2018—2019年上海市浦东新区儿童急性呼吸道感染患病及就诊行为

刘思家; 张黎; 王远萍; 叶楚楚; 郝莉鹏; 朱渭萍; 陈瑜

doi:10.16462/j.cnki.zhjbkz.2020.08.005

2018—2019年上海市浦东新区儿童急性呼吸道感染患病及就诊行为

doi: 10.16462/j.cnki.zhjbkz.2020.08.005

1.
325035 温州, 温州医科大学检验医学院生命科学学院临床检验诊断学系
2.
200136 上海, 上海市浦东新区疾病预防控制中心急性传染病防治与消毒管理科

刘思家和张黎为共同第一作者

基金项目:

国家科技重大专项 2018ZX10713001-008

上海市浦东新区优秀青年医学人才培养项目 PWRq2017-32

详细信息

通讯作者:
陈瑜, E-mail:chenyu_zy@163.com

中图分类号: R183.3
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出版历程
- 收稿日期: 2020-01-13
- 修回日期: 2020-03-08
- 刊出日期: 2020-08-10

Prevalence and healthcare-seeking practices of children with acute respiratory infections in Pudong, Shanghai during 2018—2019

1.
Department of Clinical Laboratory Diagnostics, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, China
2.
Department of Acute Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New District Center for Disease Control and Prevention，Pudong 200136, Shanghai, China

LIU Si-jia and ZHANG Li contributed equally to this article

Funds:

National Science and Technology Key Project 2018ZX10713001-008

Young Medical Talent Training Program of Health System of Pudong New Area, Shanghai PWRq2017-32

More Information

Corresponding author: CHEN Yu, E-mail:chenyu_zy@163.com

摘要

摘要: 目的了解上海市浦东新区社区儿童急性呼吸道感染（acute respiratory infections，ARI）和流感样症状（influenza like illness，ILI）发生情况及其相关就诊行为特征，并探索其影响因素。方法使用横断面研究设计、多阶段随机抽样方法，对上海市浦东新区0~14岁儿童的监护人进行面对面问卷访谈，调查2018―2019年冬春季发生ARI相关情况、就诊行为，并使用多因素Logistic回归分析模型分析其影响因素。结果共回收2 375份有效调查问卷，2018-2019年冬春季上海市浦东新区儿童ARI和ILI患病率分别为36.1%（858/2 375）和14.0%（332/2 375）；2~4岁儿童ARI患病率（42.4%）高于其他年龄组（OR=2.072，95% CI：1.482~2.896）；具有呼吸系统基础疾病（OR=2.740，95% CI：1.865~4.025）是儿童ARI患病的危险因素；相较于幼托儿童，散居（OR=0.579，95% CI：0.426~0.785）和在校（OR=0.547，95% CI：0.434~0.688）儿童ARI患病风险较低。儿童ARI相关就诊率和住院率分别为58.5%（502/858）和1.7%（15/858）。2~4岁（OR=0.297，95% CI：0.170~0.521）和5~14岁（OR=0.286，95% CI：0.149~0.549）儿童就诊率均低于1岁以内儿童。影响就诊行为的主要因素为发病症状（发热、咳嗽、咽痛、咳痰和乏力）（均有P < 0.05）；81.1%（407/502）的儿童前往二级以上医疗机构就诊。结论上海地区儿童冬春季急性呼吸道感染带来的疾病负担很重，不可忽视。应持续开展基于社区和医疗机构的综合监测以获得更加准确的疾病负担资料，并推行流感、肺炎等呼吸道传染病疫苗接种等防控措施的实施。
- 儿童 /
- 急性呼吸道感染 /
- 就诊行为 /
- 横断面研究
Abstract: Objective To acquire the incidence of acute respiratory infections (ARI) and influenza like illness (ILI) among children in Pudong New Area, Shanghai, and to explore the characteristics of their healthcare-seeking practices and the influencing factors. Methods Cross-sectional study design and multi-stage random sampling method were used to conduct face-to-face questionnaire interviews with guardians of children aged 0-14 years old in Pudong New Area, Shanghai. ARI related conditions and healthcare-seeking practices during the winter and spring of 2018-2019 were investigated through those interviews. The influencing factors were analyzed by multivariate Logistic regression model. Results A total of 2 375 valid questionnaires were collected. The prevalences of ARI and ILI among children in Pudong New Area, Shanghai during the winter and spring of 2018-2019 were 36.1% (858/2 375) and 14.0% (332/2 375). The prevalence of ARI in children aged 2-4 years old (42.4%) was significantly higher than other age groups (OR=2.072, 95% CI: 1.482-2.896). Suffering from basic respiratory diseases (OR=2.740, 95% CI: 1.865-4.025) was the risk factor for ARI in children. Compared with children in kindergarten, the risk of ARI in diaspora children (OR=0.579, 95% CI: 0.426-0.785) and in school students (OR=0.547, 95% CI: 0.434-0.688) were lower. The rates of ARI related healthcare-seeking and hospitalization were 58.5% (502/858) and 1.7% (15/858), respectively. Healthcare-seeking rate of 2-4 years old children (OR=0.297, 95% CI: 0.170-0.521) and 5-14 years old children (OR=0.286, 95% CI: 0.149-0.549) were significantly lower than children under 1 year old. The main factors affecting the behavior of consultations were symptoms (fever, cough, sore throat, sputum, and fatigue)(all P < 0.05). 81.1% (407/502) of children had gone to the secondary medical institutions for healthcare. Conclusions The burden of disease caused by ARI among children in Shanghai cannot be ignored. Comprehensive monitoring based on communities and medical institutions should be continued to obtain a more accurate disease burden data, and vaccination against respiratory infectious diseases such as influenza and pneumonia and other preventive measures should be promoted.
- Children /
- Acute respiratory infections /
- Healthcare-seeking practices /
- Cross-sectional study

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表 1 受调查儿童ARI、ILI患病情况

Table 1. The prevalence of ARI and ILI in the children surveyed

特征	调查人数 [n(%)]	ARI 数(例)	ARI患病率 [%, (95% CI值)]	χ² 值	P 值	ILI数 (例)	ILI患病率 [%, (95% CI值)]	χ² 值	P 值
性别				1.891	0.172			1.901	0.174
男性	1 185(49.9)	412	34.8(32.1~37.6)			154	13.0(11.1~15.0)
女性	1 190(50.1)	446	37.5(34.7~40.3)			178	15.0(13.0~17.1)
年龄(岁)				34.494	＜0.001			16.606	＜0.001
0~	302(12.7)	67	22.2(17.6~27.3)			23	7.6(4.9~11.2)
2~	509(21.4)	216	42.4(38.1~46.9)			91	17.9(14.6~21.5)
5~14	1 564(65.9)	575	36.8(34.4~39.2)			218	13.9(12.3~15.8)
职业				52.818	＜0.001			17.824	＜0.001
幼托儿童	693(29.2)	325	46.9(43.1~50.7)			129	18.6(15.8~21.7)
散居儿童	512(21.6)	145	28.3(24.5~32.4)			58	11.3(8.7~14.4)
在校学生	1 170(49.3)	388	33.2(30.5~35.9)			145	12.4(10.6~14.4)
健康状况				51.754	＜0.001			5.221	0.025
好	2 105(88.6)	707	33.6(31.6~35.6)			282	13.4(12.0~14.9)
一般	270(11.4)	151	55.9(49.8~61.9)			50	18.5(14.1~23.7)
有无呼吸系统疾病				48.373	＜0.001			12.939	＜0.001
是	130(5.5)	84	64.6(55.8~72.8)			32	24.6(17.5~32.9)
否	2 245(94.5)	774	34.5(32.5~36.5)			300	13.4(12.0~14.8)
合计	2 375(100.0)	858	36.1(34.2~38.1)			332	14.0(12.6~15.4)

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表 2 ARI儿童患病相关因素的多因素Logistic回归分析[n(%)]

Table 2. Analysis of multivariate Logistic regression model of ARI children's risk factors [n(%)]

特征	ARI	β 值	Wald 值	OR(95% CI) 值	P 值
年龄(岁)
＜2	67(22.2)			1.000
2~	216(42.4)	0.728	18.160	2.072(1.482~2.896)	＜0.001
5~14	575(36.8)	0.578	8.165	1.783(1.199~2.651)	0.004
户籍所在地
上海市	690(37.7)	0.252	5.437	1.287(1.041~1.591)	0.020
外省市	168(30.7)			1.000
职业
幼托儿童	325(46.9)			1.000
散居儿童	145(28.3)	-0.547	12.322	0.579(0.426~0.785)	＜0.001
在校学生	388(33.2)	-0.604	26.370	0.547(0.434~0.688)	＜0.001
健康状况
好	707(33.6)			1.000
一般	151(55.9)	0.717	27.336	2.048(1.566~2.680)	＜0.001
呼吸系统基础疾病
是	84(64.6)	1.008	26.368	2.740(1.865~4.025)	＜0.001
否	774(34.5)			1.000

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表 3 ARI儿童就诊、住院情况

Table 3. Visits and hospitalization of ARI children

特征	就诊数 (例)	就诊率 [%, (95% CI值)]	χ² 值	P 值	住院数 (例)	住院率 [%, (95%CI值)]	χ² 值	P 值
性别			0.073	0.835			0.881	0.437
男性	243	59.0(54.1~63.8)			9	2.2(1.0~4.1)
女性	259	58.1(53.3~62.7)			6	1.3(0.5~2.9)
年龄(岁)			28.860	＜0.001			9.629	0.005
0~	51	76.1(64.1~85.7)			4	6.0(1.7~14.6)
2~	114	52.8(45.9~59.6)			6	2.8(1.0~5.9)
5~14	249	43.3(39.2~47.5)			5	0.9(0.3~2.0)
职业			27.637	＜0.001			5.224	0.057
幼托儿童	165	50.8(45.2~56.3)			5	1.5(0.5~3.6)
散居儿童	94	64.8(56.5~72.6)			6	4.1(1.5~8.8)
在校学生	155	39.9(35.0~45.0)			4	1.0(0.3~2.6)
家庭人均月收入(元)			4.026	0.258			2.217	0.564
＜3 000	8	44.4(21.5~69.2)			0	0.0(0.0~18.5)
3 000~	68	43.3(35.4~51.4)			1	0.6(0.0~3.5)
10 000~	56	50.0(40.4~59.6)			2	1.8(0.2~6.3)
≥20 000	12	31.6(17.5~48.7)			1	2.6(0.1~13.8)
保险			1.315	0.505			3.025	0.233
有	401	48.4(45.0~51.9)			14	1.7(0.9~2.8)
无	7	53.8(25.1~80.8)			1	7.7(0.2~36.0)
未知	6	35.3(14.2~61.7)			0	0.0(0.0~19.5)
合计	502	58.5(55.1~61.8)			15	1.7(1.0~2.9)

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表 4 ARI儿童就诊相关因素的多因素Logistic回归分析[n(%)]

Table 4. Multivariate Logistic regression analysis of ARI children's visit-related risk factors [n(%)]

特征	就诊数	β 值	Wald 值	OR(95% CI) 值	P 值
年龄(岁)
＜2	51(76.1)			1.000
2~	114(52.8)	-1.213	17.946	0.297(0.170~0.521)	＜0.001
5~14	249(43.3)	-1.253	14.140	0.286(0.149~0.549)	＜0.001
职业
幼托儿童	165(50.8)			1.000
散居儿童	94(64.8)	0.191	0.616	1.210(0.752~1.948)	0.432
在校学生	155(39.9)	-0.663	13.640	0.515(0.363~0.733)	＜0.001
发热
是	287(65.1)	1.559	121.908	4.755(3.606~6.272)	＜0.001
否	127(30.5)			1.000
咳嗽
是	325(48.3)	0.767	22.263	2.154(1.566~2.963)	＜0.001
否	89(48.1)			1.000
流涕
是	293(44.6)	-0.588	14.113	0.556(0.409~0.755)	＜0.001
否	121(60.2)			1.000
咽喉痛
是	175(51.0)	0.516	11.184	1.676(1.238~2.268)	0.001
否	239(46.4)			1.000
咳痰
是	123(54.9)	0.520	9.042	1.682(1.198~2.360)	0.003
否	291(45.9)			1.000
乏力
是	67(63.2)	0.540	5.382	1.717(1.087~2.710)	0.020
否	347(46.1)			1.000

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特征	调查人数 [n(%)]	ARI 数(例)	ARI患病率 [%, (95% CI值)]	χ² 值	P 值	ILI数 (例)	ILI患病率 [%, (95% CI值)]	χ² 值	P 值
性别				1.891	0.172			1.901	0.174
男性	1 185(49.9)	412	34.8(32.1~37.6)			154	13.0(11.1~15.0)
女性	1 190(50.1)	446	37.5(34.7~40.3)			178	15.0(13.0~17.1)
年龄(岁)				34.494	＜0.001			16.606	＜0.001
0~	302(12.7)	67	22.2(17.6~27.3)			23	7.6(4.9~11.2)
2~	509(21.4)	216	42.4(38.1~46.9)			91	17.9(14.6~21.5)
5~14	1 564(65.9)	575	36.8(34.4~39.2)			218	13.9(12.3~15.8)
职业				52.818	＜0.001			17.824	＜0.001
幼托儿童	693(29.2)	325	46.9(43.1~50.7)			129	18.6(15.8~21.7)
散居儿童	512(21.6)	145	28.3(24.5~32.4)			58	11.3(8.7~14.4)
在校学生	1 170(49.3)	388	33.2(30.5~35.9)			145	12.4(10.6~14.4)
健康状况				51.754	＜0.001			5.221	0.025
好	2 105(88.6)	707	33.6(31.6~35.6)			282	13.4(12.0~14.9)
一般	270(11.4)	151	55.9(49.8~61.9)			50	18.5(14.1~23.7)
有无呼吸系统疾病				48.373	＜0.001			12.939	＜0.001
是	130(5.5)	84	64.6(55.8~72.8)			32	24.6(17.5~32.9)
否	2 245(94.5)	774	34.5(32.5~36.5)			300	13.4(12.0~14.8)
合计	2 375(100.0)	858	36.1(34.2~38.1)			332	14.0(12.6~15.4)

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2018—2019年上海市浦东新区儿童急性呼吸道感染患病及就诊行为

doi: 10.16462/j.cnki.zhjbkz.2020.08.005

通讯作者:
陈瑜, E-mail:chenyu_zy@163.com

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Prevalence and healthcare-seeking practices of children with acute respiratory infections in Pudong, Shanghai during 2018—2019

Corresponding author: CHEN Yu, E-mail:chenyu_zy@163.com

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2018—2019年上海市浦东新区儿童急性呼吸道感染患病及就诊行为

doi: 10.16462/j.cnki.zhjbkz.2020.08.005

通讯作者: 陈瑜, E-mail:chenyu_zy@163.com

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Prevalence and healthcare-seeking practices of children with acute respiratory infections in Pudong, Shanghai during 2018—2019

Corresponding author: CHEN Yu, E-mail:chenyu_zy@163.com

计量

出版历程

目录

通讯作者:
陈瑜, E-mail:chenyu_zy@163.com