Sex and Race/Ethnicity-specific Multilevel Factors Influencing Pubertal Trajectories: a Population-based Study

摘要 在美国，女孩和男孩的青春期开始年龄都急剧下降， 差距。这具有重要的公共卫生意义，因为青春期提前与各种有害的 青少年的行为和情绪后果以及成人慢性病。为了应对这些趋势， 临床医生已经通过将青春期提前的分界点从<8岁调整为 <6岁的女孩。为了设计有效的干预措施，我们必须首先：（1）建立当前的规范轨迹 美国青少年的性别、种族/民族和BMI，以可靠地识别正在经历青春期的儿童 显著早于相同种族/民族的同龄人，（2）识别性别特异性可改变的风险 这些因素可以作为高危人群干预策略的目标。健康人2020 强调改善青少年健康的重要性，因为青春期是一个重要的窗口， 影响青少年行为和成人发病率的易感性。为了解决缺乏青春期数据的问题， 根据PA-18-033中描述的种族/族裔群体的轨迹，我们将利用 种族/民族多元化的人口凯撒永久北方加州（KPNC）进行最大的 迄今为止进行的基于人口的纵向研究。认识到早期筛查的重要性 青春期，KPNC开始在电子健康中对儿科医生评估的坦纳阶段进行常规记录 我们在2010年发布了电子健康记录（EHR），此后我们验证了这些数据的质量。我们将利用这些青春期 发育数据、种族/民族和青春期前BMI数据，以有效表征性别和 青春期开始和克里思的种族/种族特异性规范性分布（从 在170 000名男孩和女孩中（目标1），然后，我们将使用一个子队列的数据， 在KPNC实施EHR系统（2006年）后出生的男孩和女孩，以创建一个虚拟的 出生队列研究个体水平的生命早期可干预的代谢因素，如母亲产前， 妊娠期肥胖、妊娠期体重增加和出生后生长轨迹（Aim 2）作为影响 青春期的时间最后，我们将把历史地理编码地址数据链接到加州邻里数据 系统，我们开发的，调查上下文因素（例如，社会和建筑环境）影响 青春期时间（目标3）。我们的研究结合了几项创新和优势，包括使用大型 和全面的EHR和不同的男孩和女孩人口进行否则昂贵的纵向 研究，检查青春期的几个重要标志，并调查个人和背景 水平因素作为风险因素。本研究确定的风险因素以及性别和人种/种族的作用将 指导设计上游的个人以及政策一级的干预措施。这些干预措施针对高 风险群体将推进我们防止青春期提前加剧健康差距的长期目标。

ABSTRACT Age of pubertal onset has declined dramatically in both girls and boys in the US, with substantial racial/ethnic disparities. This has important public health implications as early puberty is linked with a variety of detrimental adolescent behavioral and emotional outcomes as well as adult chronic diseases. In response to these trends, clinicians have adjusted by shifting the guidelines for the cutoff point for early puberty from age <8 to as early as age <6 in girls. To design effective interventions, we must first: (1) establish current normative trajectories for US adolescents by sex, race/ethnicity and BMI to reliably identify children who are going through puberty substantially earlier than their peers of the same racial/ethnic group, and (2) identify sex-specific modifiable risk factors that can serve as targets for intervention strategies in high-risk groups. Healthy People 2020 emphasizes the importance of improving adolescent health because puberty is an important window of susceptibility that impacts adolescent behaviors and adult morbidity. To address the lack of data on pubertal trajectories by racial/ethnic groups, described in PA-18-033, we will take advantage of the robust data for the racially/ethnically diverse population of Kaiser Permanente Northern California (KPNC) to conduct the largest population-based, longitudinal study undertaken to date. Acknowledging the importance of screening for early puberty, KPNC began routine documentation of pediatrician-assessed Tanner stages in the electronic health record (EHR) in 2010, and we have since validated the quality of these data. We will use these pubertal development data, race/ethnicity, and pre-pubertal BMI data to efficiently characterize the sex- and race/ethnicity specific normative distributions of pubertal onset and tempo (rate of pubertal progression from onset to completion of maturation) in 170,000 boys and girls (Aim 1). We will then use data on a sub-cohort of boys and girls who were born at KPNC after the implementation of the EHR system (2006) to create a virtual birth cohort to investigate individual-level early life intervenable metabolic factors such as maternal pre- pregnancy obesity, gestational weight gain, and postnatal growth trajectory (Aim 2) as factors influencing pubertal timing. Lastly, we will link historical geocoded address data to the California Neighborhood Data System, which we developed, to investigate contextual factors (e.g., social and built environment) influencing pubertal timing (Aim 3). Our studies incorporate several innovations and strengths including the use of large and comprehensive EHR and a diverse population of boys and girls to conduct an otherwise costly longitudinal study, examination of several important hallmarks of puberty, and investigation of individual and contextual level factors as risk factors. Risk factors identified from this study and the role of sex and race/ethnicity will guide the design of upstream individual- as well as policy-level interventions. Such interventions targeting high risk groups will advance our long-term goal of preventing health disparities worsened by early puberty.