Grimberg Adda, Ramos Mark, Grundmeier Robert, Feemster Kristen A, Pati Susmita, Cucchiara Andrew J, Stallings Virginia A
Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
J Pediatr. 2009 Apr;154(4):567-572.e2. doi: 10.1016/j.jpeds.2008.10.041. Epub 2008 Dec 10.
To determine the sex-based prevalence of growth faltering in a pediatric primary care setting.
A total of 33 476 children attending 4 urban pediatric primary care practices affiliated with a tertiary pediatric hospital between July 2002 and June 2005 were studied. Growth faltering was defined as height <5th percentile or a drop in height z-score by >or= 1.5 standard deviations (SD) before age 18 months or by >or= 1 SD thereafter. The growth-faltering and nonfaltering groups were compared in terms of sex, race, age, number of clinic visits, and insurance, and by US census tract, socioeconomic status and parental education. Similar comparisons were made for children with height z-scores below -2.25 SD.
Growth faltering was present in 3007 of the children studied (9%). Univariate and multivariate logistic regression analyses identified significant associations between growth faltering and younger age (P< .0001), Caucasian race (P< .0001), fewer clinic visits (P< .0001), and Medicaid insurance (P< .005), but not with sex nor by residential census tract, median income or proportion with less than high school education. Height below -2.25 SD was associated with male sex (P< .01), Medicaid insurance (P< .01), and more primary care visits (P< .0005).
The sex disparity in subspecialty growth center referrals (2:1 male:female) is not due to male predominance in growth faltering among children in the urban primary care setting.
确定儿科初级保健机构中生长发育迟缓按性别划分的患病率。
对2002年7月至2005年6月期间在一家三级儿科医院附属的4家城市儿科初级保健机构就诊的33476名儿童进行了研究。生长发育迟缓的定义为：18个月前身高低于第5百分位数或身高z评分下降≥1.5个标准差（SD），18个月后身高z评分下降≥1个标准差。对生长发育迟缓组和非生长发育迟缓组在性别、种族、年龄、门诊就诊次数、保险类型方面进行比较，并按美国人口普查区、社会经济地位和父母教育程度进行比较。对身高z评分低于 -2.25 SD的儿童也进行了类似的比较。
在所研究的儿童中，有3007名（9%）存在生长发育迟缓。单因素和多因素逻辑回归分析确定生长发育迟缓与年龄较小（P < .0001）、白种人种族（P < .0001）、门诊就诊次数较少（P < .0001）以及医疗补助保险（P < .005）之间存在显著关联，但与性别、居住人口普查区、中位数收入或高中以下教育程度比例无关。身高低于 -2.25 SD与男性性别（P < .01）、医疗补助保险（P < .01）以及更多的初级保健就诊次数（P < .0005）相关。
专科生长中心转诊中的性别差异（男性与女性比例为2:1）并非由于城市初级保健机构中儿童生长发育迟缓的男性占主导地位所致。
