中国2014年7～14岁汉族学生贫血流行现状
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摘要
目的分析中国7～14岁汉族中小学生贫血流行现状和地区差异,为改善中国儿童贫血状况提供依据。方法选取2014年全国学生体质与健康调研中7～14岁汉族中小学生71 115名。使用WHO贫血诊断标准,根据血红蛋白水平定义贫血及其严重程度。用秩和检验比较不同群体贫血程度分布的差异,通过Logistic回归分析贫血和中重度贫血的影响因素。结果 7～14岁中小学生总体贫血率为8.9%,其中轻度和中重度贫血率分别为5.8%和3.1%。男生7～14岁平均血红蛋白水平随年龄的增加而上升,7岁男生贫血率(9.8%)和中重度贫血率(4.4%)最高。女生7～12岁平均血红蛋白水平逐渐上升,14岁有轻微下降,14岁贫血率(13.3%)最高,7岁中重度贫血率(4.8%)最高。30个省份中,学生总体贫血率最高的2个省为海南(24.1%)和甘肃(19.6%),最低的为北京(2.0%)。Logistic回归分析显示,对于7岁和9岁学生,相比于居住在城市,居住在农村是贫血(OR=1.34)和中重度贫血(OR=1.48)的危险因素;相比于居住在好片,中片、差片均是贫血(OR值分别为1.43,1.26)和中重度贫血(OR值分别为1.41,1.35)的危险因素;对于12和14岁学生,女生患贫血和中重度贫血(OR值分别为2.41,2.20)的风险高于男生。结论中国7～14岁中小学生贫血率总体较低,但地区和人群变异大。在贫血率高的地区应基于实际情况通过除虫或补充铁剂等方式降低贫血率,干预应关注青春期女孩和社会经济地位较低的人群。
Objective To describe the subnational disparity of anemia among Chinese Han students aged 7-14 years, and to provide a reference for making intervention measures to improve anemia among Chinese children. Methods A total of 71 115 Chinese Han students aged 7-14 years were selected from the project '2014 Chinese National Survey on Students' Constitution and Health'. Anemia and its severity were defined according to the diagnosis criteria of World Health Organization(WHO). The rank sum test was used to compare anemia distribution of different subgroups. Logistic regression models were established to analyze the influencing factors of anemia and moderate-to-severe anemia. Results In the 71 115 students with measured hemoglobin concentrations in the 2014 CNSSCH, the overall prevalence rate of anemia was 8.9%, with 5.8% to be mild anemia and 3.1% to be moderate-to-severe anemia. For boys aged 7-14 years, the hemoglobin concentration increased with age; Boys aged 7 years had the highest anemia prevalence(9.8%) and moderate-to-severe anemia prevalence(4.4%). For girls aged 7-12 years, the hemoglobin concentration increased with age, but the concentration decreased a little when girls reached 14 years of age; 14-year-old girls had the highest prevalence of anemia(13.3%), and 7-year-old girls had the highest prevalence of moderate-to-severe anemia(4.8%). The highest prevalence rates of anemia were found in Hainan(24.1%) and Gansu(19.6%), while the lowest was in Beijing(2.0%). Logistic regression models revealed that, for children aged 7 and 9 years, when comparing to those lived in urban areas, living in rural areas appeared to be a risk factor for anemia(OR=1.34) and moderate-to-severe anemia(OR=1.48); when comparing to living in cities of upper socio-economic status, living in cities of intermediate socio-economic status appeared to be a risk factor for anemia(OR=1.43) and moderate-to-severe anemia(OR=1.41), and living in cities of lower socio-economic status also appeared to be a risk factor for anemia(OR=1.26) and moderate-to-severe anemia(OR=1.35). For students aged 12 and 14 years, girls were at higher risks for anemia and moderate-to-severe anemic(OR=2.41,2.20). Conclusion The overall prevalence of anemia was low in Chinese school-aged children, but substantial subnational disparity and subgroup disparity exists. Our data called for setting up context-specific measures, such as deworming and iron supplementation, to deal with child anemia. Intervention programs need to be implemented among adolescent girls and those with relatively low socioeconomic status.
Objective To describe the subnational disparity of anemia among Chinese Han students aged 7-14 years, and to provide a reference for making intervention measures to improve anemia among Chinese children. Methods A total of 71 115 Chinese Han students aged 7-14 years were selected from the project '2014 Chinese National Survey on Students' Constitution and Health'. Anemia and its severity were defined according to the diagnosis criteria of World Health Organization(WHO). The rank sum test was used to compare anemia distribution of different subgroups. Logistic regression models were established to analyze the influencing factors of anemia and moderate-to-severe anemia. Results In the 71 115 students with measured hemoglobin concentrations in the 2014 CNSSCH, the overall prevalence rate of anemia was 8.9%, with 5.8% to be mild anemia and 3.1% to be moderate-to-severe anemia. For boys aged 7-14 years, the hemoglobin concentration increased with age; Boys aged 7 years had the highest anemia prevalence(9.8%) and moderate-to-severe anemia prevalence(4.4%). For girls aged 7-12 years, the hemoglobin concentration increased with age, but the concentration decreased a little when girls reached 14 years of age; 14-year-old girls had the highest prevalence of anemia(13.3%), and 7-year-old girls had the highest prevalence of moderate-to-severe anemia(4.8%). The highest prevalence rates of anemia were found in Hainan(24.1%) and Gansu(19.6%), while the lowest was in Beijing(2.0%). Logistic regression models revealed that, for children aged 7 and 9 years, when comparing to those lived in urban areas, living in rural areas appeared to be a risk factor for anemia(OR=1.34) and moderate-to-severe anemia(OR=1.48); when comparing to living in cities of upper socio-economic status, living in cities of intermediate socio-economic status appeared to be a risk factor for anemia(OR=1.43) and moderate-to-severe anemia(OR=1.41), and living in cities of lower socio-economic status also appeared to be a risk factor for anemia(OR=1.26) and moderate-to-severe anemia(OR=1.35). For students aged 12 and 14 years, girls were at higher risks for anemia and moderate-to-severe anemic(OR=2.41,2.20). Conclusion The overall prevalence of anemia was low in Chinese school-aged children, but substantial subnational disparity and subgroup disparity exists. Our data called for setting up context-specific measures, such as deworming and iron supplementation, to deal with child anemia. Intervention programs need to be implemented among adolescent girls and those with relatively low socioeconomic status.
引文
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[12] 林绍雄,王善青,胡锡敏,等.海南省土源性线虫病流行现状分析[J].中国热带医学,2010,10(8):939-941.
[13] BROOKER S,JARDIM-BOTELHO A,QUINNELL R J,et al.Age-related changes in hookworm infection,anaemia and iron deficiency in an area of high Necator americanus hookworm transmission in south-eastern Brazil[J].Trans R Soc Trop Med Hyq,2007,101(2):146-154.
[14] 中华人民共和国国家统计局.2015中国统计年鉴[EB/OL].[2019-01-03].http://www.stats.gov.cn/tjsj/ndsj/2015/indexch.htm.
[15] SMITH J L,BROOKER S.Impact of hookworm infection and deworming on anaemia in non-pregnant populations:a systematic review[J].Trop Med Int Health,2010,15(7):776-95.
[16] PASRICHA S R,DRAKESMITH H,BLACK J,et al.Control of iron deficiency anemia in low-and middle-income countries[J].Blood,2013,121(14):2607-2617.
[17] MILLER G,LUO R,ZHANG L,et al.Effectiveness of provider incentives for anaemia reduction in rural China:a cluster randomised trial[J].BMJ,2012,345:e4809.doi:10.1136/bmj.e4809.
[2] BALARAJAN Y,RAMAKRISHNAN U,?ZALTIN E,et al.Anaemia in low-income and middle-income countries[J].Lancet,2011,378(9809):2123-2135.
[3] MCCANN J,AMES B.An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function[J].Am J Clin Nutr,2007,85(4):931-45.
[4] 中国学生体质与健康研究组.2014年中国学生体质与健康调研报告[M].北京:高等教育出版社,2016.
[5] WHO.Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity[M].Geneva:WHO,2011.
[6] 中华人民共和国国家统计局.东西中部和东北地区划分方法[EB/OL].[2019-01-03].http://www.stats.gov.cn/ztjc/zthd/sjtjr/dejtjkfr/tjkp/201106/t20110613_71947.htm.
[7] SONG Y,WANG H J,DONG B,et al.National trends in hemoglobin concentration and prevalence of anemia among Chinese school-aged children,1995-2010[J].J Pediatr,2017,183:164-169.DOI:10.1016/j.jpeds.2017.01.012.
[8] World Health Organization,Regional Office for South-East Asia.Prevention of iron deficiency anaemia in adolescents[R].New Delhi:WHO Regional Office for South-East Asia,2011:2-4.
[9] SANA S,YAW A O,VANESSA C G,et al.Determinants of anemia among school-aged children in Mexico,the United States and Colombia[J].Nutrients,2016,8(7):387.
[10] WHO.Guideline:intermittent iron and folic acid supplementation in menstruating women[R].Geneva:WHO,2011:5.
[11] LYNCH S R.The potential impact of iron supplementation during adolescence on iron status in pregnancy[J].J Nutr,2000,130(2):448-451.
[12] 林绍雄,王善青,胡锡敏,等.海南省土源性线虫病流行现状分析[J].中国热带医学,2010,10(8):939-941.
[13] BROOKER S,JARDIM-BOTELHO A,QUINNELL R J,et al.Age-related changes in hookworm infection,anaemia and iron deficiency in an area of high Necator americanus hookworm transmission in south-eastern Brazil[J].Trans R Soc Trop Med Hyq,2007,101(2):146-154.
[14] 中华人民共和国国家统计局.2015中国统计年鉴[EB/OL].[2019-01-03].http://www.stats.gov.cn/tjsj/ndsj/2015/indexch.htm.
[15] SMITH J L,BROOKER S.Impact of hookworm infection and deworming on anaemia in non-pregnant populations:a systematic review[J].Trop Med Int Health,2010,15(7):776-95.
[16] PASRICHA S R,DRAKESMITH H,BLACK J,et al.Control of iron deficiency anemia in low-and middle-income countries[J].Blood,2013,121(14):2607-2617.
[17] MILLER G,LUO R,ZHANG L,et al.Effectiveness of provider incentives for anaemia reduction in rural China:a cluster randomised trial[J].BMJ,2012,345:e4809.doi:10.1136/bmj.e4809.