A longitudinal study on the long-term systematic child health care on the health outcomes of children and adolescents in welfare institutions: empirical analysis based on eight years of physical examination data
长期系统化儿童保健对福利机构儿童青少年健康结局的纵向研究：基于八年体检数据的实证分析

摘要

目的 本研究旨在评估一项长期、系统化的儿童保健模式对改善某儿童福利机构内儿童青少年身心健康结局的长期有效性，为优化福利机构儿童健康管理提供循证依据。方法 采用回顾性纵向研究设计，收集某大型儿童福利机构在2018年至2025年共八年间，所有在院儿童的年度体检数据、医疗记录及保健档案。构建包含生长发育、营养状况、常见疾病、心理行为等维度的健康指标体系。运用描述性统计、卡方检验、配对t检验以及广义估计方程等统计方法，分析健康指标在系统化保健实施前后的变化趋势及影响因素。结果 八年间，共纳入有效记录1073人次，涉及儿童218名。系统化保健实施后，研究对象的生长发育水平显著提升，体重、身高与同性别、同年龄群体比较，正常范围（P3-P97）从47.6%和26%提升至64.4%和61.4%；营养性贫血患病率从36.88%持续下降至10.3%；微量元素（铁、锌）缺乏率大幅降低；心理行为问题筛查阳性率从45.2%下降至26.6%。广义估计方程模型显示，在控制了年龄、性别、残疾状况等混杂因素后，系统化保健的实施时间是健康结局改善的独立保护因素。结论 长期、系统化的儿童保健模式能显著且持续地改善福利机构儿童青少年的生长发育、营养状况和心理健康水平，有效扭转其因早期逆境带来的健康劣势^[1]。

Abstract

Objective This study aims to evaluate the long-term effectiveness of a systematic child healthcare model in improving the physical and mental health outcomes of children and adolescents in a certain child welfare institution, and provide evidence-based support for optimizing child health management in welfare institutions.
Methods A retrospective longitudinal study design was adopted to collect annual physical examination data, medical records, and health records of all hospitalized children in a large children's welfare institution from 2018 to 2025, for a total of eight years. Construct a health indicator system that includes dimensions such as growth and development, nutritional status, common diseases, and psychological behavior. Using descriptive statistics, chi square tests, paired t-tests, and generalized estimation equations, analyze the trends and influencing factors of health indicators before and after the implementation of systematic healthcare.
Results Over the course of eight years, a total of 1073 valid records were included, involving 218 children. After the implementation of systematic healthcare, the growth and development level of the research subjects significantly improved. Compared with the same gender and age groups, the normal range (P3-P97) of weight and height increased from 47.6% and 26% to 64.4% and 61.4%, respectively; The prevalence of nutritional anemia has continued to decline from 36.88% to 10.3%; The deficiency rate of trace elements (iron, zinc) has significantly decreased; The positive rate of screening for psychological and behavioral problems has decreased from 45.2% to 26.6%. The generalized estimating equation model shows that after controlling for confounding factors such as age, gender, and disability status, the implementation time of systematic healthcare is an independent protective factor for improving health outcomes.
Conclusion   A long-term and systematic child health care model can significantly and continuously improve the growth and development, nutritional status, and mental health of children and adolescents in welfare institutions, effectively reversing their health disadvantages caused by early adversity.