Utilization of oral health services for school-age children in Xiangfang District of Harbin
-
摘要:
目的 调查哈尔滨市香坊区学龄儿童口腔卫生服务需要及利用现状，为下一步开展学龄儿童口腔预防保健工作提供参考。 方法 2019年9月16日—10月31日，普查哈尔滨市香坊区6~11岁7 944名儿童的口腔健康状况并进行问卷调查，采用描述性分析、χ2检验、非参数检验及Logistic回归分析学龄儿童口腔卫生服务需要及利用情况。 结果 学龄儿童患龋率为89.7%，龋齿未充填率为60.7%，错牙合畸形率为59.3%，牙外伤率为12.5%。过去12个月中53.8%的儿童有牙痛经历。近12个月内口腔科就医率为31.6%，就医主要原因为治疗(47.6%)，预防性口腔就医率为15.6%。多因素Logistic分析表明，女生、父亲学历为高中或中专、父亲学历为大专及以上、口腔健康评价差、口腔知识得分高、口腔态度得分高、每天刷牙1次、每天刷牙≥2次、上过口腔保健课程、有牙痛经历、有牙外伤经历、患龋者更可能到口腔科就诊(OR值分别1.11，1.17，1.50，0.80，1.07，1.21，1.60，2.27，1.28，1.49，1.54，1.67，P值均＜0.05)。 结论 哈尔滨市香坊区学龄儿童口腔卫生服务需要量大、但利用率低、预防性就医率低，多因素影响儿童口腔卫生服务利用，相关部门应通过采取针对性措施，提高学龄儿童卫生资源利用水平。 Abstract:Objective To investigate the oral health service demands and utilization among school-age children in Xiangfang district of Harbin, and to explore the related influencing factors. Methods A total of 7 944 children aged 6-11 were investigated for oral health status through questionnaire survey in Xiangfang District, Harbin. Descriptive analysis, Chi-square test, nonparametric test and Logistic regression were used to analyze the oral health service demands and utilization of school-age children. Results The rate of caries, unfilled caries, malocclusion and traumatic dental injuries were 89.7%, 60.7%, 59.3% and 12.5%, respectively. In the past 12 months, 53.8% of children had toothache. The rate of seeking medical treatment in stomatology department was 31.6%, with the primary reason being treatment (47.6%), while the rate of preventive dental treatment was 15.6%. Multivariate analysis showed that girls, father's education being high school or technical secondary school, father's education higher or equal to junior college, poor oral health evaluation, high score on oral knowledge and oral attitude, brushing teeth once a day, brushing teeth twice a day or more, having attended oral health courses, having toothache experience, having dental trauma experience, suffering from dental caries were more likely to visit the oral clinics (OR=1.11, 1.17, 1.50, 0.80, 1.07, 1.21, 1.60, 2.27, 1.28, 1.49, 1.54, 1.67, P < 0.05). Conclusion In Xiangfang District of Harbin, there is a large demand for oral health services for school-age children, however, both of the utilization rate and the preventive medical treatment rate is low. Many factors affect the utilization of oral health services for children. It is suggested that targeted measures should be taken to improve the utilization level of school-age children's health resources. -
Key words:
- Oral hygiene /
- Delivery of health care /
- Regression analysis /
- Child
-
表 1 不同组别儿童牙痛检出率比较
Table 1. Comparison of the detection rate of toothache in different groups of children
组别 选项 人数 牙痛人数 χ2值 P值 性别 男 4 031 2 108(52.3) 7.48 0.01 女 3 913 2 166(55.4) 年龄/岁 6~8 4 215 2 349(55.7) 13.43 ＜0.01 9~11 3 729 1 925(51.6) 是否独生子女 否 1 983 1 101(55.5) 3.15 0.08 是 5 961 3 173(53.2) 父亲学历 初中及以下 2 924 1 631(55.8) 20.08 ＜0.01 高中/中专 2 412 1 348(55.9) 大专及以上 2 608 1 295(49.7) 母亲学历 初中及以下 2 789 1 549(55.5) 13.98 ＜0.01 高中/中专 2 337 1 300(55.6) 大专及以上 2 818 1 425(50.6) 注： ()内数字为检出率/%。 
下载: 导出CSV
表 2 不同组别儿童口腔健康状况自我评价分布比较
Table 2. Comparison of self-evaluation distribution of oral health status among different groups of children
组别 选项 人数 很差或较差 一般 很好或较好 χ2值 P值 性别 男 4 031 509(12.6) 1 884(46.7) 1 638(40.6) 3.06 0.08 女 3 913 490(12.5) 1 773(44.3) 1 690(43.2) 年龄/岁 6~8 4 215 629(14.9) 2 027(48.1) 1 559(37.0) 102.98 ＜0.01 9~11 3 729 370(9.9) 1 590(42.6) 1 769(47.4) 是否独生子女 否 1 983 275(13.9) 879(44.3) 829(41.8) 1.10 0.30 是 5 961 724(12.1) 2 738(45.9) 2 499(41.9) 父亲学历 初中及以下 2 924 390(13.3) 1 372(46.9) 1 162(39.7) 12.32 ＜0.01 高中/中专 2 412 303(12.6) 1 105(45.8) 1 004(41.6) 大专及以上 2 608 306(11.7) 1 140(43.7) 1 162(44.6) 母亲学历 初中及以下 2 789 358(12.8) 1 316(47.2) 1 115(40.0) 5.74 0.02 高中/中专 2 337 295(12.6) 1 062(45.4) 980(41.9) 大专及以上 2 818 346(12.3) 1 239(44.0) 1 233(43.8) 牙痛经历 无 3 670 257(7.0) 1 437(39.2) 1 976(53.8) 456.46 ＜0.01 有 4 274 742(17.4) 2 180(51.0) 1 352(31.6) 注： ()内数字为构成比/%。
下载: 导出CSV
表 3 不同组别儿童口腔卫生服务利用情况比较
Table 3. Single-factor analysis of using the dental services
组别 选项 人数 就诊人数 χ2值 P值 组别 选项 人数 就诊人数 χ2值 P值 性别 男 4 031 1 216(30.2) 8.15 0.04 每日刷牙次 ＜1 505 91(18.0) 111.71 ＜0.01 女 3 913 1 297(33.1) 数/次 1 2 783 749(26.9) 年龄/岁 6~8 4 215 1 364(32.4) 2.19 0.14 ≥2 4 656 1 673(35.9) 9~11 3 729 1 149(30.8) 使用含氟 否 2 257 700(31.0) 10.11 < 0.01 是否独生子女 否 1 983 583(29.4) 6.10 0.01 牙膏 不知道 2 139 594(27.8) 是 5 961 1 930(32.4) 是 3 548 1 219(34.4) 父亲学历 初中及以下 2 924 773(26.4) 76.38 ＜0.01 牙线使用频率 不用 6 086 1 817(29.9) 37.47 ＜0.01 高中/中专 2 412 765(31.7) 偶尔/每周 1 698 632(37.2) 大专及以上 2 608 975(37.4) 每天用 160 64(40.0) 母亲学历 初中及以下 2 789 752(27.0) 45.86 ＜0.01 牙痛经历 无 3 670 968(26.4) 87.20 ＜0.01 高中/中专 2 337 764(32.7) 有 4 274 1 545(36.1) 大专及以上 2 818 997(35.4) 牙外伤经历 无 6 953 2 110(30.3) 42.71 ＜0.01 口腔健康评价 很差或较差 999 336(33.6) 11.89 0.01 有 991 403(40.7) 一般 3 617 1 201(33.2) 患龋 无 822 173(21.0) 47.53 ＜0.01 很好或较好 3 328 976(29.3) 有 7 122 2 340(32.9) 保健课程 无 5 616 1 658(29.5) 39.49 ＜0.01 错 
无 3 233 1 015(31.4) 0.14 0.70 有 2 328 855(36.7) 有 4 711 1 498(31.8) 注： ()内数字为就诊率/%。
下载: 导出CSV
表 4 儿童口腔就诊情况多因素Logistic回归分析(n=7 944)
Table 4. Multivariate Logistic regression analysis of the rate of visiting the dentist in children(n=7 944)
自变量 选项 β值 标准误 Wald χ2值 P值 OR值(OR值95%CI) 性别 女 0.10 0.05 4.91 0.04 1.11(1.00~1.22) 是否独生子女 是 0.01 0.06 0.01 0.91 1.01(0.90~1.13) 父亲学历 高中/中专 0.16 0.07 4.36 0.04 1.17(1.01~1.35) 大专及以上 0.41 0.09 22.44 ＜0.01 1.50(1.27~1.78) 母亲学历 高中/中专 0.06 0.08 0.56 0.45 1.06(0.91~1.23) 大专及以上 -0.05 0.09 0.29 0.59 0.96(0.81~1.13) 口腔健康评价 一般 -0.03 0.08 0.14 0.71 0.97(0.83~1.14) 很好或较好 -0.22 0.09 6.63 0.01 0.80(0.68~0.95) 口腔健康知识 0.07 0.02 13.40 ＜0.01 1.07(1.03~1.11) 口腔健康态度 0.19 0.06 9.18 < 0.01 1.21(1.07~1.37) 每天刷牙次数/次 1 0.47 0.13 13.79 ＜0.01 1.60(1.25~2.05) ≥2 0.82 0.13 43.42 ＜0.01 2.27(1.78~2.90) 使用含氟牙膏 不知道 -0.08 0.07 1.49 0.22 0.92(0.80~1.05) 是 0.03 0.06 0.21 0.65 1.03(0.91~1.16) 牙线使用频率 偶尔/每周 0.19 0.06 10.02 < 0.01 1.21(1.08~1.36) 每天用 0.25 0.17 2.08 0.15 1.28(0.92~1.78) 口腔保健课程 有 0.25 0.05 21.22 ＜0.01 1.28(1.15~1.43) 牙痛经历 有 0.40 0.05 58.79 ＜0.01 1.49(1.35~1.65) 牙外伤经历 有 0.44 0.07 36.09 ＜0.01 1.54(1.34~1.78) 患龋 有 0.51 0.09 30.62 ＜0.01 1.67(1.39~2.00) 注：性别以男，是否独生子女为否，父/母亲学历以初中及以下，口腔健康评价以很差或较差，每天刷牙次数以 < 1次，使用含氟牙膏以否，牙线使用频率以不用，口腔保健课程、牙痛经历、牙外伤经历、患龋均以无为参照组。
下载: 导出CSV
-
[1] SANADHYA Y K, THAKKAR J P, DIVAKAR D D, et al. Effectiveness of oral health education on knowledge, attitude, practices and oral hygiene status among 12-15-year-old schoolchildren of fishermen of Kutch district, Gujarat, India[J]. Int Marit Health, 2014, 65(3): 99-105. doi: 10.5603/IMH.2014.0022 [2] 白英龙, 刘福定, 郭洁, 等. 沈阳市家长对学龄前儿童龋齿的关注与认知现况[J]. 中国学校卫生, 2013, 34(11): 1392-1393. http://www.cjsh.org.cn/article/id/zgxxws201311042BAI Y LF, LIU D, GUO J, et al. The present situation of parents' concern and cognition about the dental caries of preschool children in Shenyang[J]. Chin J Sch Health, 2013, 34(11): 1392-1393. http://www.cjsh.org.cn/article/id/zgxxws201311042 [3] 王兴. 第四次全国口腔健康流行病学调查报告[M]. 北京: 人民卫生出版社, 2018: 12-14.WANG X. The fourth national oral health epidemiological survey report[M]. Beijing: People's Medical Publishing House, 2018: 12-14. [4] 王静雪, 杨正艳, 吴晓艳, 等. 重庆市主城区学龄前儿童患龋情况及口腔卫生服务需要、利用情况和影响因素的研究[J]. 华西口腔医学杂志, 2019, 37(2): 187-192. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201902014.htmWANG J X, YANG Z Y, WU X Y, et al. An investigation on the need, the utilization, and the influencing factors of dental services for pre-school children in selected areas in Chongqing province[J]. West China J Stomatol, 2019, 37(2): 187-192. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201902014.htm [5] 刘怡然, 沈红, 仇颖莹, 等. 江苏省3~5和12~15岁人群口腔卫生服务利用情况调查及相关因素分析[J]. 口腔医学, 2020, 40(5): 448-452. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX202005012.htmLIU Y R, SHEN H, CHOU Y Y, et al. Oral health service utilization patterns and related factors among 3-to 5-year-old children and 12-to 15-year-old students in jiangsu Province[J]. Stomatol, 2020, 40(5): 448-452. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX202005012.htm [6] 邓力. 重庆市12~15岁中学生口腔健康知识、态度、行为的调查分析[D]. 重庆: 重庆医科大学, 2019.DENG L. Investigation of oral health knowledge, attitude, behavior of 12-15 years old children in Chongqing[D]. Chongqing: Chongqing Medical University, 2019. [7] 欧晓艳, 曾艺旋, 闻健琼, 等. 江西省3~5岁儿童对口腔卫生服务需求与就诊利用的现状及对策[J]. 华西口腔医学杂志, 2018, 36(6): 650-655. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201806020.htmOU X Y, CENG Y X, WEN J Q, et al. Status and strategies of oral health service demand and medical treatment utilization among 3-to 5-year-old preschool children in Jiangxi Province[J]. West China J Stomatol, 2018, 36(6): 650-655. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201806020.htm [8] 陈龙, 赵恬, 张佐, 等. 海原城乡6~12岁在校学生龋病现况调查[J]. 宁夏医学杂志, 2016, 38(7): 636-637. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX201607032.htmCHEN L, ZHAO T, ZHANG Z, et al. An epidemiological investigation of dental caries of students aged 6-12 years in urban and rural areas in Haiyuan[J]. Ningxia Med J, 2016, 38(7): 636-637. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX201607032.htm [9] 李梦源. 宁夏中卫市6~12岁儿童口腔健康状况调查及12岁儿童口腔健康状况相关因素分析[D]. 银川: 宁夏医科大学, 2017.LI M Y. An Epidemiological investigation of oral health in 6-12 year-old pupils in Zhongwei, Ningxia and relevant factors analysis on 12 year-old children[D]. Yinchuan: Ningxia Medical University, 2017. [10] 刘雯雯, 邹静. 儿童替牙期常见错 [11] 张晓东. 蚌埠市部分儿童青少年牙外伤患病情况分析[J]. 中国学校卫生, 2012, 33(6): 702-703. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201206028.htmZHANG X D. Prevalence of traumatic dental injuries among children and adolescent in Bengbu[J]. Chin J Sch Health, 2012, 33(6): 702-703. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201206028.htm [12] World Health Organization. Oral health surveys: basic methods[M]. 5th ed. Geneva: World Health Organization, 2013. [13] 傅民魁, 张丁, 王邦康, 等. 中国25392名儿童与青少年错 [14] WHO. Oral health surveys: basic method[M]. 4th ed. Geneva: World Health Organization, 1997: 40-44. [15] 傅民魁. 口腔正畸学[M]. 6版, 北京: 人民出版社, 2015: 6-9.FU M K. Orthodontics[M]. 6th ed. Beijing: People's Publishing House, 2015: 6-9. [16] 关绮华, 莫莹莹, 梁自勉. 佛山市儿童牙痛发生情况及影响因素的相关性分析[J]. 中国儿童保健杂志, 2018, 26(8): 916-920. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201808030.htmGUAN Q H, MO Y Y, LIAN Z M, et al. Analysis of current status and influential factors on toothache among children in Foshan city[J]. Chin J Child Health Care, 2018, 26(8): 916-920. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201808030.htm [17] MOYNIHAN P J, KELLY S A. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines[J]. J Dent Res, 2014, 93(1): 8-18. doi: 10.1177/0022034513508954 [18] 姜玲玲, 曹玉慧, 刘占帅, 等. 哈尔滨市12 087名学龄儿童错 [19] 李雪琦, 王泳仪, 余红兵, 等. 深圳市南山区1838名儿童主要照顾者的口腔健康知识和态度及与儿童口腔健康保健行为的关系[J]. 中国慢性病预防与控制, 2018, 26(8): 584-587. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201808006.htmLI X Q, WANG Y Y, YU H B, et al. Relationship among knowledge, attitude and behavior for children's oral health in 1838 primary caregivers of Nanshan district in Shenzhen[J]. Chin J Prev Contr Chron Dis, 2018, 26(8): 584-587. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201808006.htm [20] 蔡楠. 长春市五~六年级小学生口腔健康知信行与牙龈出血的调查分析[D]. 长春: 吉林大学, 2016.CAI N. The investigation and analysis of grade 5-6 students' oral health the relevant knowledge, attitude, behavior and gingival bleeding in Chang Chun[D]. Changchun: Jilin University, 2016 [21] MOLARIUS A, ENGSTRM S, FLINK H, et al. Socioeconomic differences in self-rated oral health and dental care utilisation after the dental care reform in 2008 in Sweden[J]. BMC Oral Health, 2014, 14: 134. DOI: 10.1186/1472-6831-14-134. [22] BELL J F, HUEBNER C E, REED S C. Oral health need and access to dental services: evidence from the National Survey of Children's Health, 2007[J]. Matern Child Health J, 2012, 16(Suppl 1): S27-34. http://europepmc.org/abstract/MED/22456986 [23] XU M, YUAN C, SUN X G, et al. Oral health service utilization patterns among preschool children in Beijing, China[J]. BMC Oral Health, 2018, 18(1): 31. doi: 10.1186/s12903-018-0494-6 [24] 李忠, 张亮. 新时代下的健康需要、卫生服务需求与利用: 一个新的分析框架[J]. 中国卫生政策研究, 2019, 12(9): 5-11. doi: 10.3969/j.issn.1674-2982.2019.09.002LI Z, ZHANG L. Health need, healthcare demand and utilization in the new era: a new analytical framework[J]. Chin J Health Policy, 2019, 12(9): 5-11. doi: 10.3969/j.issn.1674-2982.2019.09.002 [25] 夏刚. 从我国口腔卫生服务需要需求和利用现状看我国目前口腔卫生工作中存在的问题和今后的工作思路[J]. 中华老年口腔医学杂志, 2018, 8(2): 65-67. doi: 10.3969/j.issn.1672-2973.2010.02.001XIA G. Problems in oral health work and future work ideas from the needs and utilization of oral health services in China[J]. Chin J Geriat Dent, 2010, 8(2): 65-67. doi: 10.3969/j.issn.1672-2973.2010.02.001 [26] BADRI P, SALTAJI H, FLORES-MIR C, et al. Factors affecting children's adherence to regular dental attendance: a systematic review[J]. J Am Dent Assoc, 2014, 145(8): 817-28. doi: 10.14219/jada.2014.49 [27] CURI D S C, FIGUEIREDO A C L, JAMELLI S R, Factors associated with the utilization of dental health services by the pediatric population: an integrative review[J]. Cien Saude Colet, 2018, 23(5): 1561-1576. doi: 10.1590/1413-81232018235.20422016 [28] FINLAYSON T L, ASGARI P, DOUGHERTY E, et al. Child, caregiver, and family factors associated with child dental utilization among Mexican migrant families in California[J]. Commun Dent Health, 2018, 35(2): 89-94. http://europepmc.org/abstract/MED/29645407 [29] CIANETTI S, LOMBARDO G, LUPATELLI E, et al. Dental caries, parents educational level, family income and dental service attendance among children in Italy[J]. Eur J Paediatr Dent, 2017, 18(1): 15-18. http://www.ncbi.nlm.nih.gov/pubmed/28494596 [30] LIN M, SAPPENFIELD W, HERNANDEZ L, et al. Child-and state-level characteristics associated with preventive dental care access among U.S. children 5-17 years of age[J]. Matern Child Health J, 2012, 16(Supple 2): 320-329. http://www.ncbi.nlm.nih.gov/pubmed/22935910 [31] GRANVILLE-GARCIA A F, CLEMENTINO M A, GOMES M C, et al. Influence of oral problems and biopsychosocial factors on the utilization of dental services by preschool children[J]. J Dent Child (Chic), 2015, 82(2): 76-83. http://www.ncbi.nlm.nih.gov/pubmed/26349794 [32] 白玥, 江虹, 曲美霞, 等. 宁夏小学生口腔健康促进效果评估[J]. 中国学校卫生, 2014, 35(1): 28-30. http://www.cjsh.org.cn/article/id/zgxxws201401010BAI Y, JIANG H, QU M X, et al. Effects of comprehensive oral health promotion among primary school students in Ningxia Province[J]. Chin J Sch Health, 2014, 35(1): 28-30. http://www.cjsh.org.cn/article/id/zgxxws201401010 [33] 刘奕君, 周平, 王琳, 等. 兰州市8所高校大学生口腔健康知识及行为调查[J]. 中国学校卫生, 2010, 31(12): 1479-1480. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201012033.htmLIU Y J, ZHOU P, WANG L, et al. Oral health recognition and practice among college students in 8 universities in Lanzhou[J]. Chin J Sch Health, 2010, 31(12): 1479-1480. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201012033.htm -
点击查看大图
表(4)
计量
- 文章访问数: 544
- HTML全文浏览量: 287
- PDF下载量: 36
- 被引次数: 0
