉瑞，纽约，纽约）的长期疗效和安全性，按性别、地点、治疗开始日期和年龄以及诊断进行分类。还比较了国家健康状况、医疗保健支出、一般经济指数和成人平均身高的指标。
在过去20年中，美国总体上男女比例几乎为2:1。性别比例取决于具体适应症和年龄。与地理区域、儿科人口规模或儿科内分泌学家密度没有一致的关系。在亚洲（主要是日本）、美国以及欧洲/澳大利亚/新西兰（分别为65%、64%和55%）观察到男性占主导地位，但在世界其他地区（47%）并非如此，在这些地区rhGH的处方频率较低。在rhGH使用最多的国家，性别比例取决于具体适应症，但与成人平均身高、国家医疗保健措施或一般经济指数无关。
美国儿科rhGH接受者中男性占主导地位的情况仍然存在，特别是对于没有明确器质性病因的适应症。全球性别比例的差异表明，除了生物学因素外，还有其他因素在起作用。我们推测，社会和文化压力以及医疗保健系统对支付rhGH治疗费用的宽松态度导致了这些国际差异。
