海南省6月龄~18岁儿童贫血现状与影响因素研究

Prevalence and influencing factors of anemia in children of 6 months to 18 years in Hainan Province

摘要

目的 调查海南省6月龄~18岁儿童贫血患病现状及影响因素,为区域性儿童贫血防控策略制定提供科学依据。方法 采用横断面研究设计,于2020年12月—2021年7月采用多阶段分层整群抽样方法,在海南省18个市县(除三沙市外)抽取58 649名6月龄~18岁儿童作为研究对象。依据年龄分为6月龄~<3岁组和3~18岁组,采用标准化问卷收集人口学特征及生活行为资料;采用电阻抗联合光电比色法检测血红蛋白水平,并依据世界卫生组织《贫血定义指南》(2024版)进行贫血诊断。采用Rao-Scott χ²检验进行组间比较,采用加权二分类logistic回归分析贫血影响因素。结果 海南省6月龄~18岁儿童贫血加权患病率为6.92%,其中轻度、中度和重度贫血患病率分别为4.60%、2.26%和0.06%。婴幼儿期贫血患病率最高(10.81%),小学阶段最低(4.88%),青春期再次升高;青春期女童贫血患病率高于男童(13.98% vs. 3.22%,P<0.001)。不同市县儿童贫血患病率差异具有统计学意义(P<0.001),保亭黎族苗族自治县患病率最高(17.62%)。多因素logistic回归分析显示,少数民族、非独生子女及肉类摄入不足是两年龄组儿童贫血的共同危险因素(P<0.05)。6月龄~<3岁组中,婴儿期、母亲文化程度低及蛋类摄入不足与贫血风险增加相关(P<0.05);3~18岁组中,12~18岁、女童、农村地区、有出生疾病史、多胎、非核心家庭、非父母带养、父亲文化程度低、家庭年收入＜3万元、挑食及经常补铁均与贫血风险增加相关(P<0.05)。结论 海南省6月龄~18岁儿童贫血患病率总体处于较低水平,但婴幼儿、青春期女童、少数民族及农村地区儿童仍为重点防控人群。应加强家庭营养健康教育,重视儿童早期营养干预及青春期膳食指导,构建父母共同参与的综合干预模式,以降低儿童贫血疾病负担。

Abstract

Objective To investigate the prevalence and influencing factors of anemia among children aged 6 months to 18 years in Hainan Province, so as to provide evidence for region-specific prevention and control strategies. Methods A cross-sectional study was conducted from December 2020 to July 2021 using a multistage stratified cluster sampling method. A total of 58 649 children aged 6 months to 18 years were recruited from 18 municipalities/counties in Hainan Province (excluding Sansha City). Participants were stratified into two age groups: 6 months -<3 years old and 3 - 18 years old. Demographic characteristics and lifestyle behaviors were collected using standardized questionnaires. Hemoglobin concentration was measured by electrical impedance combined with photoelectric colorimetry, and anemia was diagnosed according to the WHO Guideline on Haemoglobin Cutoffs to Define Anaemia (2024). Rao-Scott χ² tests were used for group comparisons, and weighted binary logistic regression models were applied to identify influencing factors. Results The weighted prevalence of anemia among children aged 6 months to 18 years in Hainan Province was 6.92%, including 4.60% mild anemia, 2.26% moderate anemia, and 0.06% severe anemia. The prevalence was highest during infancy (10.81%), decreased during primary school age (4.88%), and increased again during adolescence. Adolescent girls had a significantly higher prevalence than boys (13.98% vs. 3.22%, P<0.001). Significant regional differences in anemia prevalence were observed across municipalities/counties (P<0.001), with Baoting Li and Miao Autonomous County showing the highest prevalence (17.62%). Multivariable logistic regression analysis indicated that ethnic minority status, non-only-child status, and insufficient meat intake were common risk factors in both age groups (P<0.05). In the 6 months -<3 years group, infancy, lower maternal educational level, and insufficient egg intake were additionally associated with increased anemia risk (P<0.05). In the 3 - 18 years group, adolescence (12 - 18 years old), female, rural residence, history of neonatal diseases, multiple births, non-nuclear family structure, non-parental caregiving, lower paternal educational level, annual household income <30 000 RMB, picky eating, and frequent iron supplementation were associated with higher anemia risk (P<0.05). Conclusions Although the overall prevalence of anemia among children aged 6 months to 18 years in Hainan Province is relatively low, infants, adolescent girls, ethnic minority children, and rural populations remain key target groups for intervention. Strengthening nutrition education, emphasizing early-life nutritional intervention and adolescent dietary guidance, and promoting parent-involved comprehensive intervention strategies may help reduce the burden of childhood anemia.

关键词

贫血 / 现况 / 儿童 / 海南省

Key words

anemia / prevalence / children / Hainan Province

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基金资助

海南省重大科技计划项目(ZDKJ2019010);海南省临床医学研究中心专项项目(LCYX202405);海南省优秀人才团队项目(QRCBT202121);海南省临床医学研究中心科技计划项目(LCYX202501);海南省国际科技合作研发项目(GHYF2025042);海南省儿童健康与疾病临床研究中心