Utilization of oral health services for school-age children in Xiangfang District of Harbin
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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
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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/%。 
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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/%。
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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/%。
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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。
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