Abstract: Background　Identifying the characteristics of disease spectrum will help to triage patients more rationally，promoting the sound development of different types of hospitals. Objective　To understand the percentage and features of diseases in the pediatric disease spectrum in healthcare institutions in Shanghai's Chongming District，providing scientific basis for rationally guiding the tiered diagnosis and treatment of pediatric diseases and community pediatric care development in this district. Methods　Data about diseases suffered by children and adolescents（0-18 years old） were collected from the hospital health information system of all hospitals in Chongming District from 2016 to 2018. The diseases were analyzed，and ranked by their percentage of the spectrum. Changes in the disease spectrum were analyzed by year，age group，and level of hospitals. Results　In these three years，the outpatient and inpatient visits in the 21 hospitals in Chongming District numbered 410 711，and 15 665，respectively. Among all diseases，the first and third major diseases in each year were respiratory diseases，and digestive diseases，respectively. In diseases treated with outpatient care，skin and subcutaneous tissue diseases accounted for a large proportion，ranking in the top third. Of the diseases treated with inpatient care，the top third was diseased conditions of perinatal origin，and the sufferers were mainly aged 0-5 years. The visits in the tertiary hospitals were much more than those in community hospitals. Moreover，the visits showed a year-to-year growth in tertiary hospitals while demonstrated a year-to-year decline in community hospitals. Conclusion　The spectrum of pediatric diseases in Chongming District is not significantly different from that in other regions. In the prevention and treatment of such diseases，attention should be paid to the local special conditions，such as high-incidence skin and subcutaneous tissue diseases and diseased conditions of perinatal origin in children aged 0-5 years. Furthermore，to achieve tiered diagnosis and treatment for pediatric diseases in this district，it is urgent to develop community pediatric care to improve the diagnosis and treatment level of common pediatric diseases in community hospitals.

Key words: Disease spectrum, Community, Community pediatrics, Children

摘要： 背景　厘清就医疾病谱特征有助于合理分流患者，推动不同类型医院的优质发展。目的　本研究通过分析上海市崇明区儿童就医疾病谱，旨在掌握崇明区儿童就医疾病的构成特征和各级医疗机构儿童疾病的接诊特征，为合理引导崇明区儿童分级诊疗和社区儿科发展提供科学依据。方法　对2016—2018年崇明区所有医院卫生信息平台中0~18岁儿童疾病诊断进行疾病谱顺位及构成比分析，深入挖掘疾病谱随年份变化趋势、不同年龄和不同级别医疗机构的疾病谱差异。结果　崇明区21所医疗机构2016—2018年共收治门诊患儿410 711人次，住院患儿15 665人次。门诊与住院患儿中，呼吸系统疾病始终排在第一位，消化系统疾病始终位居前三顺位；门诊患儿中“皮肤与皮下组织疾病”占比较大，达第三顺位；住院患儿中“起源于围生期的某些情况”居第三顺位，均以0~5岁患儿为主；三级医院接诊儿童数量远大于社区卫生服务中心，且三级医院患儿逐年上升，社区卫生服务中心患儿数量逐年下降。结论　崇明区儿童就医疾病谱与其他地区差异不大，但应在防治过程中，加以关注区域内特殊情况，如0~5岁儿童高发的“皮肤与皮下组织疾病”和“起源于围生期的某些情况”；要实现崇明区儿童分级诊疗，亟须发展社区儿科以有效提高当前社区卫生服务中心儿童常见病的诊疗能力。

关键词: 疾病谱, 社区, 社区儿科, 儿童