Sex-based prevalence of growth faltering in an urban pediatric population

Abstract

Objective: To determine the sex-based prevalence of growth faltering in a pediatric primary care setting.

Study design: A total of 33 476 children attending 4 urban pediatric primary care practices affiliated with a tertiary pediatric hospital between July 2002 and June 2005 were studied. Growth faltering was defined as height <5th percentile or a drop in height z-score by >or= 1.5 standard deviations (SD) before age 18 months or by >or= 1 SD thereafter. The growth-faltering and nonfaltering groups were compared in terms of sex, race, age, number of clinic visits, and insurance, and by US census tract, socioeconomic status and parental education. Similar comparisons were made for children with height z-scores below -2.25 SD.

Results: Growth faltering was present in 3007 of the children studied (9%). Univariate and multivariate logistic regression analyses identified significant associations between growth faltering and younger age (P< .0001), Caucasian race (P< .0001), fewer clinic visits (P< .0001), and Medicaid insurance (P< .005), but not with sex nor by residential census tract, median income or proportion with less than high school education. Height below -2.25 SD was associated with male sex (P< .01), Medicaid insurance (P< .01), and more primary care visits (P< .0005).

Conclusions: The sex disparity in subspecialty growth center referrals (2:1 male:female) is not due to male predominance in growth faltering among children in the urban primary care setting.

Figure 1. Age distribution, by sex, of the children in the pediatric primary care practices

(A) Total number of children seen by each year of age. (B) Percentage of children seen at each year of age that have growth faltering.

Figure 2. Prevalence of growth faltering, as percentage of patients, by census tract in Philadelphia County

Excludes all census tracts with counts fewer than 10 patients in our pediatrics primary care network. All practices providing pediatric primary care, as well as the four practices caring for our patient population, are shown.