重庆市2018—2021年儿童青少年视力不良检出率变化趋势和健康公平性

周春江; 李梦; 胡柯; 万文娟; 黄洪云; 刘志远

doi:10.16835/j.cnki.1000-9817.2022.08.027

重庆市2018—2021年儿童青少年视力不良检出率变化趋势和健康公平性

doi: 10.16835/j.cnki.1000-9817.2022.08.027

周春江^{1, 2},
李梦²,
胡柯²,
万文娟²,
黄洪云³,
刘志远^1, ,

1.
重庆医科大学马克思主义学院，重庆 400016
2.
重庆医科大学附属第一医院眼科/眼科学重庆市市级重点实验室/重庆市眼科研究所
3.
重庆市教育委员会

基金项目:

国家自然科学基金项目 81870650

国家自然科学基金项目 81970832

重庆市自然科学基金面上项目 cstc2021jcyj-msxmX0967

详细信息

作者简介:
周春江(1984-)，女，重庆市人，在读硕士，主要研究方向为社会医学与卫生事业管理

通讯作者:
刘志远，E-mail: liuzhiyuan700200@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R778.1 G478
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-16
- 修回日期: 2022-05-07
- 网络出版日期: 2022-08-24
- 刊出日期: 2022-08-25

Changes and health equity of low vision among children and adolescents in Chongqing during 2018 to 2021

1.
School of Marxism, Chongqing Medical University, Chongqing(400016), China

摘要

摘要: 目的了解重庆市儿童青少年视力不良检出率及变化趋势，分析其健康公平性，为学生视力保护及近视防控提供参考。方法采用纵向研究，对2018—2021年度重庆市小学、初中和高中全年级的所有在校生进行裸眼视力检查，分析儿童青少年视力不良检出率及变化趋势。同时于2021年采用分层随机抽样，对重庆市2 302名儿童青少年裸眼视力和屈光度数(等效球镜，SE)进行健康公平性评价。结果 2018—2021年重庆市儿童青少年视力不良检出率分别为54.12%，58.17%，60.03%和58.20%，视力不良检出率前3年呈增长趋势，2021年较2020年下降1.83%(χ_趋势²=13 870.45，P < 0.01)；小学、初中、高中学生不同年份间视力不良检出率差异均有统计学意义(χ²值分别为17 396.36，2 093.95，771.87，P值均 < 0.01)。2018—2021年，女生视力不良检出率均高于男生(P值均 < 0.01)。裸眼视力基尼系数城市为0.054 57，高于乡村(0.035 94)；SE的基尼系数城市为0.065 82，高于乡村(0.049 30)，即儿童青少年近视在城市中表现得更不公平。结论新型冠状病毒肺炎疫情后期近视防控策略的应对调整与重庆市儿童青少年视力不良检出率降低相关。不同学段、性别在视力不良检出率上有差异。应根据变化趋势制定相应的近视防控措施；城市的视力不良检出率较乡村更加不公平，需要针对区域特点实施不同的近视防控措施。
- 视力，低 /
- 屈光，眼 /
- 儿童 /
- 青少年
Abstract: Objective To understand changes and health equity of low vision in children and adolescents in Chongqing, and to provide reference for student myopia prevention and control. Methods Using longitudinal studies, all school students in grades 1 to grade 12 in Chongqing were examined for visual acuity during 2018 to 2021, and the prevalence as well as changes of low vision were analyzed. In 2021, stratified random sampling was used to evaluate the health equity of uncorrected visual acuity and diopter(spherical equivalent, SE). Results The prevalence of low vision for children and adolescents in Chongqing from 2018 to 2021 was 54.12%, 58.17%, 60.03% and 58.20% respectively. Low vision showed an increasing trend in the first three years and decreased by 1.83% in 2021 as compared with 2020(χ_trend²=13 870.45, P < 0.01). The difference in the detection rate of poor vision among students in different grades was statistically significant(χ²=17 396.36, 2 093.95, 771.87, P < 0.01). From 2018 to 2021, the detection rate of low vision in girls was higher than that of boys(P < 0.01). The Gini coefficient was 0.054 57 for uncorrected visual acuity in urban area, higher than in rural areas (0.035 94). Meanwhile, the Gini coefficient of urban and rural SE was 0.065 82, higher than the country (0.049 30). The results showed that myopia in children and adolescents was more uneven in urban areas. Conclusion The adjustment of myopia prevention and control strategies in the late stage of the novel coronavirus pneumonia epidemic is related to the reduction of the detection rate of poor vision in children and adolescents in Chongqing. Low vision varied by grade and gender, suggesting tailored myopia prevention and control strategy. The detection rate of poor vision in cities is more uneven than in rural areas, and different myopia prevention and control measures need to be implemented according to regional characteristics.
- Vision, low /
- Refraction, ocular /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 重庆市2018—2021年儿童青少年视力不良检出率

Table 1. Detection rate of poor vision among children and adolescent in Chongqing from 2018 to 2021

年级	2018年		2019年		2020年		2021年
年级	人数	视力不良人数	人数	视力不良人数	人数	视力不良人数	人数	视力不良人数
一	243 009	65 662(27.02)	191 424	62 490(32.64)	220 342	73 836(33.51)	71 348	18 841(26.41)
二	234 837	70 411(29.98)	194 522	67 763(34.84)	234 512	85 239(36.35)	69 394	19 701(28.39)
三	242 911	84 685(34.86)	190 125	76 587(40.28)	236 582	99 960(42.25)	73 807	25 917(35.11)
四	241 758	98 094(40.58)	196 307	90 867(46.29)	228 609	113 838(49.80)	73 780	31 945(43.30)
五	261 075	123 550(47.32)	196 649	102 205(51.97)	236 387	132 105(55.89)	72 049	37 609(52.20)
六	271 361	147 106(54.21)	211 594	122 770(58.02)	235 627	145 842(61.90)	75 710	43 772(57.82)
初一	262 530	164 767(62.76)	231 384	150 300(64.96)	261 885	177 257(67.69)	90 489	60 471(66.83)
初二	247 014	173 664(70.31)	213 905	153 496(71.76)	269 915	196 648(72.86)	94 572	68 292(72.21)
初三	218 736	163 585(74.79)	188 231	143 139(76.04)	234 242	179 847(76.78)	95 978	71 730(74.74)
高一	188 178	142 889(75.93)	176 204	134 963(76.59)	189 272	148 970(78.71)	78 512	61 839(78.76)
高二	168 622	132 824(78.77)	146 806	116 884(79.62)	158 806	129 092(81.29)	58 432	47 031(80.49)
高三	100 621	83 404(82.89)	84 720	71 031(83.84)	94 198	78 365(83.19)	36 809	31 345(85.16)
合计	2 680 652	1 450 641(54.12)	2 221 871	1 292 495(58.17)	2 600 377	1 560 999(60.03)	890 880	518 493(58.20)
注： ()内数字为检出率/%。

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表 2 重庆市2018—2021年不同学段儿童青少年视力不良检出率比较

Table 2. Comparison of the detection rate of poor vision among children and adolescents in different grades in Chongqing from 2018 to 2021

年份	小学		初中		高中		χ²值	P值
年份	人数	视力不良人数	人数	视力不良人数	人数	视力不良人数	χ²值	P值
2018	1 494 951	589 508(39.43)	728 280	502 016(68.93)	457 421	359 117(78.51)	555 365.70	< 0.01
2019	1 180 621	522 682(44.27)	633 520	446 935(70.55)	407 730	322 878(79.19)	207 645.85	< 0.01
2020	1 392 059	650 820(46.75)	766 042	553 752(72.29)	442 276	356 427(80.59)	228 161.38	< 0.01
2021	436 088	177 785(40.77)	281 039	200 493(71.34)	173 753	140 215(80.70)	110 567.19	< 0.01
χ²值		17 396.36		2 093.95		771.87
P值		< 0.01		< 0.01		< 0.01
注： ()内数字为检出率/%。

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表 3 重庆市2018—2021年各学段不同性别学生视力不良检出率比较

Table 3. Comparison of the detection rate of poor vision in children and adolescents of different genders and grades in Chongqing from 2018 to 2021

学段	性别	统计值	2018年		2019年		2020年		2021年
学段	性别	统计值	人数	视力不良人数	人数	视力不良人数	人数	视力不良人数	人数	视力不良人数
小学	男		784 602	290 690(37.05)	619 345	258 881(41.80)	728 952	323 412(44.37)	228 490	88 893(38.90)
	女		710 349	298 818(42.07)	561 276	263 801(47.00)	663 107	327 408(49.37)	207 598	88 892(42.82)
		χ²值		3 929.04		3 228.36		3 498.42		690.32
		P值		< 0.01		< 0.01		< 0.01		< 0.01
初中	男		381 362	245 327(64.33)	331 139	219 601(66.32)	401 251	274 474(68.40)	147 761	100 545(68.05)
	女		346 918	256 689(73.99)	302 381	227 334(75.18)	364 791	279 278(76.56)	133 278	99 948(74.99)
		χ²值		7 919.03		5 977.30		6 341.43		1 653.73
		P值		< 0.01		< 0.01		< 0.01		< 0.01
高中	男		232 504	173 295(74.53)	206 595	156 014(75.52)	225 414	174 146(77.26)	89 036	69 287(77.82)
	女		224 917	185 822(82.62)	201 135	166 864(82.96)	216 862	182 281(84.05)	84 717	70 928(83.72)
		χ²值		4 427.88		3 427.16		3 265.08		971.59
		P值		< 0.01		< 0.01		< 0.01		< 0.01
合计	男		1 398 468	709 312(50.72)	1 157 079	634 496(54.84)	1 355 617	772 032(56.95)	465 287	258 725(55.61)
	女		1 282 184	741 329(57.82)	1 064 792	657 999(61.80)	1 244 760	788 967(63.38)	425 593	259 768(61.04)
		χ²值		13 568.37		11 039.389		11 190.19		2 695.24
		P值		< 0.01		< 0.01		< 0.01		< 0.01
注： ()内数字为检出率/%。

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参考文献(20)

[1]	WANG W, ZHU L, ZHENG S, et al. Survey on the progression of myopia in children and adolescents in Chongqing during COVID-19 pandemic[J]. Front Public Health, 2021, 28(9): 646-770.
[2]	王路, 黄剑辉, 夏志伟, 等. 北京市2010-2016年中小学生视力不良检出结果分析[J]. 中国学校卫生, 2019, 40(10): 1539-1541. doi: 10.16835/j.cnki.1000-9817.2019.10.028 WANG L, HUANG J H, XIA Z W, et al. Poor eyesight in primary and middle school students in Beijing during 2010-2016[J]. Chin J Sch Health, 2019, 40(10): 1539-1541. doi: 10.16835/j.cnki.1000-9817.2019.10.028
[3]	卫生部. 学生健康检查技术规范: GB/T 26343-2010[S]. 北京: 中国标准出版社, 2011. Ministry of Health of the PRC. Technical standard for physical examination for students: GB/T 26343-2010[S]. Beijing: Standards Press of China, 2011.
[4]	PELLEGRINI M, BERNABEI F, SCORCIA V, et al. May home confinement during the COVID-19 outbreak worsen the global burden of myopia?[J]. Graef Arch Clin Exp Ophthalmol, 2020, 258(9): 2069-2070. doi: 10.1007/s00417-020-04728-2
[5]	MOORE S A, FAULKNER G, RHODES R E, et al. Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey[J]. Int J Behav Nutr Phys Act, 2020, 17(1): 85. doi: 10.1186/s12966-020-00987-8
[6]	HU Y, DING X, GUO X, et al. Association of age at myopia onset with risk of high myopia in adulthood in a 12-year follow-up of a Chinese cohort[J]. JAMA Ophthalmol, 2020, 138(11): 1129-1134. doi: 10.1001/jamaophthalmol.2020.3451
[7]	YAO Y, FU J, LIU J, et al. Distribution, progression, and associated factors of refractive status of children in Lhasa, Tibet after COVID-19 quarantine[J]. Ophthalmic Res, 2022, 65(3): 321-327. doi: 10.1159/000522548
[8]	MA D, WEI S, LI S M, et al. The impact of study-at-home during the COVID-19 pandemic on myopia progression in Chinese children[J]. Front Public Health, 2022, 9: 720514. doi: 10.3389/fpubh.2021.720514
[9]	GUAN H, YU N N, WANG H, et al. Impact of various types of near work and time spent outdoors at different times of day on visual acuity and refractive error among Chinese school-going children[J]. PLoS One, 2019, 14(4): e0215827. doi: 10.1371/journal.pone.0215827
[10]	SAW S M, CHUA W H, HONG C Y, et al. Nearwork in early-onset myopia[J]. Invest Ophthalmol Vis Sci, 2002, 43(2): 332-339.
[11]	ROSE K A, FRENCH A N, MORGAN I G. Environmental factors and myopia: paradoxes and prospects for prevention[J]. Asia Pac J Ophthalmol(Phila), 2016, 5(6): 403-410. doi: 10.1097/APO.0000000000000233
[12]	LIN L L, SHIH Y F, HSIAO C K, et al. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000[J]. Ann Acad Med Singap, 2004, 33(1): 27-33.
[13]	MU J, ZHONG H, LIU M, et al. Trends in myopia development among primary and secondary school students during the COVID-19 pandemic: a large-scale cross-sectional study[J]. Front Public Health, 2022, 10: 859285. doi: 10.3389/fpubh.2022.859285
[14]	LI S M, LIU L R, LI S Y, et al. Design, methodology and baseline data of a school-based cohort study in central China: the Anyang childhood eye study[J]. Ophthalmic Epidemiol, 2013, 20(6): 348-359. doi: 10.3109/09286586.2013.842596
[15]	徐渴, 刘忠慧, 冯宝佳, 等. 天津市2018年中小学生视力不良现状及影响因素分析[J]. 中国慢性病预防与控制, 2021, 29(8): 589-592, 596. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202108006.htm XU K, LIU Z H, FENG B J, et al. Analysis on the current situation and influencing factors of poor vision in primary and middle school students of Tianjin in 2018[J]. Chin J Prev Control Chron Dis, 2021, 29(8): 589-592, 596. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202108006.htm
[16]	吕若然, 宋玉珍, 段佳丽, 等. 北京市2017年中小学生视力不良现状分析[J]. 中华流行病学杂志, 2019, 40(4): 457-460. doi: 10.3760/cma.j.issn.0254-6450.2019.04.016 LYU R R, SONG Y Z, DUAN J L, et al. Study on the status of low vision among students of Beijing in 2017[J]. Chin J Epidemiol, 2019, 40(4): 457-460. doi: 10.3760/cma.j.issn.0254-6450.2019.04.016
[17]	罗春燕, 齐文娟, 何鲜桂, 等. 上海市中小学生近视相关因素分析[J]. 中国学校卫生, 2021, 42(2): 185-189. doi: 10.16835/j.cnki.1000-9817.2021.02.007 LUO C Y, QI W J, HE X G, et al. Analysis of myopia related factors among primary and secondary school students in Shanghai[J]. Chin J Sch Health, 2021, 42(2): 185-189. doi: 10.16835/j.cnki.1000-9817.2021.02.007
[18]	尹立, 张雯. 2014年-2018年太原市迎泽区中小学生视力不良流行趋势[J]. 护理研究, 2019, 33(13): 2361-2363. doi: 10.12102/j.issn.1009-6493.2019.13.047 YIN L, ZHANG W. Epidemic trend of poor eyesight among students in primary and secondary school in Yingze District of Taiyuan City from 2014 to 2018[J]. Nurs Res, 2019, 33(13): 2361-2363. doi: 10.12102/j.issn.1009-6493.2019.13.047
[19]	DONG L, KANG Y K, LI Y, et al. Prevalence and time trends of myopia in children and adolescents in China: a systemic review and Meta-analysis[J]. Retina, 2020, 40(3): 399-411. doi: 10.1097/IAE.0000000000002590
[20]	郭磊, 赵迪, 范嘉音, 等. 医保一体化背景下山东省城乡居民健康的公平性[J]. 山东大学学报(医学版), 2020, 58(6): 115-120. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYB202006020.htm GUO L, ZHAO D, FAN J Y, et al. Health equity of urban and rural residents in Shandong Province under the background of medical insurance integration[J]. J Shandong Univ(Med Sci), 2020, 58(6): 115-120. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYB202006020.htm