Analysis of epidemiological characteristics and influencing factors of scoliosis among middle school students in Tianjin
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摘要:
目的 了解天津市中学生脊柱侧弯发生率及影响因素, 为脊柱弯曲异常防治工作提供科学依据。 方法 分层整群随机抽取天津市62所中学(初中35所, 高中27所)21 679名中学生, 开展脊柱侧弯筛查并完成相关调查问卷。 结果 天津市中学生脊柱侧弯检出率为4.00%, 女生(5.13%)高于男生(2.94%), 职业高中(5.96%)高于普通高中(4.98%)和初中学生(3.00%), 差异均有统计学意义(χ2值分别为67.56, 71.46, P值均 < 0.01)。多因素Logistic回归分析结果显示, 性别、片区、学段、每周体育课节数、每天白天户外活动时长、过去1周≥60 min中高强度运动天数与脊柱侧弯的检出率有关(OR=0.12~1.95, P值均 < 0.05)。 结论 天津市中学生脊柱侧弯检出率在性别、片区、学段方面差异有统计学意义, 需要多关注女生、高中生和经济中等片区学校学生; 脊柱侧弯的预防应考虑运动时间和运动强度、运动方式的综合影响。 Abstract:Objective To understand the prevalence and influencing factors of scoliosis among middle school students in Tianjin, and to provide scientific basis for the prevention and treatment of scoliosis. Methods Based on stratified cluster random sampling method, 21 679 middle school students from 62 middle schools (35 middle schools and 27 high schools) in Tianjin were selected for scoliosis screening and completed relevant questionnaires. Results The prevalence of scoliosis in middle school students in Tianjin was 4.00%, with girls (5.13%) higher than that in boys (2.94%), vocational high school (5.96%) higher than that in ordinary senior high school (4.98%) and junior high school (3.00%), the differences were statistically significant (χ2=67.56, 71.46, P < 0.01).Multivariate Logistic regression showed that gender, district, school segment, number of physical educaiotn (PE) classes per week, outdoor activity time per day, and days of 60 minutes or more of moderate and vigorous exercise per day in a week were related to the detection rate of scoliosis (OR=0.12-1.95, P < 0.05). Conclusion The detection rate of scoliosis among middle school students in Tianjin varies in gender, resident area and school level, so more attention should be paid to girls, high school students and students in middle economic area.Comprehensive efforts should incorporate duration, intensity and type of physical exercise. -
Key words:
- Scoliosis /
- Epidemiologic studies /
- Regression analysis /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 不同组别中学生脊柱侧弯检出率比较
Table 1. Comparision of the detection rates of scoliosis of different groups
组别 选项 人数 检出人数 χ2值 P值 城郊 城区 12 502 488(3.90) 0.78 0.38 郊县 9 177 380(4.14) 片区 好片 10 884 465(4.27) 22.51 < 0.01 中片 5 770 259(4.49) 差片 5 025 144(2.87) 年龄/岁 11~ < 14 6 831 197(2.88) 33.44 < 0.01 14~ < 17 10 798 498(4.61) 17~≤21 4 050 173(4.27) 学段 初中 11 787 354(3.00) 71.46 < 0.01 普通高中 7 746 386(4.98) 职业高中 2 146 128(5.96) 性别 男 11 129 327(2.94) 67.56 < 0.01 女 10 550 541(5.13) 注: ()内数字为检出率/%。 表 2 天津市中学生脊柱侧弯单因素分析
Table 2. Univariate analysis of the detection rates of scoliosis in different groups in Tianjin
因素 选项 人数 检出人数 χ2值 P值 每周体育课节数/节 0~2 2 462 70(2.84) 47.29 < 0.01 3~4 9 473 487(5.14) ≥5 9 101 309(3.40) 每天白天户外活动时长/h < 1 4 861 202(4.16) 12.37 0.01 1~ < 2 8 455 289(3.42) 2~ < 3 3 244 117(3.61) ≥3 4 053 187(4.61) 每天静坐时间/h < 10 16 290 662(4.06) 0.92 0.34 ≥10 3 320 147(4.43) 过去1周≥60 min中高强度 0~2 5 928 278(4.69) 24.76 < 0.01 运动天数/d 3~5 6 501 304(4.68) 6~7 8 614 284(3.30) 是否使用双肩背包 是 20 868 836(4.01) 0.16 0.69 否 744 32(4.30) 与脊柱弯曲相关的读写姿势 良好 9 732 393(4.04) 0.04 0.84 较差 11 927 475(3.98) 书包重量 轻 352 14(3.98) 1.62 0.45 中 13 893 557(4.01) 重 5 206 230(4.42) 注:所有变量均有缺失值;()内数字为检出率/%。 表 3 天津市中学生脊柱侧弯影响因素的多因素Logistic回归分析(n=21 679)
Table 3. Multivariate Logistic regression analysis of the influe- ncing factors of scoliosis in middle school students in Tianjin (n=21 679)
自变量 选项 β值 标准误 Wald χ2值 P值 OR值(OR值95%CI) 性别 女 0.52 0.08 46.27 < 0.01 1.68(1.44~1.95) 片区 中片 -1.37 0.25 30.27 < 0.01 0.25(0.16~0.41) 差片 -2.11 0.28 59.05 < 0.01 0.12(0.07~0.21) 学段 普通高中 0.50 0.11 19.70 < 0.01 1.65(1.32~2.07) 职业高中 0.67 0.14 21.92 < 0.01 1.95(1.47~2.58) 每周体育课 3~4 0.40 0.14 7.89 0.01 1.49(1.13~1.97) 节数/节 ≥5 0.40 0.15 6.77 0.01 1.49(1.10~2.01) 每天白天户外活动 1~ < 2 -0.20 0.09 4.60 < 0.05 0.82(0.68~0.98) 时长/h 2~ < 3 -0.12 0.12 1.06 0.30 0.88(0.70~1.12) ≥3 0.13 0.11 1.44 0.23 1.13(0.92~1.39) 过去1周≥60 min 3~5 -0.05 0.09 0.35 0.56 0.95(0.80~1.13) 中高强度运动 6~7 -0.22 0.09 5.54 < 0.05 0.80(0.67~0.96) 天数/d -
[1] CHENG J C, CASTELEIN R M, CHU W C, et al. Adolescent idiopathic scoliosis[J]. Nat Rev Dis Primers, 2015, 1: 15030. doi: 10.1038/nrdp.2015.30 [2] KONIECZNY M R, SENYURT H, KRAVSPE R, et al. Epidemiology of adolescent idiopathic scoliosis[J]. J Child Orthop, 2013, 7(1): 3-9. doi: 10.1007/s11832-012-0457-4 [3] ZHANG H, GUO C, TANG M, et al. Prevalence of scoliosis among primary and middle school students in Mainland China: a systematic review and Meta-analysis[J]. Spine, 2015, 40(1): 41-49. doi: 10.1097/BRS.0000000000000664 [4] 儿童青少年脊柱弯曲异常防控技术指南编写组. 《儿童青少年脊柱弯曲异常防控技术指南》解读[J]. 中国学校卫生, 2022, 43(2): 165-170, 175. doi: 10.16835/j.cnki.1000-9817.2022.02.002Expert Group of Editorial Committee of Technical Guide for Prevention and Control of Abnormal Spinal Curvature in Chinese Children and Adolescents. Interpretation of Technical Guide for Prevention and Control of Abnormal Spinal Curvature in Children and Adolescents[J]. Chin J Sch Health, 2022, 43(2): 165-170, 175. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2022.02.002 [5] 蒋志成, 徐慧琼, 万宇辉, 等. 儿童青少年脊柱弯曲异常筛查研究进展[J]. 中国学校卫生, 2021, 42(2): 312-315, 320. doi: 10.16835/j.cnki.1000-9817.2021.02.037JIANG Z C, XU H Q, WAN Y H, et al. Research progress of screening for vertebral column defects in children and adolescents[J]. Chin J Sch Health, 2021, 42(2): 312-315, 320. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.02.037 [6] MITSIAKI I, THIRIOS A, PANAGOULI E, et al. Adolescent idiopathic scoliosis and mental health disorders: a narrative review of the literature[J]. Children (Basel, Switzerland), 2022, 9(5): 597. [7] 天津市统计局, 国家统计局天津调查总队. 天津统计年鉴各区主要经济指标(2020)[M]. 北京: 中国统计出版社, 2020.Tianjin Bureau of Statistics, Tianjin Investigation Team of National Bureau of Statistics. Tianjin statistical yearbook main economic indicators of each district(2020)[M]. Beijing: China Statistics Press, 2020. (in Chinese) [8] 国家卫生和计划生育委员会. 儿童青少年脊柱弯曲异常的筛查: GB/T 16133—2014[S]. 2015-01-01.National Health and Family Planning Commission of the PRC. Screening of spinal curvature abnormality of children and adolescents: GB/T 16133-2014[S]. 2015-01-01. (in Chinese) [9] 亓德云, 李丽平, 江艳微, 等. 上海市虹口区儿童青少年脊柱弯曲异常现状及影响因素分析[J]. 中国学校卫生, 2021, 42(3): 444-447, 453. doi: 10.16835/j.cnki.1000-9817.2021.03.030QI D Y, LI L P, JIANG Y W, et al. Abnormal spinal curvature and influencing factors in children and adolescents in Hongkou District, Shanghai[J]. Chin J Sch Health, 2021, 42(3): 444-447, 453. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.03.030 [10] 孙艺, 刘伟佳, 熊莉华, 等. 广州市中学生脊柱侧弯现状及影响因素分析[J]. 中国学校卫生, 2021, 42(12): 1865-1870, 1873. doi: 10.16835/j.cnki.1000-9817.2021.12.026SUN Y, LIU W J, XIONG L H, et al, Scoliosis and associated factors among middle school students in Guangzhou City[J]. Chin J Sch Health, 2021, 42(12): 1865-1870, 1873. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.12.026 [11] 杜建业, 蔡史健, 马志发, 等. 广东省汕头市12881名初中生脊柱侧凸调查分析[J]. 中国基层医药, 2018, 25(15): 1976-1979. doi: 10.3760/cma.j.issn.1008-6706.2018.15.019DU J Y, CAI S J, MA Z F, et al. Survey analysis of idiopathic scoliosis in 12881 junior middle school students from Shantou City, Guangdong Province[J]. Chin J Primary Med Pharmacy, 2018, 25(15): 1976-1979. (in Chinese) doi: 10.3760/cma.j.issn.1008-6706.2018.15.019 [12] 邓万霞, 张金枝, 汪雪洋, 等. 襄阳市区中小学生脊柱弯曲异常现状及影响因素分析[J]. 中国校医, 2016, 30(4): 285-287. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201604025.htmDENG W X, ZHANG J Z, WANG X Y, et al. Abnormal spinal curvature situation and influencing factors in schoolchildren in Xiangyang City[J]. Chin J School Doctor, 2016, 30(4): 285-287. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201604025.htm [13] 邱贵兴, 庄乾宇. 青少年特发性脊柱侧弯的流行病学研究进展[J]. 中华医学杂志, 2006, 86(11): 790-792. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYX200611023.htmQIU G X, ZHUANG Q Y. Advances in epidemiological research on idiopathic scoliosis in adolescents[J]. Nat Med J China, 2006, 86(11): 790-792. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYX200611023.htm [14] 崔明星. 青少年特发性脊柱侧弯病因学研究现状[J]. 广西医科大学学报, 2013, 30(2): 326-328. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD201302063.htmCUI M X. Research status of etiology of adolescent idiopathic scoliosis[J]. J Guangxi Med Univ, 2013, 30(2): 326-328. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD201302063.htm [15] BURWELL R G, AUJLA R K, GREVITT M P, et al. Pathogenesis of adolescent idiopathic scoliosis in girls: a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with imlications for medical therapy[J]. Scoliosis, 2009, 4: 24. [16] NEGRINI S, FUSCO C, MINOZZI S, et al. Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature[J]. Disabil Rehabil, 2008, 30(10): 772-785. [17] KENANIDIS E, POTOUPNIS M E, PAPAVASILIOU K A, et al. Adolescent idiopathic scoliosis and exercising: is there truly a liaison?[J]. Spine, 2008, 33(20): 2160-2165. [18] GHANEM I, RIZKALLAH M. Adolescent idiopathic scoliosis for the primary care physician: frequently asked questions[J]. Curr Opin Pediatr, 2019, 31(1): 48-53. [19] TAHIRBEGOLLI B, OBERTINCA R, BYTYQI A, et al. Factors affecting the prevalence of idiopathic scoliosis among children aged 8-15 years in Prishtina, Kosovo[J]. Sci Rep, 2021, 11(1): 1-7. [20] TOBIAS J H, FAIRBANK J, HARDING I, et al. Association between physical activity and scoliosis: a prospective cohort study[J]. Int J Epidemiol, 2019, 48(4): 1152-1160. [21] FAN Y, REN Q, TO M K T, et al. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review[J]. BMC Musculoskelet Disord, 2020, 21(1): 495. [22] LAITA L C, KINESIOLOGISTA C T C, KINESIOLOGISTB T M G, et al. Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis: a systematic review[J]. Arch Argent Pediatr, 2018, 116(4): 582-589. [23] GELALIS I D, RISTANIS S, NIKOLOPOULOS A, et al. Loading rate patterns in scoliotic children during gait: the impact of the schoolbag carriage and the importance of its position[J]. Eur Spine J, 2012, 21(10): 1936-1941. [24] AMENDT L E, AUSE-ELLIAS K L, EYBERS J L, et al. Validity and reliability testing of the Scoliometer[J]. Phys Ther, 1990, 70(2): 108-117. [25] KOMANG-AGUNG I, DWI-PURNOMO S, SUSILOWATI A. Prevalence rate of adolescent idiopathic scoliosis: results of school-based screening in Surabaya, Indonesia[J]. Malays Orthop J, 2017, 11(3): 17-22. [26] YILMAZ H, ZATERI C, OZKAN A K, et al. Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study[J]. Spine J, 2020, 20(6): 947-955. -

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