上海市黄浦区屈光筛查异常儿童青少年复诊依从性相关因素分析

陈健; 何鲜桂; 赵雪斐; 朱晶; 谢晖; 潘臣炜; 王菁菁

doi:10.16835/j.cnki.1000-9817.2022.09.006

上海市黄浦区屈光筛查异常儿童青少年复诊依从性相关因素分析

doi: 10.16835/j.cnki.1000-9817.2022.09.006

1.
上海市黄浦区疾病预防控制中心学校卫生与眼病防治科, 200023
2.
上海市眼病防治中心
3.
苏州大学医学部公共卫生学院

基金项目:

上海市公共卫生优秀学科带头人培养计划 GWV-10.2-XD09

国家自然科学基金项目 82003562

上海市卫生健康委员会青年课题 20194Y0308

详细信息

作者简介:
陈健(1977-), 女, 上海市人, 大学本科, 副主任医师, 主要研究方向为学校卫生与青少年健康

通讯作者:
王菁菁, E-mail: 13011220922@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 R778.2
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- 文章访问数: 348
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- 被引次数: 0
出版历程
- 收稿日期: 2021-12-21
- 修回日期: 2022-04-26
- 网络出版日期: 2022-09-23
- 刊出日期: 2022-09-25

Analysis of referral adherence and associated factors in children and adolescents screened with abnormal refractive error in Huangpu District, Shanghai

1.
School Health and Eye Disease Prevention Department, Center for Disease Prevention and Control of Huangpu Disctrict, Shanghai (200023), China

摘要

摘要: 目的了解屈光筛查异常儿童青少年复诊率和复诊依从性相关影响因素, 为加强儿童青少年屈光发育档案管理与应用、提升近视防控效率和效果提供依据。方法采用整群抽样的方法, 选取上海市黄浦区3所小学和3所初中学校开展调查, 对所有学生建立屈光发育档案, 包括视力、非睫状肌麻痹电脑验光和眼轴长度等眼科检查, 并通过问卷调查收集复诊及相关因素信息, 采用多因素Logistic回归分析复诊的相关因素。结果筛查出疑似屈光异常的儿童青少年共2 104名, 通知需复诊儿童青少年实际复诊率60.4%, 其中指定定点医院复诊占58.8%。筛查前已有近视(OR=1.37, 95%CI=1.08~1.72)、筛查前已佩戴框架眼镜或角膜塑形镜(OR=2.05, 95%CI=1.62~2.59)、初筛后近视度数(OR_{-0.5 D以下}=2.08, 95%CI=1.48~2.92, OR_{-3.0~-0.5 D}=1.86, 95%CI=1.47~2.36)、初筛结果家长知晓(OR=2.92, 95%CI=1.89~4.50)、对复诊建议满意(OR=3.54, 95%CI=1.16~10.79)等5个因素为屈光筛查异常儿童青少年复诊依从性的影响因素(P值均 < 0.05)。结论屈光筛查异常需复诊儿童青少年实际复诊率有待提高。需进一步优化屈光档案医防融合信息化, 针对重点人群加强科普宣教、规范初筛屈光检查结果的专业解读, 并通过健康宣教提升家长知晓度、参与度和满意度, 实现屈光档案分级分类全流程闭环管理。
- 屈光不正 /
- 回归分析 /
- 儿童 /
- 青少年
Abstract: Objective To understand the referral rate in children with abnormal refractive error in screening programs and associated factors, aiming to provide evidence for improving the rate and myopia prevention and control in the future. Methods Using cluster sampling, three primary schools and three junior middle schools in Huangpu District, Shanghai were selected. All students were archived for refractive development, including examinations such as visual acuity, non-cycloplegic autorefraction and axial length. The follow-up visit and related factor information were collected through questionnaire, and the influencing factors of referral rate were analyzed by multivariate Logistic regression. Results A total of 2 104 high-risk children and adolescents with suspected refractive abnormalities were suggested follow-up visit, and the actual referral rate was estimated to be 60.4%; the rate of referral to designated hospitals was estimated to be 58.8%. Non-conditional Logistic regression analysis showed that myopic status before the screening(OR=1.37, 95%CI=1.08-1.72), wearing spectacles or ortho contact lens(OR=2.05, 95%CI=1.62-2.59), myopic degree (OR_{below -0.5 D}=2.08, 95%CI=1.48-2.92, OR_{-3.0~-0.5 D}=1.86, 95%CI=1.47-2.36), parents' familiarity with screening results(OR=2.92, 95%CI=1.89-4.50), parents' satisfaction with suggestions after screening (OR=3.54, 95%CI=1.16-10.79) were significant factors associated with the referral rate(P < 0.05). Conclusion The actual referral rate among children and adolescents needs to be improved. It is necessary to further optimize the informatization of refractive archives, strengthen popular science education for key population, standardize the professional interpretation of preliminary screening refractive examination results, improve parents' awareness, participation and satisfaction through health education, and achieve the whole process management of refractive archives.
- Refractive errors /
- Regression analysis /
- 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 屈光筛查异常儿童青少年复诊的单因素分析

Table 1. Single factor analysis of subsequent visit among children and adolescents screened with abnormal refraction

因素	复诊组 (n=1 270)	未复诊组 (n=834)	χ²值	P值	因素	复诊组 (n=1 270)	未复诊组 (n=834)	χ²值	P值
父亲文化程度					是	913(71.9)	509(61.0)	60.19	< 0.01
小学及以下	9(0.7)	10(1.2)	15.14	0.01	否	320(25.2)	237(28.4)
初中	88(6.9)	73(8.8)			不清楚	37(2.9)	88(10.6)
高中或中专	225(17.7)	163(19.5)			筛查前是否已佩戴框架眼镜或角膜塑形镜
大专	296(23.3)	214(25.7)			是	591(46.5)	271(32.5)	41.04	< 0.01
本科	487(38.3)	303(36.3)			否	679(53.5)	563(67.5)
研究生及以上	165(13.0)	71(8.5)			初筛后近视度数/度
母亲文化程度					< 50	178(14.0)	112(13.4)	6.04	0.05
小学及以下	20(1.6)	23(2.8)	11.33	0.05	50~300	722(56.9)	437(52.4)
初中	118(9.3)	83(10.0)			>300	370(29.1)	285(34.2)
高中或中专	185(14.6)	143(17.1)			初筛检查结果家长是否知晓
大专	324(25.5)	228(27.3)			是	1 231(96.9)	736(88.2)	62.30	< 0.01
本科	520(40.9)	305(36.6)			否	39(3.1)	98(11.8)
研究生及以上	103(8.1)	52(6.2)			对屈光筛查项目是否满意
父亲是否近视					满意	1 258(99.1)	807(96.8)	14.54	< 0.01
是	727(57.2)	445(53.4)	3.08	0.08	不满意	12(0.9)	27(3.2)
否	543(42.8)	389(46.6)			屈光筛查结果反馈及时性是否满意
母亲是否近视					满意	1 265(99.6)	811(97.2)	21.43	< 0.01
是	743(58.5)	450(54.0)	4.24	0.04	不满意	5(0.4)	23(2.8)
否	527(41.5)	384(46.0)			屈光筛查的时间和次数安排是否满意
家庭年均收入/万元					满意	1 260(99.2)	813(97.5)	10.39	< 0.01
1~5	103(8.1)	66(7.9)	12.53	0.01	不满意	10(0.8)	21(2.5)
6~10	142(11.2)	108(12.9)			对复诊通知上的复诊建议是否满意
11~15	162(12.8)	144(17.3)			满意	1 264(99.5)	802(96.2)	32.13	< 0.01
16~20	223(17.6)	148(17.7)			不满意	6(0.5)	32(3.8)
≥21	640(50.4)	368(44.1)			安排指定的定点医院是否满意
孩子的医保形式					满意	1 221(96.1)	773(92.7)	12.13	< 0.01
上海城乡居民医保	1 130(89.0)	740(88.7)	0.21	0.90	不满意	49(3.9)	61(7.3)
其他医疗保险	72(5.7)	51(6.1)			安排的复诊时间是否满意
未参加	68(5.4)	43(5.2)			满意	1 245(98.0)	792(95.0)	15.36	< 0.01
筛查前是否已有近视					不满意	25(2.0)	42(5.0)
注：()内数字为构成比/%。

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表 2 屈光筛查异常儿童青少年转诊依从性多因素Logistic回归分析(n=2 104)

Table 2. Logistic regression results of factors associated with referral adherence in children with non-normal screening refractive error(n=2 104)

常数项与自变量	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
常数项	-0.87	0.35	6.26	0.01	0.42
筛查前已有近视	0.31	0.12	6.98	0.01	1.37(1.08~1.72)
筛查前已佩戴框架眼镜或角膜塑形镜	0.72	0.12	35.99	< 0.01	2.05(1.62~2.59)
近视度数/度 < 50	0.73	0.17	17.94	< 0.01	2.08(1.48~2.92)
50~300	0.62	0.12	26.73	< 0.01	1.86(1.47~2.36)
初筛结果知晓	1.07	0.22	23.45	< 0.01	2.92(1.89~4.50)
对复诊建议满意	1.27	0.57	4.96	0.03	3.54(1.16~10.79)
注：筛查前已有近视以“否/不清楚”为参照，筛查前已佩戴框架眼镜或角膜塑形镜以“否”为参照，近视度数范围以“>300度”为参照，初筛结果知晓和对复诊建议满意均以“否”为参照。

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