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
计量
- 文章访问数: 605
- HTML全文浏览量: 256
- PDF下载量: 55
- 被引次数: 0
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

HTML全文

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)

下载: 导出CSV

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

下载: 导出CSV

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)

下载: 导出CSV

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

下载: 导出CSV

参考文献(22)

[1]	Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015:a systematic analysis for the Global Burden of Disease Study 2015[J]. Lancet, 2016, 388(10053):1545-1602. DOI: 10.1016/S0140-6736(16)31678-6.
[2]	Qazi S, Aboubaker S, Maclean R, et al. Ending preventable child deaths from pneumonia and diarrhoea by 2025. Development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea[J]. Arch Dis Child, 2015, 100(Suppl 1):s23-s28. DOI: 10.1136/archdischild-2013-305429.
[3]	Yu H, Alonso WJ, Feng L, et al. Characterization of regional influenza seasonality patterns in China and implications for vaccination strategies:spatio-temporal modeling of surveillance data[J]. PLoS Med, 2013, 10(11):e1001552. DOI: 10.1371/journal.pmed.1001552.
[4]	Casalegno JS, Eibach D, Valette M, et al. Performance of influenza case definitions for influenza community surveillance:based on the French influenza surveillance network GROG, 2009-2014[J]. Euro Surveill, 2017, 22(14):30504. DOI: 10.2807/1560-7917.ES.2017.22.14.30504.
[5]	Azziz-Baumgartner E, Alamgir AS, Rahman M, et al. Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008-2010[J]. Bull World Health Organ, 2012, 90(1):12-19. DOI: 10.2471/BLT.11.090209.
[6]	高立雪.流感大流行期间急性呼吸道感染患病、态度、知识和行为调查[D].北京: 中国疾病预防控制中心, 2011. Gao LX. Survey of prevalence, attitude, knowledge and behavior of acute respiratory infections during an influenza pandemic[D]. Beijing: Chinese Center for Disease Control and Prevention, 2011.
[7]	刘营, 宋绍霞, 王伟, 等.济南市社区居民急性上呼吸道感染与流感样病例发病及其疫苗接种情况[J].中华预防医学杂志, 2015, 49(12):1032-1035. DOI: 10.3760/cma.j.issn.0253-9624.2015.12.003. Liu Y, Song SX, Wang W, et al. Status of acute upper respiratory infection, influenza-like illness, and influenza vaccination coverage among community residents in Jinan[J]. Chin J Prev Med, 2015, 49(12):1032-1035. DOI: 10.3760/cma.j.issn.0253-9624.2015.12.003.
[8]	Ren X, Geoffroy E, Tian K, et al. Knowledge, attitudes, and behaviors (KAB) of influenza vaccination in China:a cross-sectional study in 2017/2018[J]. Vaccines, 2020, 8(1):7. DOI: 10.3390/vaccines8010007.
[9]	康敏, 谭小华, 杨宇威, 等.广东省2017-2018年冬季流感流行特征研究[J].中华流行病学杂志, 2018, 39(8):1071-1076. DOI: 10.3760/cma.j.issn.0254-6450.2018.08.011. Kang M, Tan XH, Yang YW, et al. Epidemiological characteristics of influenza in Guangdong province, during winter of 2017-2018[J]. Chin J Epidemiol, 2018, 39(8):1071-1076. DOI: 10.3760/cma.j.issn.0254-6450.2018.08.011.
[10]	刘丽军, 杨静, 祝菲, 等. 2017-2018年中国流感样病例暴发疫情分析[J].中华预防医学杂志, 2019, 53(10):982-986. DOI: 10.3760/cma.j.issn.0253-9624.2019.10.006. Liu LJ, Yang J, Zhu F, et al. Influenza-like illness outbreaks in China during 2017-2018 surveillance season[J]. Chin J Prev Med, 2019, 53(10):982-986. DOI: 10.3760/cma.j.issn.0253-9624.2019.10.006.
[11]	Rahman SR, Ahmed MF, Islam MA, et al. Effect of risk factors on the prevalence of influenza infections among children of slums of Dhaka city[J]. Springer Plus, 2016, 5:602. DOI: 10.1186/s40064-016-2275-5.
[12]	Rahman MM, Shahidullah M. Risk factors for acute respiratory infections among the slum infants of Dhaka city[J]. Bangladesh Med Res Counc Bull, 2001, 27(2):55-62. http://www.ncbi.nlm.nih.gov/pubmed/11942489
[13]	Imran MIK, Inshafi MUA, Sheikh R, et al. Risk factors for acute respiratory infection in children younger than five years in Bangladesh[J]. Public health, 2019, 173:112-119. DOI: 10.1016/j.puhe.2019.05.011.
[14]	Tupasi TE, Velmonte MA, Sanvictores ME, et al. Determinants of morbidity and mortality due to acute respiratory infections:implications for intervention[J]. J Infect Dis, 1988, 157(4):615-623. DOI: 10.1093/infdis/157.4.615.
[15]	李明, 冯录召, 曹玉, 等.中国2005-2013年流感暴发疫情的流行病学特征分析[J].中华流行病学杂志, 2015, 36(7):705-708. DOI: 10.3760/cma.j.issn.0254-6450.2015.07.009. Li M, Feng LZ, Cao Y, et al. Epidemiological characteristics of influenza outbreaks in China, 2005-2013[J]. Chin J Epidemiol, 2015, 36(7):705-708. DOI: 10.3760/cma.j.issn.0254-6450.2015.07.009.
[16]	Durigon GS, Oliveira DB, Felicio MC, et al. Poor outcome of acute respiratory infection in young children with underlying health condition in Brazil[J]. Int J Infect Dis, 2015, 34:3-7. DOI: 10.1016/j.ijid.2015.03.003.
[17]	吴双胜, 孙瑛, 马春娜, 等. 2016-2017年流感流行季北京市二级及以上医疗机构流感应对情况[J].国际病毒学杂志, 2018, 25(3):150-153. DOI: 10.3760/cma.j.issn.1673-4092.2018.03.002. Wu SS, Sun Y, Ma CN, et al. Response to influenza in secondary-and tertiary-level medical institutions during 2016-2017 influenza season in Beijing, China[J]. Int J Virol, 2018, 25(3):150-153. DOI: 10.3760/cma.j.issn.1673-4092.2018.03.002.
[18]	Shang M, Blanton L, Brammer L, et al. Influenza-associated pediatric deaths in the United States, 2010-2016[J]. Pediatrics, 2018, 141(4):e20172918. DOI: 10.1542/peds.2017-2918.
[19]	GBD 2017 Lower Respiratory Infection Collaborators. Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years:an analysis for the Global Burden of Disease Study 2017[J]. Lancet Infect Dis, 2020, 20(1):60-79. DOI: 10.1016/S1473-3099(19)30410-4.
[20]	国家免疫规划技术工作组流感疫苗工作组.中国流感疫苗预防接种技术指南(2019-2020) [J].中华流行病学杂志, 2019, 40(11): 1333-1349.
[21]	Fu C, Xu J, Lin J, et al. Concurrent and cross-season protection of inactivated influenza vaccine against A(H1N1)pdm09 illness among young children:2012-2013 case-control evaluation of influenza vaccine effectiveness[J]. Vaccine, 2015, 33(25):2917-2921. DOI: 10.1016/j.vaccine.2015.04.063.
[22]	Yang Z, Dong Z, Fu C. Seasonal influenza vaccine effectiveness among children aged 6 to 59 months in Southern China[J]. PLoS One, 2012, 7(1):e30424. DOI: 10.1371/journal.pone.003.

施引文献

资源附件(0)

访问统计

点击查看大图

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)

表(4)

计量

文章访问数: 605
HTML全文浏览量: 256
PDF下载量: 55
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

留言板

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

计量

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

目录

留言板

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

计量

出版历程

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