A multilevel model analysis of the association between reading and writing posture with myopia in primary and secondary school students
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摘要:
目的 探讨中国儿童青少年读写姿势与近视的关联，为减少中小学生近视的发生提供参考。 方法 于2020年11月—2022年6月采用多阶段分层整群概率抽样方法选取北京市、浙江省、重庆市、陕西省、辽宁省、河南省6个省(市)的中小学生为研究对象，收取完成按照《儿童青少年近视筛查规范》进行睫状肌麻痹验光检查及问卷调查的16 782名学生数据，分析中小学生读写姿势与近视之间的关联。 结果 中小学生近视总体检出率为45.7%，其中小学生35.0%，初中生84.1%，高中生90.4%；73.6%的中小学生存在读写姿势不良。调整性别、学段、区域、每天白天户外活动时间、父母是否近视等混杂因素，多水平Logistic回归结果显示，读写姿势不良(OR=1.17，95%CI=1.07~1.28)、从不/偶尔在读写时眼睛距离书本超过一尺(OR=1.28，95%CI=1.08~1.53；OR=1.23，95%CI=1.08~1.40)、老师偶尔提醒孩子注意读写姿势(OR=1.13，95%CI=1.01~1.25)、经常/总是趴着读书写字或脸放在手臂上(OR=1.15，95%CI=1.01~1.32；OR=1.46，95%CI=1.17~1.82)、总是用手托着头读书写字(OR=1.56，95%CI=1.20~2.01)与近视呈正相关，父母偶尔提醒孩子注意读写姿势(OR=0.85，95%CI=0.76~0.96)与近视呈负相关(P值均＜0.05)。 结论 读写姿势不良是中小学生近视患病的风险因素。需加强读写姿势的干预，以减少中小学生近视的发生。 Abstract:Objective To explore the association between reading and writing posture with the occurrence of myopia in Chinese children and adolescents, so as to provide a reference for reducing its prevalence among primary and secondary school students. Methods Using data from the 2020 survey on the current status of hyperopia reserve in primary and secondary school students from six provinces/cities, namely Beijing, Zhejiang, Chongqing, Shaanxi, Liaoning, and Henan selected by multi-stage stratified cluster probability sampling method during November 2020 to June 2022. A total 16 782 students who completed the optometry examination of cycloplegia according to the Children and Adolescents Myopia Screening Standard and questionnaire survey were included for analyzing analyze the association between reading and writing posture with myopia. Results The overall detection rate of myopia among primary and secondary school students was 45.7%, of which 35.0% were primary school students, 84.1% junior high school students, and 90.4% senior high school students. Poor reading and writing posture was found in 73.6% of primary and secondary school students. Adjusting for confounding factors such as gender, school period, region, outdoor time every day, and whether parents were myopic, the results of the multilevel Logistic regression showed that the following factors were positively correlated with myopia: poor reading and writing posture (OR=1.17, 95%CI=1.07-1.28), never/occasionally reading and writing with a reading distance which was more than one foot away between the eyes and book (OR=1.28, 95%CI=1.08-1.53, OR=1.23, 95%CI=1.08-1.40), teachers occasionally reminding the child of their reading and writing posture (OR=1.13, 95%CI=1.01-1.25), and often/always reading and writing while lying down or with the face on the arm (OR=1.15, 95%CI=1.01-1.32, OR=1.46, 95%CI=1.17-1.82), always reading and writing with the head in the hand (OR=1.56, 95%CI=1.20-2.01). Further, a negative correlation was detected between myopia and parents occasionally reminding their children of their reading and writing posture (OR=0.85, 95%CI=0.76-0.96) (P < 0.05). Conclusion Poor reading and writing posture is a risk factor for the development of myopia in primary and secondary school students, and interventions for reading and writing posture need to be strengthened to reduce the occurrence of myopia among primary and secondary school students. -
Key words:
- Reading /
- Handwriting /
- Myopia /
- Regression analysis /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 中国6省市不同组别中小学生近视检出率比较
Table 1. Comparison of myopia detection rates among different groups of primary and secondary school students in six provinces/citys of China
组别 选项 人数 近视人数 χ2值 P值 性别 男 8 396 3 730(44.4) 11.06 ＜0.01 女 8 386 3 940(47.0) 学段 小学 13 300 4 650(35.0) 2 993.87 ＜0.01 初中 2 040 1 716(84.1) 高中 1 442 1 304(90.4) 区域 东部 8 632 4 050(46.9) 153.85 ＜0.01 中部 3 043 1 612(53.0) 西部 5 107 2 008(39.3) 每天白天户外活动时间/h ＜1 3 298 1 632(49.5) 37.05 ＜0.01 1~＜2 5 811 2 621(45.1) 2~＜3 3 157 1 467(46.5) ≥3 3 244 1 434(44.2) 不知道 1 272 516(40.6) 每天睡眠时间 充足 2 834 1 278(45.1) 0.51 0.48 不足 13 948 6 392(45.8) 父母是否近视 只有父亲近视 2 357 1 059(44.9) 52.26 ＜0.01 只有母亲近视 3 355 1 497(44.6) 父母都近视 2 749 1 332(48.5) 父母都不近视 7 437 3 290(44.2) 不知道 884 492(55.7) 读写姿势判定 良好 4 423 2 023(45.7) 0.00 0.96 不良 12 359 5 647(45.7) 胸口离桌子边沿超过一拳 从不 1 437 684(47.6) 9.17 0.03 偶尔 8 643 3 909(45.2) 经常 4 675 2 100(44.9) 总是 2 027 977(48.2) 眼睛距离书本超过一尺 从不 1 283 620(48.3) 5.83 0.12 偶尔 8 845 4 046(45.7) 经常 4 848 2 167(44.7) 总是 1 806 837(46.3) 手指距离笔尖一寸左右 从不 1 458 720(49.4) 14.45 ＜0.01 偶尔 6 932 3 151(45.5) 经常 5 572 2 471(44.3) 总是 2 820 1 328(47.1) 趴着读书写字或脸放在 从不 6 810 2 798(41.1) 102.31 ＜0.01 手臂上 偶尔 7 295 3 545(48.6) 经常 2 078 1 049(50.5) 总是 599 278(46.4) 用手托着头读书写字 从不 7 393 2 930(39.6) 204.99 ＜0.01 偶尔 7 050 3 511(49.8) 经常 1 893 1 012(53.5) 总是 446 217(48.7) 臀部和大腿在椅面上，脚 从不 1 997 875(43.8) 3.48 0.32 平放在地或踏板上 偶尔 6 010 2 775(46.2) 经常 6 016 2 760(45.9) 总是 2 759 1 260(45.7) 老师是否提醒孩子注意 从不 1 097 654(59.6) 315.02 ＜0.01 读写姿势 偶尔 4 730 2 528(53.4) 经常 7 428 3 141(42.3) 总是 3 527 1 347(38.2) 父母是否提醒孩子注意 从不 526 324(61.6) 163.72 ＜0.01 读写姿势 偶尔 3 131 1 672(53.4) 经常 8 590 3 761(43.8) 总是 4 535 1 913(42.2) 注：()内数字为检出率/%。 
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表 2 中国6省市中小学生近视相关因素的Logistic回归分析(n=16 782)
Table 2. Logistic regression analysis of factors affecting myopia among primary and secondary school students in six provinces/citys of China (n=16 782)
自变量 选项 β值 OR值(95%CI) P值 性别 男 1.00 女 0.08 1.08(1.01~1.16) 0.03 学段 小学 -2.88 0.06(0.05~0.07) ＜0.01 初中 -0.53 0.59(0.47~0.73) ＜0.01 高中 1.00 区域 东部 0.48 1.62(1.50~1.76) ＜0.01 中部 0.52 1.68(1.51~1.87) ＜0.01 西部 1.00 每天白天户外活动 ＜1 1.00 时间/h 1~＜2 -0.13 0.88(0.80~0.97) 0.01 2~＜3 -0.05 0.95(0.85~1.06) 0.34 ≥3 -0.05 0.95(0.85~1.06) 0.39 不知道 -0.25 0.78(0.67~0.91) ＜0.01 父母是否近视 只有父亲近视 1.00 只有母亲近视 0.03 1.03(0.92~1.16) 0.60 父母都近视 0.28 1.32(1.17~1.49) ＜0.01 父母都不近视 -0.23 0.80(0.72~0.88) ＜0.01 不知道 0.37 1.45(1.21~1.74) ＜0.01 胸口离桌子边沿 从不 -0.17 0.84(0.71~1.00) 0.05 超过一拳 偶尔 -0.21 0.81(0.71~0.92) ＜0.01 经常 -0.22 0.80(0.70~0.92) ＜0.01 总是 1.00 手指距离笔尖 从不 0.09 1.09(0.93~1.28) 0.30 一寸左右 偶尔 -0.02 0.98(0.87~1.11) 0.76 经常 -0.08 0.92(0.82~1.04) 0.18 总是 1.00 趴着读书写字或脸 从不 1.00 放在手臂上 偶尔 0.06 1.07(0.98~1.17) 0.16 经常 0.16 1.17(1.01~1.36) 0.03 总是 0.18 1.19(0.92~1.54) 0.18 用手托着头读书写字 从不 1.00 偶尔 0.10 1.10(1.01~1.20) 0.04 经常 0.28 1.32(1.13~1.54) ＜0.01 总是 0.20 1.22(0.90~1.65) 0.20 老师是否提醒孩子 从不 0.18 1.20(0.99~1.46) 0.07 注意读写姿势 偶尔 0.32 1.38(1.21~1.57) ＜0.01 经常 0.19 1.21(1.08~1.36) ＜0.01 总是 1.00 父母是否提醒孩子 从不 -0.04 0.97(0.75~1.25) 0.79 注意读写姿势 偶尔 -0.17 0.84(0.74~0.96) 0.01 经常 -0.16 0.86(0.77~0.95) ＜0.01 总是 1.00
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表 3 中小学生读写姿势与近视关系的Logistic回归分析(n=16 782)
Table 3. Logistic regression analysis of the relationship between reading and writing posture and myopia among primary and secondary school students (n=16 782)
自变量 选项 参照组 模型1 模型2 β值 OR值(95%CI) P值 β值 OR值(95%CI) P值 读写姿势判定 不良 良好 0.05 1.05(0.97~1.14) 0.23 0.16 1.17(1.07~1.28) ＜0.01 胸口离桌子边沿超过一拳 从不 总是 -0.06 0.94(0.81~1.10) 0.44 0.09 1.09(0.92~1.29) 0.30 偶尔 -0.16 0.85(0.76~0.95) ＜0.01 0.10 1.11(0.98~1.25) 0.10 经常 -0.20 0.82(0.73~0.92) ＜0.01 -0.08 0.93(0.81~1.06) 0.25 眼睛距离书本超过一尺 从不 总是 0.06 1.06(0.90~1.24) 0.51 0.25 1.28(1.08~1.53) 0.01 偶尔 -0.05 0.96(0.85~1.07) 0.43 0.21 1.23(1.08~1.40) ＜0.01 经常 -0.15 0.86(0.76~0.97) 0.02 0.04 1.04(0.91~1.19) 0.60 手指距离笔尖一寸左右 从不 总是 0.06 1.07(0.92~1.23) 0.38 0.10 1.11(0.95~1.29) 0.21 偶尔 -0.04 0.96(0.87~1.06) 0.42 0.06 1.06(0.95~1.18) 0.32 经常 -0.13 0.88(0.79~0.97) ＜0.01 -0.03 0.98(0.87~1.09) 0.66 趴着读书写字或脸放在手臂上 偶尔 从不 0.10 1.11(1.03~1.19) 0.01 0.06 1.06(0.98~1.15) 0.15 经常 0.28 1.33(1.19~1.49) ＜0.01 0.14 1.15(1.01~1.32) 0.04 总是 0.34 1.40(1.16~1.69) ＜0.01 0.38 1.46(1.17~1.82) ＜0.01 用手托着头读书写字 偶尔 从不 0.12 1.13(1.05~1.22) ＜0.01 0.01 1.01(0.94~1.10) 0.73 经常 0.34 1.41(1.25~1.58) ＜0.01 0.14 1.15(0.99~1.33) 0.07 总是 0.36 1.44(1.16~1.79) ＜0.01 0.44 1.56(1.20~2.01) ＜0.01 老师是否提醒孩子注意读写姿势 从不 总是 0.08 1.09(0.92~1.28) 0.33 -0.05 0.95(0.80~1.14) 0.57 偶尔 0.17 1.19(1.08~1.31) ＜0.01 0.12 1.13(1.01~1.25) 0.04 经常 0.07 1.08(0.98~1.18) 0.11 0.10 1.10(1.00~1.22) 0.05 父母是否提醒孩子注意读写姿势 从不 总是 0.08 1.08(0.87~1.35) 0.48 -0.17 0.84(0.67~1.07) 0.16 偶尔 0.02 1.02(0.92~1.13) 0.75 -0.16 0.85(0.76~0.96) 0.01 经常 -0.04 0.97(0.89~1.05) 0.38 -0.03 0.97(0.89~1.06) 0.50
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