摘要：Objectives. We conducted a large-scale study of newly arrived refugee children in the United States with data from 2006 to 2012 domestic medical examinations in 4 sites: Colorado; Minnesota; Philadelphia, Pennsylvania; and Washington State. Methods. Blood lead level, anemia, hepatitis B virus (HBV) infection, tuberculosis infection or disease, and Strongyloides seropositivity data were available for 8148 refugee children (aged < 19 years) from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq, and Somalia. Results. We identified distinct health profiles for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Hepatitis B was more prevalent among male children than female children and among children aged 5 years and older. The odds of HBV, tuberculosis, and Strongyloides decreased over the study period. Conclusions. Medical screening remains an important part of health care for newly arrived refugee children in the United States, and disease risk varies by population. Each year, approximately 35 000 children enter the United States as refugees, defined as immigrants who enter the United States through the Department of State’s Refugee Resettlement Program to receive protection from persecution. 1,2 An additional 200 000 to 250 000 immigrant children receive lawful permanent residency in the United States each year, meaning that they are permitted to remain in the United States indefinitely. 2 Overall, 3.7% of children living in the United States (including 7.7% of Latino children and 16.7% of Asian children) were born overseas. 3 Although immigrant children constitute an important and growing sector of the US child population, comprehensive guidelines for clinicians caring for children new to the United States are lacking. In part, this has been because data on the health status of immigrant and refugee children have been limited. With a few exceptions, studies have been limited to small samples of children and have not allowed detailed analysis by age, gender, or country of origin. 4–16 Larger studies of refugees rapidly become out of date as countries of origin change. 17–19 Despite these limitations, the Centers for Disease Control and Prevention (CDC) has used the best available data to develop screening guidelines that are specific for refugees and that have been implemented by many state and local departments of public health, as well as clinicians specializing in refugee health services. 20 These guidelines recommend a minimum set of screening tests for infectious, nutritional, and environmental health problems (e.g., tuberculosis [TB], anemia, and elevated blood lead [EBL] levels). Some screening tests (e.g., anemia) are recommended for all children, whereas others (e.g., schistosomiasis) are recommended only for children from regions with endemic disease. Screening usually takes place within 90 days (and preferably within 30 days) of arrival in the United States as part of a domestic medical examination. Lacking other recommendations, these guidelines have also been adopted by some clinicians specializing in health care for other populations of immigrant children in the United States. We describe results from the first large-scale study to our knowledge of newly arrived refugee children in the United States by using data from 2006 to 2012 domestic medical examinations in 4 states. This study is important because it demonstrates that it is feasible to create a unified refugee health data set by using public health data from multiple states and that a data set of this type can be used to examine the value of existing screening guidelines. In addition, this analysis includes subgroup data by age, gender, country of origin, and country of departure that may be used to refine population-specific screening guidelines for immigrant children. Finally, it includes tests for temporal trends to determine whether conditions previously believed to be prevalent among refugee children have become more or less common over time.
