Geographic distribution of childhood diabetes and obesity relative to the supply of pediatric endocrinologists in the United States
Geographic distribution of childhood diabetes and obesity relative to the supply of pediatric endocrinologists in the United States
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DOI：
10.1016/j.jpeds.2007.08.037
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发表时间：
2008-03-01
影响因子：
5.1
通讯作者：
Freed, Gary L.
中科院分区：
文献类型：
--
作者：
Lee, Joyce M.;Davis, Matthew M.;Freed, Gary L.
目的确定儿童糖尿病和肥胖症的地理分布与美国儿科内分泌学家的供应情况。研究设计估计儿童糖尿病的观察比率和“指数”比率（按区域和部门分列）和肥胖（体重指数>=年龄和性别的95%）结果在全国范围内，糖尿病儿童与儿科内分泌医生的比例为290：1，肥胖儿童与儿科内分泌医生的比例为17,741：1。中西部、南部和西部的糖尿病儿童与儿科内分泌医生的比例分别为370：1、335：1和367：1，是东北部的两倍（144：1）。在各州之间，肥胖儿童与儿科内分泌学家的观察比例有19倍的差异。在公平分配的条件下，内分泌学家供应，各州之间的变化将大大减轻。结论糖尿病和肥胖儿童的分布并不平行的儿科内分泌学家在美国的分布，主要是由于内分泌学家供应的地理差异。鉴于肥胖儿童给内分泌学家带来的巨大负担，多学科护理模式对于美国医疗保健系统解决糖尿病和肥胖儿童的需求至关重要。
Objective To determine the geographic distribution of childhood diabetes and obesity relative to the supply of US pediatric endocrinologists.Study design Estimation of observed and "index" ratios of children with diabetes (by region and division) and obesity (body mass index >= 95th % for age and sex) (by region and state) to board-certified pediatric endocrinologists.Results At the national level, the ratio of children with diabetes to pediatric endocrinologists is 290:1, and the ratio of obese children to pediatric endocrinologists is 17,741:1. Ratios of children with diabetes to pediatric endocrinologists in the Midwest (370:1), South (335:1), and West (367:1) are twice as high as in the Northeast (144:1). Across states, there is lip to a 19-fold difference in the observed ratios of obese children to pediatric endocrinologists. Under conditions of equitably distributed endocrinologist supply, variation across states would be mitigated considerably.Conclusions The distribution of children with diabetes and obesity does not parallel the distribution of pediatric endocrinologists in the United States, due largely to geographic disparities in endocrinologist supply. Given the large burden of obese children to endocrinologists, multidisciplinary models of care delivery are essential for the US health care system to address the needs of children with diabetes and obesity.