我国2005年和2015年低龄儿童龋影响因素及其地区差异特征的变化情况分析

Analysis of regional disparities in influencing factors of early childhood caries in China in 2005 and 2015

目的 分析我国2005年和2015年低龄儿童龋的患病状况及其影响因素,并探讨影响因素地区差异特征的变化情况。方法 研究于2022年9月至2023年3月在北京大学口腔医院进行。基于我国2005年第三次和2015年第四次全国口腔健康流行病学调查(以下分别简称为“2005年流调”和“2015年流调”)中5岁儿童口腔检查及问卷调查数据库,选择所属地区及四大方面(社会人口学特征、儿童早期因素、口腔健康行为、自我口腔健康感知)潜在影响因素共17项自变量,以5岁儿童患龋状况为因变量构建负二项回归模型以明确低龄儿童龋的影响因素,并分析影响因素的地区分布差异特征及其10年间的变化情况。结果 纳入2005年流调中5岁儿童11 099人、2015年流调中5岁儿童12 915人,共24 014人。2005年和2015年各地区5岁儿童患龋状况总的比较,差异均有统计学意义(均P <0.05)。其中,2015年东部和东北地区5岁儿童患龋率分别78.4%和85.7%,均显著高于中部(64.5%)和西部地区(70.3%),差异均有统计学意义(均P <0.05);除中部地区外,东部、东北、西部地区2015年患龋状况均较2005年差(均P <0.05)。我国低龄儿童龋的独立影响因素包括:所属地区、城乡、监护人教育水平、家庭人均收入水平、喂养方式、开始刷牙年龄、甜食摄入频率、睡前甜食摄入、末次口腔科就诊时间、近1年牙痛经历、自我口腔健康评价、口腔健康认知水平。东部及东北地区的城市、监护人教育水平为高中及以上、家庭收入水平为中低收入及以上、甜食摄入频率<2次/d、在12个月内有口腔科就诊经历、近1年有牙痛经历、口腔健康认知较好的人群占比均高于中部和西部地区(均P <0.05)。与2005年相比,2015年各地区监护人教育水平为高中或中专以上(除东北地区外)、家庭人均收入水平为中低收入及以上、采用人工喂养方式、儿童开始刷牙年龄≤3岁、6个月内有口腔科就诊经历的人群占比显著升高(均P <0.05);且除西部地区外,其他地区甜食摄入频率≥2次/d的儿童占比均显著上升,睡前从不摄入甜食的占比均显著下降,近1年有时或经常牙痛的儿童占比均显著上升,以上影响因素在10年间的分布变化差异均具有统计学意义(均P <0.05)。结论 2015年我国大部分地区低龄儿童龋患病状况较2005年更加不容乐观,而其影响因素分布及10年间变化情况呈现出明显的地区差异特征。

Objective To analyze the prevalence and influencing factors of early childhood caries in China in 2005 and 2015,and to explore regional disparities and changes of influencing factors.Methods The study was conducted in Peking University School and Hospital of Stomatology from September 2022 to March 2023.Based on the databases of oral examination and questionnaire survey of 5-year-old children from the third and fourth national oral health survey in China in 2005 and 2015(abbreviated as"2005 survey"and"2015 survey",respectively),a total of 17 independent variables including region and potential influencing factors of four aspects(socio-demographic characteristics,early childhood factors,oral health behavior,and self-perception of oral health)were selected.The caries status of 5-year-old children was used as the dependent variable to construct a negative binomial regression model to identify the influencing factors of caries in young children.The regional distribution differences of influencing factors and their changes in the decade from 2005 to 2015 were analyzed.Results A total of 24014 children aged 5 years old were included,including 11099 from 2005 survey and 12915 from 2015 survey.There were significant differences in the prevalence of dental caries among different regions in 2005 and 2015(all P<0.05).In 2015,the caries prevalence rates of 5-year-old children in the eastern and northeastern regions were 78.4%and 85.7%,respectively,which were significantly higher than those in the central region(64.5%)and western region(70.3%)(both P<0.05).Except for the central region,the caries status in the eastern,northeastern and western regions in 2015 were worse than those in 2005(all P<0.05).The independent influencing factors of caries in preschool children in China included:region,urbanicity,guardian′s education level,family income level per capita,feeding pattern,the age of starting toothbrushing,sweet intake frequency,sweet intake before bedtime,last dental visit,toothache experience in the past year,self-evaluation of oral health,and oral health cognition level.The proportions of participants under circumstances of urban residents,guardian with education level of high school or above,family income of low to medium level or above,less than 2 times of sweet food intake per day,dental attendance in the past 12 months,dental pain present in the past 1 year,and better oral health cognition in the eastern and northeastern regions were higher than those in the central and western regions(all P<0.05).Compared with 2005 survey,the proportion of people with guardian education level of high school or above(except for the northeastern region),family income per capita of low to medium level or above,artificial feeding,children′s toothbrushing age starting at 3 years old or earlier and dental visit experience in the past 6 months increased significantly in all regions(all P<0.05).The proportion of children who consumed sweets≥2 times per day increased significantly in all regions except the western region,whereas the proportion of children who never consumed sweets before bedtime decreased significantly.The proportion of children who had toothache(sometimes or often)in the past year(except for the western region)increased significantly.The change in distribution of these above influencing factors in the decade from 2005 to 2015 exhibited statistical significance(all P<0.05).Conclusion Compared with the status in 2005,the change in prevalence of dental caries in most regions of China in 2015 shows an unoptimistic tendency,and the distribution of influencing factors and the change during the decade show evident regional disparities.