Prevalence and associated factors of autism among children in central and eastern Inner Mongolia
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摘要:
目的 了解内蒙古中东部城乡地区儿童孤独症(ASD)的患病情况及影响因素，为采取相应干预措施和提供依据。 方法 在内蒙古呼伦贝尔市、赤峰市、乌兰察布市、通辽市、锡林郭勒盟5个盟市，采用随机整群抽样的方法，选取16所小学及幼儿园，对15 817名3~14岁儿童进行调查，根据克氏孤独症行为量表进行初筛；初筛阳性者根据教师填写提名表和孤独症行为检测量表进一步诊断，结合量表的得分再由2名以上临床专业人员根据美国精神障碍诊断与统计手册第5版的诊断标准最终确诊ASD。 结果 确诊42例ASD儿童，患病率为0.27%(42/15 817)，城市地区儿童ASD患病率为0.16%(15/9 231)，农村地区为0.41%(27/6 586)，差异有统计学意义(χ2=8.89，P < 0.01)。Logistic回归分析显示，母亲文化程度、语言发展水平与城市儿童发生ASD呈负相关；存在遗尿的不良习惯、家庭有极度内向者与农村儿童发生ASD呈正相关。 结论 内蒙古中东部农村地区儿童ASD患病率高于城市，儿童存在不良习惯、患过新生儿疾病、父母文化水平低、语言发展水平差、运动水平差是影响城乡地区儿童发生ASD的主要因素。应尽早筛查孤独症患儿并采取积极有效的治疗措施。 Abstract:Objective To understand the prevalence and influencing factors of children with ASD in central and eastern Inner Mongolia, and to provide theoretical basis for disease prevention and prevalence of ASD. Methods Sixteen primary schools and kindergartens were selected from 5 cities in central and eastern Inner Mongolia through random cluster sampling. A total of 15 817 children aged 3-14 years were selected. Children who were positive using Clancy Autism Behavior Scale were further diagnosed according to the teacher's nomination form and the Autism Behavior Checklist, as well as the diagnostic criteria of the fifth edition of the American Diagnostic & Statistical Manual of Mental Disorders by 2 professionals. Results The prevalence of ASD was 0.27% (42/15 817), with prevalence in urban areas (0.16%, 15/9 231) higher than that of rural areas (0.41%, 27/6 586) (χ2=8.89, P < 0.01). Logistic regression analysis showed that maternal education and language development were negatively associated with ASD in urban children. ASD in rural children were positively associated with enuresis and introverted family members. Conclusion High prevalence of ASD is found in urban area of central and eastern Inner Mongolia. Unhealthy habits, neonatal diseases, low parental education, delayed language development and poor exercise performance are primary factors associated with ASD in both urban and rural areas. -
Key words:
- Autistic disorder /
- Prevalence /
- Mental health /
- Regression analysis /
- Child
1) 郝金奇与付慧渊为共同第一作者 -
表 1 内蒙古中东部儿童一般情况构成城乡间比较
Table 1. Composition of general situation characteristics of children in urban and rural areas of central and Eastern Inner Mongolia
组别 选项 城市(n=9 231) 农村(n=6 586) χ2/Z值 P值 性别 男 4 787(51.86) 3 706(56.27) 30.55 < 0.01 女 4 444(48.14) 2 880(43.73) 年龄/岁 3~ < 6 2 972(32.19) 1 653(25.10) 93.57 < 0.01 6~14 6 259(67.81) 4 933(74.90) 民族 汉族 4 413(47.81) 3 441(52.25) 4.87 0.03 蒙古族 4 121(44.64) 2 987(45.35) 其他 697(7.55) 158(2.40) 家族经济情况 很好 569(6.16) 535(8.12) 11.82 < 0.01 中等以上 1 410(15.27) 843(12.80) 中等 6 380(69.11) 3 821(58.02) 中等以下 689(7.46) 921(13.98) 差 183(1.98) 466(7.08) 语言发展水平 好于同龄人 1 756(19.02) 998(15.15) 7.03 < 0.01 与同龄人相当 7 165(77.62) 5 292(80.35) 比同龄人差 310(3.36) 296(4.49) 不良习惯 有 7 031(76.17) 5 144(78.11) 8.06 0.01 无 2 200(23.83) 1 442(21.89) 新生儿疾病 有 720(7.80) 404(6.13) 16.15 < 0.01 无 8 511(92.20) 6 182(93.87) 胎儿孕周 足月产 8 502(92.10) 6 095(92.54) 6.57 < 0.01 早产 555(6.01) 345(5.24) 过期产 174(1.88) 146(2.22) 分娩方式 顺产 3 815(41.33) 5 034(76.43) 935.59 < 0.01 剖宫产 5 416(58.67) 1 552(23.57) 喂养方式 母乳 5 184(56.16) 4 435(67.34) 503.49 < 0.01 混合 2 695(29.20) 1 629(24.73) 人工 1 352(14.65) 622(9.44) 注： ()内数字为构成比/%。 
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表 2 内蒙古中东部城市地区不同组别儿童ASD检出率比较
Table 2. Prevalence of ASD among children of different age groups in middle and East Inner Mongolia
组别 选项 人数 ASD人数 χ2/Z值 P值 性别 男 4 787 10(0.21) 1.33 0.25 女 4 447 5(0.11) 民族 汉族 4 413 7(0.16) 0.01 0.91 蒙古族 4 121 7(0.17) 父亲文化程度 小学 174 0 5.00 0.08 中学 2 542 8(0.31) 大学及以上 6 515 7(0.11) 母亲文化程度 小学 292 1(0.34) 6.31 0.04 中学 2 500 8(0.32) 大学及以上 6 439 6(0.09) 父亲温和 是 3 161 0 7.82 0.01 否 6 070 15(0.25) 新生儿疾病 是 720 4(0.56) 7.44 0.01 否 8 511 11(0.13) 运动水平 好于同龄人 1 611 4(0.25) 0.96 0.62 与同龄人相当 7 099 10(0.14) 比同龄人差 521 1(0.19) 语言发展水平 好于同龄人 1 755 1(0.06) 42.01 < 0.01 与同龄人相当 7 156 9(0.13) 比同龄人差 305 5(1.64) 注： ()内数字为检出率/%。
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表 3 内蒙古中东部农村地区不同组别儿童ASD检出率比较
Table 3. Prevalence of ASD among children of different age groups in middle-eastern rural areas of Inner Mongolia
组别 选项 人数 ASD人数 χ2/Z值 P值 性别 男 3 706 19(0.51) 2.20 0.14 女 2 880 8(0.28) 民族 汉族 3 441 6(0.17) 17.55 < 0.01 蒙古族 2 987 19(0.64) 父亲温和 是 4 588 24(0.52) 4.50 0.03 否 1 998 3(0.15) 胎儿孕周 足月产 6 095 19(0.31) 34.65 < 0.01 早产 345 3(0.87) 过期产 146 5(3.42) 新生儿疾病 否 6 182 22(0.36) 7.13 0.01 是 404 5(1.24) 运动水平 好于同龄人 967 4(0.41) 21.09 < 0.01 与同龄人相当 5 326 17(0.32) 比同龄人差 293 6(2.05) 语言发展水平 好于同龄人 998 4(0.40) 30.07 < 0.01 与同龄人相当 5 292 16(0.30) 比同龄人差 296 7(2.36) 不良习惯 有 5 096 26(0.51) 5.31 0.02 无 1 442 1(0.07) 家庭有无极度 有 188 5(2.66) 23.62 < 0.01 内向者 无 6 398 22(0.34) 注： ()内数字为检出率/%。
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