SanGiovanni Christine, McElligott James, Morella Kristen, Basco William
From the Departments of Pediatrics and Public Health, Medical University of South Carolina, Charleston.
South Med J. 2017 Jul;110(7):480-485. doi: 10.14423/SMJ.0000000000000672.
This study compared the number of children enrolled in Medicaid in rural and urban areas of South Carolina with an overweight/obesity diagnosis and the mean rates of office visits with overweight/obesity diagnosed.
Medicaid claims data from 2012 for children in three South Carolina counties, categorized as urban, rural high resource, and rural low resource, were used to identify those who had been diagnosed as being overweight/obese during any encounter. Logistic and Poisson regressions were performed to predict whether overweight/obese children in each county would receive an overweight/obesity visit diagnosis and to calculate the mean rate of total office visits with an overweight/obesity diagnosis in each county.
A total of 1233 children enrolled in Medicaid were diagnosed as being overweight/obese at any encounter in the designated counties. Well visits with overweight/obesity diagnosed varied significantly, with 42.6%, 28%, and 11% in urban, rural high-resource counties, and rural low-resource counties, respectively ( < 0.01). In the logistic regression rural high-resource children (adjusted odds ratio 0.58, 95% confidence interval 0.38-0.88) and rural low-resource children (adjusted odds ratio 0.16, 95% confidence interval 0.09-0.28) were less likely than urban children to be diagnosed as being overweight/obese at a well visit. All of the children had a low number of total office visits with overweight/obesity diagnosed. When comparing the counties, urban children (1.22 visits per year) had more visits than rural low-resource children (0.75 visits per year, < 0.01) and rural high-resource children (0.89 visits per year, < 0.01).
Overweight/obesity is underdiagnosed in rural children enrolled in Medicaid in South Carolina, which affects the number of children who receive help to manage their weight. Interventions to overcome barriers of diagnosis and management are necessary to address childhood obesity properly.
本研究比较了南卡罗来纳州农村和城市地区参加医疗补助计划且被诊断为超重/肥胖的儿童数量，以及被诊断为超重/肥胖的儿童的平均门诊就诊率。
利用南卡罗来纳州三个县（分为城市、农村高资源和农村低资源）2012年儿童的医疗补助索赔数据，确定在任何一次就诊中被诊断为超重/肥胖的儿童。进行逻辑回归和泊松回归，以预测每个县超重/肥胖儿童是否会得到超重/肥胖就诊诊断，并计算每个县被诊断为超重/肥胖的儿童的总门诊就诊平均率。
在指定县，共有1233名参加医疗补助计划的儿童在任何一次就诊中被诊断为超重/肥胖。被诊断为超重/肥胖的健康检查就诊率差异显著，城市、农村高资源县和农村低资源县分别为42.6%、28%和11%（P<0.01）。在逻辑回归中，农村高资源儿童（调整比值比0.58，95%置信区间0.38 - 0.88）和农村低资源儿童（调整比值比0.16，95%置信区间0.09 - 0.28）在健康检查时被诊断为超重/肥胖的可能性低于城市儿童。所有儿童被诊断为超重/肥胖的总门诊就诊次数都较少。比较各县时，城市儿童（每年1.22次就诊）的就诊次数多于农村低资源儿童（每年0.75次就诊，P<0.01）和农村高资源儿童（每年0.89次就诊，P<0.01）。
南卡罗来纳州参加医疗补助计划的农村儿童超重/肥胖诊断不足，这影响了获得体重管理帮助的儿童数量。有必要采取干预措施克服诊断和管理障碍，以妥善解决儿童肥胖问题。
