河南省中小学生2019—2020年近视队列研究结果

徐李莎; 黄烨; 吴汶灿; 班晓蕾; 娄晓民; 王重建; 王鲜

doi:10.16835/j.cnki.1000-9817.2023.12.012

河南省中小学生2019—2020年近视队列研究结果

doi: 10.16835/j.cnki.1000-9817.2023.12.012

徐李莎^{1, 2},
黄烨^{1, 2},
吴汶灿¹,
班晓蕾¹,
娄晓民¹,
王重建¹,
王鲜^1, ,

1.
郑州大学公共卫生学院, 河南 450001
2.
浙江大学公共卫生学院

基金项目:

国家自然科学基金青年基金项目 82003478

郑州大学校级教学改革类项目 2022ZZUJG264

详细信息

作者简介:
徐李莎(1998-)，女，江西鹰潭人，在读硕士，主要研究方向为慢性病的预防控制

通讯作者:
王鲜，E-mail：wangxian@zzu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R778.1⁺¹ R179 R193
计量
- 文章访问数: 491
- HTML全文浏览量: 268
- PDF下载量: 95
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-19
- 修回日期: 2023-09-16
- 网络出版日期: 2023-12-26
- 刊出日期: 2023-12-25

Analysis of a cohort study on myopia among primary and secondary school students in Henan Province, 2019-2020

XU Lisha^{1, 2},
HUANG Ye^{1, 2},
WU Wencan¹,
BAN Xiaolei¹,
LOU Xiaomin¹,
WANG Chongjian¹,
WANG Xian^{1
, ,}

1.
College of Public Health, Zhengzhou University, Zhengzhou (450001), Henan Province, China

摘要

摘要: 目的追踪调查新型冠状病毒感染疫情期间河南省中小学生的视力变化情况, 为近视的防控提供理论依据。方法基于队列研究设计, 于2019年9月采用多阶段随机整群抽样, 对河南省郑州、新乡、周口和平顶山4座城市2 222名小学至高中学生进行视力检测, 并在2020年6月对其进行随访, 现场开展视力检测和问卷调查。采用Wilcoxon和Kruskal-Wallis秩和检验、χ²检验、单因素方差分析、多重线性回归分析河南省中小学生2019-2020年的视力变化及其影响因素。结果相比2019年, 2020年学生总体近视率有所增长, 差异有统计学意义(55.7%, 64.9%, χ²=1 035.91, P < 0.01), 轻、中、重度近视率2年差异均有统计学意义(2019年: 32.4%, 18.8%, 4.4%;2020年: 36.7%, 22.5%, 5.7%, χ²值分别为8.43, 9.23, 3.94, P值均 < 0.05);2020年中小学生近视发病率为28.3%。多重线性回归分析显示, 初中、小学四至六年级、小学一至三年级、地区经济水平低、使用电视上网课、休息时不看远方、晴天时学习桌桌面的亮度一般、晚上学习时只使用屋顶灯与学生近视进展有关(B值分别为-0.16, -0.18, -0.20, -0.06, -0.21, -0.13, -0.11, -0.40, P值均 < 0.05)。结论河南省2019-2020年中小学生视力向近视方向进展, 且近视进展受教育阶段、经济水平、用眼习惯、用眼环境等因素综合影响。应积极干预并强化近视防控, 改善中小学生用眼环境, 以减缓近视发展。
- 近视 /
- 患病率 /
- 队列研究 /
- 回归分析 /
- 学生
Abstract: Objective To track and investigate the changes in visual acuity of primary and secondary school students in Henan Province during the COVID-19 pandemic home confinement, so as to provide theoretical basis for the prevention and control of myopia. Methods A cohort study design was employed for this research.In September 2019, visual acuity tests were conducted among 2 222 primary and secondary school students by Multi-stage random cluster sampling method from four cities in Henan Province, including Zhengzhou, Xinxiang, Zhoukou, and Pingdingshan.A follow-up study was conducted in June 2020, with on-site visual acuity tests and questionnaire surveys.Wilcoxon rank sum test, Kruskal-Wallis rank sum test, Chi-square test, one-way analysis of variance, and multiple linear regression model were used to analyze the changes in visual acuity of primary and secondary school students and the influencing factors from 2019 to 2020. Results Compared with 2019, the overall myopia rate of students increased in 2020, and the difference was statistically significant (55.7%, 64.9%, χ²=1 035.91, P < 0.01), and the difference between mild, moderate and severe myopia rates occurred at 2 years (2019:32.4%, 18.8%, 4.4%, 2020:36.7%, 22.5%, 5.7%, χ²=8.43, 9.23, 3.94, P < 0.05).The myopia incidence rate of primary and secondary school students in 2020 was 28.3%.As presented in multiple linear regression analysis, middle school, grade 4th-6th and grade 1st-3rd of primary school, low economic level, using television for online classes, the study desk being not bright on sunny days, without looking far away during breaks, the brightness of the study desk and desktop which was average on sunny days, and using roof lamp only when studying at night were associated with myopia progression among students (B=-0.16, -0.18, -0.20, -0.06, -0.21, -0.13, -0.11, -0.40, P < 0.05). Conclusions During 2019-2020, primary and secondary school students in Henan Province experience a progression towards myopia, which is comprehensively influenced by education stage, economic level, the habit of using eyes, and visual environment.Myopia prevention and control should be actively intervened and strengthened to improve the eye environment for primary and secondary school students, in order to slow down the development of myopia.Myopia; Prevalence; Cohort studies; Regression analysis; Students
- Myopia /
- Prevalence /
- Cohort studies /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同人口学特征中小学生近视率比较

Table 1. Comparison of rates of myopia among primary and secondary school students with different characteristics

人口学指标	选项	人数	2019年			2020年
人口学指标	选项	人数	近视人数	χ²值	P值	近视人数	χ²值	P值
性别	男	1 104	575(52.1)	11.44	< 0.01	670(60.7)^**	17.06	< 0.01
	女	1 118	662(59.2)			772(69.1)^**
教育阶段	小学一至三年级	661	147(22.2)	562.27	< 0.01	254(38.4)^**	366.02	< 0.01
	小学四至六年级	663	352(53.1)			423(63.8)^**
	初中	442	346(78.3)			375(84.8)^*
	高中	456	392(86.0)			390(85.5)
城乡	城市	1 158	624(53.9)	3.12	0.08	723(62.4)^**	6.43	0.01
	农村	1 064	613(57.6)			719(67.6)^**
地区经济水平	高	659	386(58.6)	12.74	< 0.01	425(64.5)^*	0.78	0.68
	中	508	305(60.0)			338(66.5)^*
	低	1 055	546(51.8)			679(64.4)^**
父母近视	都不近视	1 313	684(52.1)	25.29	< 0.01	796(60.6)^**	30.38	< 0.01
	父亲近视	317	202(63.7)			228(71.9)^*
	母亲近视	357	196(54.9)			240(67.2)^**
	都近视	235	155(66.0)			178(75.7)^*
合计		2 222	1 237(55.7)			1 442(64.9)^**
注： ()内数字为检出率/%；与2019年比较，P < 0.05，*P < 0.01。

下载: 导出CSV

表 2 不同人口学特征中小学生2020年近视发病率比较(n=985)

Table 2. Comparison of incidence of myopia among primary and secondary school students with different characteristics in 2020(n=985)

人口学指标	人数	发病人数	χ²值	P值
性别
男	529	135(25.5)	4.14	0.04
女	456	144(31.6)
教育阶段
小学一至三年级	514	137(26.7)	8.91	0.03
小学四至六年级	311	93(29.9)
初中	96	37(38.5)
高中	64	12(18.8)
城乡
城市	534	139(26.0)	2.78	0.09
农村	451	140(31.0)
地区经济水平
高	273	62(22.7)	7.47	0.02
中	203	55(27.1)
低	509	162(31.8)
父母近视
都不近视	629	159(25.3)	8.44	0.04
父亲近视	115	36(31.3)
母亲近视	161	56(34.8)
都近视	80	28(35.0)
注： ()内数字为发病率/%。

下载: 导出CSV

表 3 不同人口学特征中小学生SE变化[M(P₂₅, P₇₅), D]

Table 3. Changes of the spherical equivalent (SE) among primary and secondary school students in different characteristics[M(P₂₅, P₇₅), D]

人口学指标	2019年	2020年	Z值	P值
性别
男	-1.00(-2.63, -0.13)	-1.38(-3.12, -0.44)	26.83	< 0.01
女	-1.25(-2.88, -0.25)	-1.65(-3.25, -0.63)	26.27	< 0.01
教育阶段
小学一至三年级	-0.13(-0.63, 0.25)	-0.50(-1.25, 0.00)	35.53	< 0.01
小学四至六年级	-0.88(-2.00, -0.25)	-1.38(-2.50, -0.59)	35.44	< 0.01
初中	-2.13(-3.50, -1.00)	-2.50(-4.12, -1.38)	38.54	< 0.01
高中	-3.25(-5.00, -1.84)	-3.50(-5.25, -1.88)	38.82	< 0.01
城乡
城市	-1.00(-2.75, -0.13)	-1.50(-3.13, -0.50)	25.26	< 0.01
农村	-1.13(-2.75, -0.25)	-1.63(-3.25, -0.50)	27.79	< 0.01
经济水平
高	-1.00(-2.50, -0.13)	-1.25(-3.13, -0.25)	36.32	< 0.01
中等	-1.25(-3.00, -0.38)	-1.75(-3.41, -0.63)	38.12	< 0.01
低	-1.00(-2.50, -0.13)	-1.63(-3.16, -0.62)	26.57	< 0.01
父母近视
都不近视	-1.00(-2.50, -0.13)	-1.50(-2.94, -0.50)	21.48	< 0.01
父亲近视	-1.38(-3.50, -0.25)	-2.00(-3.75, -0.75)	40.14	< 0.01
母亲近视	-1.38(-3.25, -0.25)	-1.81(-3.63, -0.63)	39.60	< 0.01
都近视	-0.88(-2.63, -0.25)	-1.50(-3.00, -0.50)	39.31	< 0.01
合计	-1.13(-2.75, -0.13)	-1.50(-3.25, -0.50)	16.26	< 0.01

下载: 导出CSV

表 4 中小学生2019年SE变化多重线性回归分析

Table 4. Multiple linear regression analysis of factors related to the change of SE among primary and secondary school students in 2019

自变量	合计(n=2 222)			近视学生(n=1 237)			不近视学生(n=985)
自变量	B值(95%CI)	t值	P值	B值(95%CI)	t值	P值	B值(95%CI)	t值	P值
教育阶段
初中	-0.16(-0.30~-0.02)	-2.29	0.02	-0.20(-0.36~-0.04)	-2.47	0.01	-0.02(-0.32~0.29)	-0.10	0.92
小学四至六年级	-0.18(-0.31~-0.05)	-2.71	< 0.01	-0.20(-0.36~-0.03)	-2.31	0.02	-0.15(-0.41~0.12)	-1.09	0.28
小学一至三年级	-0.20(-0.34~-0.06)	-2.83	< 0.01	-0.24(-0.47~-0.02)	-2.10	0.04	-0.13(-0.40~0.13)	-0.97	0.33
地区经济水平
中	-0.01(-0.07~0.05)	-0.31	0.76	-0.00(-0.08~0.09)	0.05	0.96	-0.02(-0.11~0.07)	-0.51	0.61
低	-0.06(-0.10~-0.02)	-2.99	< 0.01	-0.08(-0.14~-0.03)	-3.01	< 0.01	-0.02(-0.08~0.03)	-0.91	0.37
上网课的工具
平板电脑	-0.08(-0.22~0.05)	-1.20	0.23	-0.12(-0.31~0.07)	-1.26	0.21	-0.05(-0.24~0.14)	-0.52	0.61
智能手机	-0.10(-0.21~0.01)	-1.80	0.07	-0.11(-0.26~0.04)	-1.44	0.15	-0.09(-0.25~0.08)	-1.00	0.32
电视	-0.21(-0.37~-0.05)	-2.53	0.01	-0.32(-0.59~-0.05)	-2.31	0.02	-0.14(-0.34~0.06)	-1.36	0.18
投影仪	0.03(-0.62~0.67)	0.08	0.94	-0.49(-1.45~0.48)	-0.99	0.32	0.57(-0.28~1.42)	1.31	0.19
休息时是否看远方
否	-0.13(-0.22~-0.03)	-2.68	0.01	-0.12(-0.25~0.00)	-1.91	0.06	-0.13(-0.28~0.01)	-1.80	0.07
不正确的读写姿势
偶尔	-0.03(-0.17~0.11)	-0.45	0.66	0.02(-0.16~0.20)	0.17	0.86	-0.11(-0.33~0.10)	-1.03	0.30
经常	-0.06(-0.20~0.08)	-0.82	0.41	0.04(-0.15~0.23)	0.45	0.65	-0.22(-0.43~-0.01)	-2.04	0.04
晴天时学习桌桌面的亮度
一般明亮	-0.11(-0.21~-0.02)	-2.34	0.02	-0.20(-0.33~-0.07)	-2.96	< 0.01	0.02(-0.12~0.15)	0.22	0.83
很暗	0.22(-0.33~0.76)	0.79	0.43	0.13(-0.68~0.94)	0.31	0.76	0.30(-0.42~1.01)	0.82	0.41
晚上学习时使用的灯光
使用台灯	-0.15(-0.31~0.02)	-1.77	0.08	-0.19(-0.41~0.05)	-1.52	0.13	-0.11(-0.33~0.11)	-0.98	0.33
使用屋顶灯	-0.40(-0.53~-0.26)	-5.80	< 0.01	-0.29(-0.48~-0.10)	-3.00	< 0.01	-0.53(-0.72~-0.35)	-5.59	< 0.01

下载: 导出CSV

参考文献(30)

[1]	WONG K, DAHLMANN-NOOR A. Myopia and its progression in children in London, UK: a retrospective evaluation[J]. J Optom, 2020, 13(3): 146-154. doi: 10.1016/j.optom.2019.06.002
[2]	TSAI T H, LIU Y L, MA I H, et al. Evolution of the prevalence of myopia among Taiwanese schoolchildren: a review of survey data from 1983 through 2017[J]. Ophthalmology, 2021, 128(2): 290-301. doi: 10.1016/j.ophtha.2020.07.017
[3]	MORGAN I G, FRENCH A N, ASHBY R S, et al. The epidemics of myopia: aetiology and prevention[J]. Prog Retin Eye Res, 2018, 62: 134-149. doi: 10.1016/j.preteyeres.2017.09.004
[4]	CHEN M, WU A, ZHANG L, et al. The increasing prevalence of myopia and high myopia among high school students in Fenghua City, eastern China: a 15-year population-based survey[J]. BMC Ophthalmol, 2018, 18(1): 159. doi: 10.1186/s12886-018-0829-8
[5]	HOLDEN B A, FRICKE T R, WILSON D A, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050[J]. Ophthalmology, 2016, 123(5): 1036-1042. doi: 10.1016/j.ophtha.2016.01.006
[6]	HAARMAN A E G, ENTHOVEN C A, TIDEMAN J W L, et al. The complications of myopia: a review and Meta-analysis[J]. Invest Ophthalmol Vis Sci, 2020, 61(4): 49. doi: 10.1167/iovs.61.4.49
[7]	LI Q, YANG J, HE Y, et al. Investigation of the psychological health of first-year high school students with myopia in Guangzhou[J]. Brain Behav, 2020, 10(4): e01594. doi: 10.1002/brb3.1594
[8]	NAIDOO K S, FRICKE T R, FRICK K D, et al. Potential lost productivity resulting from the global burden of myopia: systematic review, Meta-analysis, and modeling[J]. Ophthalmology, 2019, 126(3): 338-346. doi: 10.1016/j.ophtha.2018.10.029
[9]	SUMITHA M, SANJAY S, KEMMANU V, et al. Will COVID-19 pandemic-associated lockdown increase myopia in Indian children?[J]. Indian J Ophthalmol, 2020, 68(7): 1496.
[10]	PELLEGRINI M, BERNABEI F, SCORCIA V, et al. May home confinement during the COVID-19 outbreak worsen the global burden of myopia?[J]. Graefes Arch Clin Exp Ophthalmol, 2020, 258(9): 2069-2070. doi: 10.1007/s00417-020-04728-2
[11]	马军. 第八次全国学生体质与健康调研精准科学实施及重要意义[J]. 中国学校卫生, 2021, 42(9): 1283-1284, 1287. doi: 10.16835/j.cnki.1000-9817.2021.09.002 MA J. Accurate and scientific implementation and significance of the Eighth National Survey on Students Physical Fitness and Health[J]. Chin J Sch Health, 2021, 42(9): 1283-1284, 1287. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.09.002
[12]	河南省统计局. 河南统计年鉴(2020)[EB/OL]. (2021-01-20)[2021-11-27]. http://oss.henan.gov.cn/sbgt-wztipt/attachment/hntjj/hntj/lib/tjnj/2020nj/zk/indexch.htm. Henan Provincial Bureau of Statistics. Henan Statistical Yearbook (2020)[EB/OL]. (2021-01-20)[2021-11-27]. http://oss.henan.gov.cn/sbgt-wztipt/attachment/hntjj/hntj/lib/tjnj/2020nj/zk/indexch.htm. (in Chinese)
[13]	LEONE J F, MITCHELL P, MORGAN I G. Use of visual acuity to screen for significant refractive errors in adolescents: is it reliable?[J]. Arch Ophthalmol, 2010, 128(7): 894-899. doi: 10.1001/archophthalmol.2010.134
[14]	BAIRD P N, SAW S M, LANCA C, et al. Myopia[J]. Nat Rev Dis Primers, 2020, 6(1): 99. doi: 10.1038/s41572-020-00231-4
[15]	中华人民共和国国家卫生健康委办公厅印发《儿童青少年近视防控适宜技术指南》[J]. 中国眼镜科技杂志, 2019(11): 12-15. Guidelines for Appropriate Techniques for Myopia Prevention and Control in Children and Adolescents issued by the General Office of the National Health Commission ot the PRC[J]. Chin Glasses Sci-Technol Magaz, 2019(11): 12-15. (in Chinese)
[16]	FLITCROFT D I, HE M, JONAS J B, et al. IMI-Defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): M20-M30. doi: 10.1167/iovs.18-25957
[17]	钟盼亮, 刘云飞, 马宁, 等. 中国9个省(自治区、直辖市)小学生户外时间对近视发生影响的队列研究[J]. 中华流行病学杂志, 2022, 43(7): 1099-1106. ZHONG P L, LIU Y F, MA N, et al. Effect of outdoor time on the incidence of myopia among primary school students in 9 provinces of China[J]. Chin J Epidemiol, 2022, 43(7): 1099-1106. (in Chinese)
[18]	吴晶, 李廷洲, 葛亮. 近视!近视!为了下一代健康成长基础教育亟须回应五大关注(三)[N]. 中国青年报, 2021-02-22(8). WU J, LI T Z, GE L. Myopia!myopia! In order for the healthy growth of the next generation, the basic education urgently needs to respond to five concerns (3)[N]. China Youth Daily, 2021-02-22(8). (in Chinese)
[19]	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
[20]	GORDON R A, DONZIS P B. Refractive development of the human eye[J]. Arch Ophthalmol, 1985, 103(6): 785-789. doi: 10.1001/archopht.1985.01050060045020
[21]	LI S M, LI S Y, KANG M T, et al. Distribution of ocular biometry in 7-and 14-year-old Chinese children[J]. Optom Vis Sci, 2015, 92(5): 566-572. doi: 10.1097/OPX.0000000000000570
[22]	WANG J, LI Y, MUSCH D C, et al. Progression of myopia in school-aged children after COVID-19 home confinement[J]. JAMA Ophthalmol, 2021, 139(3): 293-300. doi: 10.1001/jamaophthalmol.2020.6239
[23]	LIU J, LI B, SUN Y, et al. Adolescent vision health during the outbreak of COVID-19: association between digital screen use and myopia progression[J]. Front Pediatr, 2021, 9: 662984. doi: 10.3389/fped.2021.662984
[24]	周佳, 马迎华, 马军, 等. 中国6省市中小学生近视流行现状及其影响因素分析[J]. 中华流行病学杂志, 2016, 37(1): 29-34. ZHOU J, MA Y H, MA J, et al. Prevalence of myopia and influencing factors among primary and middle school students in 6 provinces of China[J]. Chin J Epidemiol, 2016, 37(1): 29-34. (in Chinese)
[25]	LIU S, YE S, XI W, et al. Electronic devices and myopic refraction among children aged 6-14 years in urban areas of Tianjin, China[J]. Ophthalmic Physiol Opt, 2019, 39(4): 282-293. doi: 10.1111/opo.12620
[26]	陶然, 王政和, 董彬, 等. 观看不同屏幕对学生视力不良的影响[J]. 中国学校卫生, 2019, 40(9): 1369-1372. doi: 10.16835/j.cnki.1000-9817.2019.09.025 TAO R, WANG Z H, DONG B, et al. Effects of watching different screens on students' visual acuity[J]. Chin J Sch Health, 2019, 40(9): 1369-1372. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.09.025
[27]	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 G X, 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. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.02.007
[28]	SPILLMANN L. Stopping the rise of myopia in Asia[J]. Graefes Arch Clin Exp Ophthalmol, 2020, 258(5): 943-959. doi: 10.1007/s00417-019-04555-0
[29]	FELDKAEMPER M, DIETHER S, KLEINE G, et al. Interactions of spatial and luminance information in the retina of chickens during myopia development[J]. Exp Eye Res, 1999, 68(1): 105-115. doi: 10.1006/exer.1998.0590
[30]	HUA W J, JIN J X, WU X Y, et al. Elevated light levels in schools have a protective effect on myopia[J]. Ophthalmic Physiol Opt, 2015, 35(3): 252-262. doi: 10.1111/opo.12207