Staiano Amanda E, Morrell Madeline, Hsia Daniel S, Hu Gang, Katzmarzyk Peter T
Pennington Biomedical Research Center , Baton Rouge, Louisiana.
Metab Syndr Relat Disord. 2016 Nov;14(9):437-441. doi: 10.1089/met.2016.0025. Epub 2016 Jul 11.
Obesity, elevated blood pressure (BP), and diabetes mellitus are rising among the general U.S. adolescent population, but prevalence estimates are not available for uninsured or Medicaid populations.
This retrospective epidemiological study extracted 155,139 electronic medical records collected between 1998 and 2012 on patients aged 10-19 years, from a clinical population predominantly uninsured or insured by Medicaid. Age, sex, race, height, weight, BP, and insurance type were captured at first clinic visit. Classifications included obesity (≥95th body mass index percentile), elevated BP (≥90th percentile), and diabetes mellitus (ICD-9-250.xx).
Among the 26,696 patients with complete data at first clinic visit, 24.4% were classified as obese and 39.5% had elevated BP. In logistic regression analyses, odds of obesity were significantly higher among uninsured versus commercially insured patients (odds ratio [OR]: 1.1 [95% confidence interval: 1.0-1.2]) and girls (OR: 1.3 [1.2-1.4]), but lower among older adolescents (for 15-17 years, OR: 0.7 [0.6-0.7]; for 18-19 years, OR: 0.7 [0.7-0.8]). Odds of elevated BP were significantly higher among Medicaid (OR: 1.1 [1.0-1.2]) and uninsured (OR: 1.2 [1.1-1.4]) versus commercially insured patients, but lower among African American versus White youth (OR: 0.9 [0.8-0.9]). Prevalence of type 1 diabetes was 1.46 per 1000 and prevalence of type 2 diabetes was 1.68 per 1000, with both occurring more often in girls versus boys and in Whites versus African Americans.
In this low-income clinical population, prevalence of obesity and elevated BP were higher than national estimates. The provision of preventive healthcare to all Medicaid and uninsured youth should remain a priority.
在美国普通青少年人群中，肥胖、血压升高和糖尿病的发病率呈上升趋势，但未参保人群或医疗补助人群的患病率估计尚无数据。
这项回顾性流行病学研究从以未参保或参加医疗补助的人群为主的临床样本中，提取了1998年至2012年间收集的155,139份10至19岁患者的电子病历。在首次就诊时记录年龄、性别、种族、身高、体重、血压和保险类型。分类包括肥胖（体重指数≥第95百分位数）、血压升高（≥第90百分位数）和糖尿病（国际疾病分类第九版代码250.xx）。
在首次就诊时有完整数据的26,696名患者中，24.4%被分类为肥胖，39.5%血压升高。在逻辑回归分析中，未参保患者的肥胖几率显著高于商业保险患者（优势比[OR]：1.1[95%置信区间：1.0 - 1.2]），女孩的肥胖几率也较高（OR：1.3[1.2 - 1.4]），但年龄较大的青少年肥胖几率较低（15 - 17岁，OR：0.7[0.6 - 0.7]；18 - 19岁，OR：0.7[0.7 - 0.8]）。医疗补助患者（OR：1.1[1.0 - 1.2]）和未参保患者（OR：1.2[1.1 - 1.4]）的血压升高几率显著高于商业保险患者，但非裔美国青少年的血压升高几率低于白人青少年（OR：0.9[0.8 - 0.9]）。1型糖尿病患病率为每1000人中有1.46例，2型糖尿病患病率为每1000人中有1.68例，两种类型在女孩中比在男孩中更常见，在白人中比在非裔美国人中更常见。
在这个低收入临床人群中，肥胖和血压升高的患病率高于全国估计水平。为所有医疗补助和未参保青少年提供预防性医疗保健仍应是优先事项。
