特大城市儿童的早期发展一致性与差异性：一项回顾性队列研究
Consistencies and Differences in Early Childhood Development Characteristics in Megacities：a Retrospective Cohort Study
刘翔 1陈红 2崔睿 3郭志超 4李盼盼 5曹子龙 6纪伊晴 6俞文雅6
作者信息
- 1. 310000 浙江省杭州市，杭州医学院附属西湖医院呼吸内科;310000 浙江省杭州市，中国人民解放军联勤保障部队第九〇三医院呼吸内科
- 2. 200030 上海市，上海交通大学医学院附属胸科医院后勤保障科;200025 上海市，上海交通大学医学院公共卫生学院
- 3. 518028 广东省深圳市，南方医科大学附属深圳市妇幼保健院医务科
- 4. 200941 上海市宝山区月浦镇社区卫生服务中心预防保健科
- 5. 200001 上海市黄浦区打浦桥社区卫生服务中心预防保健科
- 6. 200025 上海市，上海交通大学医学院公共卫生学院
- 折叠
摘要
背景 在全球各国，儿童仍然面临着早期发展迟缓的挑战。经济发达地区的儿童早期发展（ECD）特征与差异尚不明确。基于现有的儿童保健管理系统数据库开展ECD相关的分析，能够更加快速、便捷地为儿童保健医生提供ECD的精准监管方向。目的 本研究旨在评估和比较中国经济发达地区特大城市ECD特征及其影响因素。方法 本研究为一项回顾性队列研究，选取2017—2020年在上海和深圳儿童健康管理系统注册的 13 436 名 0~3 岁儿童为研究对象。儿童保健医生评估了儿童的基本人口学信息、出生状况和早期发展特征数据。全维度儿童早期发展指标包括体格发育、大动作发育以及认知 / 语言 / 社会情感 / 精细动作的综合发育指标。采用描述性分析、单因素检验和多因素检验的统计学分析方法，分析上海和深圳两个地区的 ECD 特征，并比较两地 ECD 的一致性与差异性。结果 13 436名0~3岁的儿童中，10 890名（81.1%）来自上海，2 546 名（18.9%）来自深圳。在体格发育方面，深圳市儿童的身高和体重发育得分及前囟闭合时间异常比例均高于上海市（P<0.05）。在 ECD 其他维度，仅上海区域数据库有所涵盖，结果显示，上海儿童在大动作和认知 / 语言 / 社会情感 / 精细动作的综合发育水平均低于预期的按年龄调整的能力水平。多元线性及多因素 Logistic 回归分析结果显示，夏季或冬季出生、出生身高、出生体重和早产是两地儿童身高发育的共同影响因素（P<0.05）；其中，多胞胎对上海儿童的身高发育影响最大（β=-0.067），早产对深圳儿童的身高发育影响最大（β=0.094）。冬季出生、出生身高和早产是两地儿童体重发育的共同影响因素（P<0.05）；其中，多胞胎对上海儿童的体重发育影响最大（β=-0.070），早产对深圳儿童的体重发育影响最大（β=0.066）。父亲职业、出生季节、出生体重和孕次是上海儿童前囟闭合时间的影响因素（P<0.05）；其中，夏季出生影响最大（B=2.104）。儿童外国籍、父亲职业不详、夏季或秋季出生、出生身高、孕周和早产是上海儿童早期大动作发育的影响因素（P<0.05）；其中，早产影响最大（β=0.291）。儿童流动人口或外国籍、母亲从事专业技术工作、母亲年龄、出生身高、出生体重、孕周、孕次、剖宫产、早产和多胞胎是上海儿童早期认知 / 语言 / 社会情感 / 精细动作综合发育的影响因素（P<0.05）；其中，早产影响最大（β=0.310）。结论 以上海和深圳为代表的特大城市的 ECD 水平具有一定的差异性；虽然影响机制存在差异，但影响因素存在一定共性。儿童保健专业人员可根据父母职业、户籍类型、母亲年龄、孕周、早产状况等加强对儿童的监管、干预和随访。在怀孕期间和出生后尽早实施早期干预，或可减少危险因素的潜在不利影响。
Abstract
Background Globallychildren still face the challenge of delayed early development. The disparities in early childhood developmentECDwithin economically developed areas remain unclear. Based on the analysis of the existing child health management system databasechild healthcare professionals could quickly and conveniently confirm the supervision direction of ECD. Objectives This study aimed to assess and compare ECD characteristics and influencing factors in economically developed megacities in China. Methods This is a retrospective cohort study. Participants included 13436 children aged 0-3 years enrolled in the Child Health Management System from 2017 to 2020 in Shanghai and Shenzhen. Data on demographic informationbirth statusand ECD characteristics were evaluated by child healthcare physicians. The all round ECD indicators included physical developmentgross motor developmentand comprehensive cognitivelanguagesocio-emotionaland fine motor development. Descriptive statisticsunivariate analysisand multivariate analysis were used to analyze the ECD characteristics in Shanghai and Shenzhen and compare the consistency and difference between the two regions. Results Overallamong the 13 436 children10 89081.1%were from Shanghaiand 2 546 were from Shenzhen. In terms of physical developmentShenzhen children were taller and heavier and had unfavorable anterior fontanelle closure times than Shanghai childrenP<0.05. Only the Shanghai database covered the other dimensions of ECD. The results showed that the gross motor development and comprehensive cognitivelanguagesocio-emotionaland fine motor development of Shanghai children fell behind age-adjusted standards. Birth in summer or winterbirth height and weightand premature delivery were common influencing factors for height development in both regionsShanghai children's height development was mostly influenced by multiple births=-0.067while premature delivery=0.094was the most significant factor for Shenzhen children. Birth in winterbirth heightand premature delivery were common influencing factors for weight development in both regionsP<0.05Shanghai children's weight development was especially influenced by multiple births=-0.070while premature delivery=0.066was the most significant factor for Shenzhen children. Anterior fontanel closure was influenced by father's occupationbirth weightpregnancy timesand especially the summer season of birth=2.104. The early motor development was influenced by foreign nationalityfather's occupationbirth seasonbirth heightgestational weekand especially premature delivery=0.291. The comprehensive cognitivelanguagesocial-emotionaland fine motor development was influenced by children's household registration typemother's occupationmother's agebirth height and weightgestational weekpregnancy timescesarean deliverymultiple birthsand especially premature birth =0.310. Conclusion The ECD levels in megacities such as Shanghai and Shenzhen demonstrate notable variationswhile the underlying mechanisms differthe influencing factors share certain commonalities. Child healthcare professionals can increase the monitoringinterventionand follow-up of children with the considerations of the following characteristicsparents' occupationshousehold registration typemother's agegestational weekand premature delivery. Early intervention during pregnancy and shortly after birth may reduce the potential adverse effects of risk factors.关键词
儿童早期发展/经济发达地区/特大城市/儿童/队列研究/回顾性研究/影响因素分析引用本文复制引用
刘翔,陈红,崔睿,郭志超,李盼盼,曹子龙,纪伊晴,俞文雅.特大城市儿童的早期发展一致性与差异性：一项回顾性队列研究[EB/OL].(2025-09-30)[2026-04-02].https://chinaxiv.org/abs/202510.00028.学科分类
儿科学/医学研究方法/预防医学
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