天津中小学生近视与脊柱侧弯共患现状及学校环境风险因素分析

张献伟; 陈璐; 刘忠慧; 董彦会; 宋逸; 孙志颖; 徐渴; 赵赛赛

doi:10.16835/j.cnki.1000-9817.2024162

天津中小学生近视与脊柱侧弯共患现状及学校环境风险因素分析

doi: 10.16835/j.cnki.1000-9817.2024162

1.
天津市疾病预防控制中心环境健康与公共卫生所，300011
2.
北京大学公共卫生学院/儿童青少年卫生研究所

基金项目:

天津市医学重点学科(专科)建设项目 TJYXZDXK-051A

详细信息

作者简介:
张献伟(1992-)，男，安徽阜阳人，硕士，主管医师，主要研究方向为儿童青少年健康

通讯作者:
陈璐，E-mail：chenlu6@tj.gov.cn

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⁺¹ R682.3 G478
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出版历程
- 收稿日期: 2024-04-17
- 修回日期: 2024-05-08
- 网络出版日期: 2024-05-30
- 刊出日期: 2024-05-25

Comorbidity of myopia and scoliosis in primary and secondary school students and analysis of risk factors in school environment in Tianjin

1.
Institute of Environmental and Public Health, Tianjin Center of Disease Control and Prevention, Tianjin (300011), China

摘要

摘要: 目的了解天津市中小学生近视与脊柱侧弯的共患现状，并分析学校环境中可能的风险因素，为制定更有效的预防措施提供依据。方法 2023年9—10月，采用分层整群随机抽样方法从天津市16个区抽取41 654名中小学生开展近视和脊柱侧弯筛查。采用χ²检验对数据进行单因素分析，采用二元多因素Logistic回归模型及累积效应分析探索二者共患的相关因素。结果 2023年天津市中小学生筛查性近视与脊柱侧弯共患检出率为2.65%，郊区(3.26%)高于城区(2.02%)，女生(3.81%)高于男生(1.59%)，高中生(6.17%)高于初中生(4.19%)、小学生(0.44%)，组间差异均有统计学意义(χ²值分别为62.23，198.69，953.19，P值均＜0.01)。二元多因素Logistic回归分析显示，每周体育课节数≥3节，每天在校做眼保健操次数≥2次，课间开展户外休息或活动，老师提醒注意读写姿势，对坐姿、站姿严格要求与筛查性近视和脊柱侧弯共患均呈负相关(OR值分别为0.66，0.77，0.71，0.78，0.74)；躺着或趴着看书或电子屏幕与筛查性近视和脊柱侧弯共患呈正相关(OR=1.77)(P值均＜0.05)。累积效应分析显示，累积得分(“4~7”“7~9”“≥10”)与筛查性近视和脊柱侧弯共患均呈负相关(OR值分别为0.65，0.55，0.52，P值均＜0.05)。结论学校的环境支持及学生个人在校行为习惯与筛查性近视和脊柱侧弯共患相关。防控近视与脊柱侧弯共患应改善学生校内健康相关的环境因素。
- 近视 /
- 脊柱侧凸 /
- 共病现象 /
- 环境 /
- 危险因素 /
- 学生
Abstract: Objective To investigate the comorbidity of myopia and scoliosis among primary and secondary school students in Tianjin, and to analyze the school environment risk factors contributing to these health issues, so as to provide a scientific basis for development effective prevention measures. Methods A total of 41 654 primary and secondary school students from 16 districts of Tianjin were selected by stratified random cluster sampling from September to October 2023 to screen for myopia and scoliosis. Univariate analysis was performed to examine the data, followed by a bivariate multivariate Logistic regression model and cumulative effect analysis to explore the influencing factors of their comorbidity. Results In 2023, the prevalence of comorbidity of screening positive myopia and scoliosis among primary and secondary school students in Tianjin was 2.65%. The prevalence was higher in suburban areas (3.26%) compared to urban areas (2.02%), higher among females (3.81%) compared to males (1.59%), and highest in high school students (6.17%) compared to middle school (4.19%) and primary school students (0.44%) (χ²=62.23, 198.69, 953.19, P < 0.01). Logistic regression analysis showed that the number of physical education classes ≥3 per week, the number of eye health exercises at school ≥2 per day, outdoor activities between classes, teachers' reminding to pay attention to reading and writing posture and strict eye standing posture were negatively correlated with the comorbidity of screening positive myopia and scoliosis (OR=0.66, 0.77, 0.71, 0.78, 0.74, P < 0.05). Reading or electronic screen while lying or lying on the stomach was positively associated with the comorbidity of screening positive myopia and scoliosis (OR=1.77, P < 0.05). Cumulative effect analysis showed that the cumulative score (4-7, 7-9, ≥10) was negatively correlated with the comorbidity of screening positive of myopia and scoliosis (OR=0.65, 0.55, 0.52, P < 0.05). Conclusions The school environment support and students' personal behavior habits in school are related to the comorbidity of comorbidity of screening positive myopia and scoliosis. Prevention and control of myopia and scoliosis should improve the environmental factors related to students' health in school.
- Myopia /
- Scoliosis /
- Comorbidity /
- Environment /
- Dangerous factor /
- Students
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 天津市2023年不同组别中小学生筛查性近视、脊柱侧弯及共患检出率比较

Table 1. Comparison of detection rates of screening positive myopia, scoliosis and comorbidity among primary and secondary school students in Tianjin in 2023

组别	分类	人数	脊柱侧弯			筛查性近视			共患
组别	分类	人数	检出人数	χ²值	P值	检出人数	χ²值	P值	检出人数	χ²值	P值
监测点	城区	20 477	574(2.80)	90.41	< 0.01	11 426(55.80)	106.08	< 0.01	413(2.02)	62.23	< 0.01
	郊区	21 177	966(4.56)			10 750(50.76)			690(3.26)
学段	小学	21 942	267(1.22)	832.12	< 0.01	7 289(33.22)	7 703.96	< 0.01	96(0.44)	953.19	< 0.01
	初中	10 569	609(5.76)			7 441(70.40)			443(4.19)
	高中	9 143	664(7.26)			7 446(81.44)			564(6.17)
性别	男	21 816	501(2.30)	252.40	< 0.01	11 214(51.40)	62.02	< 0.01	347(1.59)	198.69	< 0.01
	女	19 838	1 039(5.24)			10 962(55.26)			756(3.81)
注： ()内数字为检出率/%。

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表 2 天津中小学生筛查性近视与脊柱侧弯共患的单因素分析

Table 2. Univariate analysis of screening positive myopia and scoliosis comorbidities among primary and secondary students from Tianjin

因素	选项	人数	共患检出人数	χ²值	P值	因素	选项	人数	共患检出人数	χ²值	P值
每周体育课节数	≤2	16 348	570(3.49)	73.37	< 0.01	老师是否提醒注意读写姿势	否	29 794	869(2.92)	29.24	< 0.01
	≥3	25 302	533(2.11)				是	11 855	234(1.97)
班级座位每月调换频率/次	≥1	5 029	117(2.33)	2.30	0.13	躺着或趴着看书或电子屏幕	否	40 863	1061(2.60)	22.57	< 0.01
	＜1	36 620	986(2.69)				是	786	42(5.34)
课桌椅高度每学期调整频率/次	＜1	25 471	723(2.84)	9.20	< 0.01	走路或乘车时看书或电子屏幕	否	41 155	1 080(2.62)	7.81	< 0.01
课桌椅高度每学期调整频率/次	≥1	16 178	380(2.35)				是	494	23(4.66)
每天在校做眼保健操次数	≤1	11 322	397(3.51)	44.41	< 0.01	班级座位定期左右轮转	是	34 179	900(2.63)	0.18	0.67
	≥2	30 327	706(2.33)				否	7 463	203(2.72)
课间是否户外休息或活动	否	27 761	821(2.96)	30.84	< 0.01	对坐姿、站姿是否严格要求	否	34 378	147(0.43)	13.43	< 0.01
	是	13888	282(2.03)				是	7 272	900(12.38)
胸口离桌子边缘是否超过一拳	否	29 482	768(2.60)	0.74	0.39	是否背双肩包(背后背)	否	3 425	133(3.88)	22.08	< 0.01
	是	12 167	335(2.75)				是	38 226	970(2.54)
眼睛距离书本是否超过一尺	否	29 813	799(2.68)	0.41	0.52	书包重量自我感觉	轻	28 973	791(2.73)	2.49	0.12
	是	11 836	304(2.57)				重	12 678	312(2.46)
手指距离笔尖是否一寸左右	否	27 060	722(2.67)	0.12	0.73
	是	14 589	381(2.61)
注：部分数据有缺失；()内数字为检出率/%。

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表 3 天津中小学生筛查性近视与脊柱侧弯共患的Logistic回归分析(n=41 654)

Table 3. Multivariate Logistic regression analysis of screening positive myopia and scoliosis comorbidities in primary and secondary school students from Tianjin(n=41 654)

自变量	选项	β值	标准误	Wald χ²值	P值	OR值(95%CI)
每周体育课节数	≥3	-0.41	0.06	42.78	< 0.01	0.66(0.58~0.75)
课桌椅高度每学期调整频率/次	≥1	-0.03	0.07	0.14	0.71	0.98(0.86~1.11)
每天在校做眼保健操次数	≥2	-0.26	0.07	14.97	< 0.01	0.77(0.68~0.88)
课间是否户外休息或活动	是	-0.35	0.07	24.33	< 0.01	0.71(0.62~0.81)
老师是否提醒注意读写姿势	是	-0.24	0.08	9.94	< 0.01	0.78(0.67~0.91)
是否躺着或趴着看书或电子屏幕	是	0.57	0.20	8.49	< 0.01	1.77(1.20~2.59)
走路或乘车时是否看书或电子屏幕	是	-0.06	0.26	0.05	0.83	0.95(0.57~1.58)
对坐姿、站姿是否严格要求	是	-0.30	0.10	9.95	< 0.01	0.74(0.61~0.89)
是否背双肩包(背后背)	是	-0.11	0.09	1.32	0.25	0.90(0.75~1.08)

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