近日，美国宾西法尼亚费城儿童医院Neal Halfon团队研究了美国儿童死亡率、慢性病、肥胖、功能状态和症状的趋势。相关论文于2025年7月7日发表在《美国医学会杂志》上。

最近的科学和政策声明表明，美国儿童的健康状况可能正在恶化。

研究组利用多种数据收集方法和一套全面的健康指标，确定2007年至2023年美国儿童健康状况的变化情况。使用来自美国和经济合作与发展组织（OECD） 18个比较高收入国家的死亡率统计数据、5项具有全国代表性的调查和来自10个儿科卫生系统（PEDSnet）的电子健康记录进行重复的横断面分析。这些人群包括20岁以下的个体。在所有调查中，未加权分母样本量范围为1623至95677，PEDSnet为1026926至2114638，美国为8190万至8320万，OECD18为1.184亿至1.211亿，用于死亡率统计。主要结局是慢性身体、发育和精神健康状况、功能状态和症状的死亡率比（RR）和年发病率。

从2007年到2022年，美国婴儿（1岁）的死亡率是经合组织国家的1.78倍（95% CI, 1.78-1.79）， 1-19岁个体的死亡率是1.80倍（95% CI, 1.80-1.80）。美国和经合组织之间净差异最大的两种死亡原因是12个月或以下婴儿的早产（相对危险度，2.22）和意外婴儿猝死（相对危险度，2.39），以及1至19岁个体的枪支相关事件（相对危险度，15.34）和机动车碰撞（相对危险度，2.45）。从2011年到2023年，3-17岁患有慢性疾病的个体在PEDSnet中的患病率从39.9%上升到45.7% (RR, 1.15)，在一般人群中从25.8%上升到31.0% （RR, 1.20）。肥胖、月经提前、睡眠困难、活动受限、身体症状、抑郁症状和孤独感的比例在研究期间都有所增加。

研究结果表明，在过去的17年里，美国儿童的健康状况在一系列健康指标领域都有所恶化。这种恶化的范围之广，突出表明有必要查明和解决造成国民健康状况根本下降的根本原因。

附：英文原文

Title: Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms

Author: Christopher B. Forrest, Lauren J. Koenigsberg, Francis Eddy Harvey, Mitchell G. Maltenfort, Neal Halfon

Issue&Volume: 2025-07-07

Abstract:

Importance  Recent scientific and policy statements suggest that child health may be worsening in the US.

Objective  To determine how US children’s health has been changing from 2007 to 2023 using multiple data collection methods and a comprehensive set of health indicators.

Design, Setting, and Participants  Repeated, cross-sectional analyses using mortality statistics from the US and 18 comparator high-income nations from the Organisation for Economic Co-operation and Development (OECD18), 5 nationally representative surveys, and electronic health records from 10 pediatric health systems (PEDSnet). The populations included individuals younger than 20 years old. Unweighted denominator sample size ranges were 1623 to 95677 across the surveys, 1026926 to 2114638 for PEDSnet, 81.9 million to 83.2 million in the US, and 118.4 million to 121.1 million in the OECD18 for mortality statistics.

Exposure  Calendar time.

Main Outcomes and Measures  Rate ratios (RRs) and annual incidence for mortality and prevalence for chronic physical, developmental, and mental health conditions, functional status, and symptoms.

Results  From 2007 to 2022, infants (<1 year old) were 1.78 (95% CI, 1.78-1.79) and 1- to 19-year-old individuals were 1.80 (95% CI, 1.80-1.80) times more likely to die in the US than in the OECD18. The 2 causes of death with the largest net difference between the US and OECD18 were prematurity (RR, 2.22 [95% CI, 2.20-2.24]) and sudden unexpected infant death (RR, 2.39 [95% CI, 2.35-2.43]) for infants 12 months or younger, and firearm-related incidents (RR, 15.34 [95% CI, 14.89-15.80]) and motor vehicle crashes (RR, 2.45 [95% CI, 2.42-2.48]) for 1- to 19-year-old individuals. From 2011 to 2023, the prevalence of 3- to 17-year-old individuals with a chronic condition rose from 39.9% to 45.7% (RR, 1.15 [95% CI, 1.14-1.15]) within PEDSnet, and from 25.8% to 31.0% (RR, 1.20 [95% CI, 1.20-1.20]) within the general population. Rates of obesity, early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms, and loneliness all increased during the study period.

Conclusions and Relevance  The health of US children has worsened across a wide range of health indicator domains over the past 17 years. The broad scope of this deterioration highlights the need to identify and address the root causes of this fundamental decline in the nation’s health.

DOI: 10.1001/jama.2025.9855

Source: https://jamanetwork.com/journals/jama/fullarticle/2836060