U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, Maryland.
J Rural Health. 2020 Jun;36(3):394-409. doi: 10.1111/jrh.12411. Epub 2020 Feb 11.
This study's purpose was to determine the prevalence of physical, mental, and developmental health conditions among US children and assess the association with urban versus rural residence.
Bivariate/multivariable analyses were conducted with cross-sectional data for children aged 0-17 years (N = 71,811) from the 2016-2017 National Survey of Children's Health. Prevalence estimates of excellent/very good health were derived from parents' qualitative judgments. Parent-reported health conditions were aggregated by condition type (physical, mental, developmental). Prevalence was determined for condition type and severity. Adjusted risk ratios assessed the effect of residence on having physical, mental, or developmental conditions.
Among rural children in the general population, we found lower crude rates of excellent/very good overall health and higher rates of ≥1 physical condition(s) and ≥1 mental condition(s), as well as these 2 conditions in combination with ≥1 developmental condition(s). Rural children in the general population were also more likely to have physical and mental conditions that parents rated as moderate/severe in unadjusted analyses. To a lesser extent, these differences held true for the children with special health care needs. Risk ratios for rural residence were largely nonsignificant in adjusted analyses.
While rural children had lower crude rates of parent-reported excellent/very good health and higher crude rates of parent-reported or doctor-diagnosed physical and mental health conditions compared to urban children, the same pattern of urban-rural differentials was not evident in the adjusted analyses. Compositional and contextual differences in the urban/rural populations suggest that social determinants of health may have accounted for rate disparities in child health conditions.
本研究旨在确定美国儿童身体、心理和发育健康状况的流行情况，并评估城市与农村居住环境的关联。
采用横断面数据分析了 2016-2017 年全国儿童健康调查中 0-17 岁儿童（N=71811）的双变量/多变量。父母定性判断得出健康状况的优秀/非常好的估计率。父母报告的健康状况按疾病类型（身体、心理、发育）进行汇总。确定疾病类型和严重程度的患病率。调整后的风险比评估居住对身体、心理或发育状况的影响。
在普通农村儿童中，我们发现整体优秀/非常好健康的粗率较低，≥1 种身体状况和/或≥1 种精神状况的发生率较高，以及这两种状况与≥1 种发育状况同时存在的发生率较高。普通农村儿童的身体和精神状况也更有可能被父母评定为中度/重度，在未调整分析中。在有特殊医疗需求的儿童中，这种差异在一定程度上也是如此。调整分析中，农村居住的风险比大多不显著。
虽然与城市儿童相比，农村儿童的父母报告的优秀/非常好健康的粗率较低，父母报告或医生诊断的身体和精神健康状况的粗率较高，但在调整分析中，城市与农村之间的这种差异模式并不明显。城乡人群的构成和背景差异表明，健康的社会决定因素可能导致儿童健康状况的差异。
