Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Massachusetts 02114, USA.
JAMA. 2010 Feb 17;303(7):623-30. doi: 10.1001/jama.2010.104.
Rates of obesity and other childhood chronic conditions have increased over recent decades. Patterns of how conditions change over time have not been widely examined.
To evaluate change in prevalence of obesity and other chronic conditions in US children, including incidence, remission, and prevalence.
DESIGN, SETTING, AND PARTICIPANTS: Prospective study using the National Longitudinal Survey of Youth-Child Cohort (1988-2006) of 3 nationally representative cohorts of children. Children were aged 2 through 8 years at the beginning of each study period, and cohorts were followed up for 6 years, from 1988 to 1994 (cohort 1, n = 2337), 1994 to 2000 (cohort 2, n = 1759), and 2000 to 2006 (n = 905).
Parent report of a child having a health condition that limited activities or schooling or required medicine, special equipment, or specialized health services and that lasted at least 12 months. Obesity was defined as a body mass index at or above the 95th percentile for age. Chronic conditions were grouped into 4 categories: obesity, asthma, other physical conditions, and behavior/learning problems.
The end-study prevalence of any chronic health condition was 12.8% (95% confidence interval [CI], 11.2%-14.5%) for cohort 1 in 1994, 25.1% (95% CI, 22.7%-27.6%) for cohort 2 in 2000, and 26.6% (95% CI, 23.5%-29.9%) for cohort 3 in 2006. There was substantial turnover in chronic conditions: 7.4% (95% CI, 6.5%-8.3%) of participants in all cohorts had a chronic condition at the beginning of the study that persisted to the end, 9.3% (95% CI, 8.3%-10.3%) reported conditions at the beginning that resolved within 6 years, and 13.4% (95% CI, 12.3%-14.6%) had new conditions that arose during the 6-year study period. The prevalence of having a chronic condition during any part of the 6-year study period was highest for cohort 3 (51.5%; 95% CI, 47.3%-55.0%), and there were higher rates among male (adjusted odds ratio [AOR], 1.24; 95% CI, 1.07-1.42), Hispanic (AOR, 1.36; 95% CI, 1.11-1.67), and black (AOR, 1.60; 95% CI, 1.35-1.90) youth.
Prevalence of chronic conditions among children and youth increased from 1988 to 2006. However, presence of these conditions was dynamic over each 6-year cohort.
近年来，肥胖症和其他儿童期慢性疾病的发病率有所上升。疾病随时间变化的模式尚未得到广泛研究。
评估美国儿童肥胖症和其他慢性疾病的流行率变化，包括发病率、缓解率和患病率。
设计、设置和参与者：前瞻性研究使用了全国青少年纵向调查-儿童队列（1988-2006 年）的 3 个具有全国代表性的儿童队列。每个研究期开始时，儿童年龄为 2 至 8 岁，队列随访 6 年，从 1988 年至 1994 年（队列 1，n=2337）、1994 年至 2000 年（队列 2，n=1759）和 2000 年至 2006 年（n=905）。
父母报告孩子患有影响活动或学业、需要药物、特殊设备或专门医疗服务且持续至少 12 个月的健康状况。肥胖症的定义是体重指数达到或高于年龄的第 95 百分位数。慢性疾病分为 4 类：肥胖症、哮喘、其他身体状况和行为/学习问题。
1994 年队列 1 的终期研究患病率为 12.8%（95%置信区间[CI]，11.2%-14.5%），2000 年队列 2 为 25.1%（95%CI，22.7%-27.6%），2006 年队列 3 为 26.6%（95%CI，23.5%-29.9%）。慢性疾病存在大量更替：所有队列中，7.4%（95%CI，6.5%-8.3%）的参与者在研究开始时就患有持续到结束的慢性疾病，9.3%（95%CI，8.3%-10.3%）报告在 6 年内缓解的疾病，13.4%（95%CI，12.3%-14.6%）在 6 年研究期间出现新的疾病。在 6 年研究期间任何部分患有慢性疾病的患病率最高的是队列 3（51.5%；95%CI，47.3%-55.0%），男性（调整后优势比[AOR]，1.24；95%CI，1.07-1.42）、西班牙裔（AOR，1.36；95%CI，1.11-1.67）和黑人（AOR，1.60；95%CI，1.35-1.90）青少年的发病率更高。
1988 年至 2006 年间，儿童和青少年慢性疾病的患病率有所上升。然而，在每一个 6 年队列中，这些疾病的存在情况都是动态变化的。
