云南少数民族地区中小学生户外活动及近距离用眼对近视的影响

李佩谦; 黄达峰; 张金娇; 马子雪; 李茜茜; 罗筱; 肖洁; 黄莹

doi:10.16835/j.cnki.1000-9817.2025003

云南少数民族地区中小学生户外活动及近距离用眼对近视的影响

doi: 10.16835/j.cnki.1000-9817.2025003

1.
昆明医科大学公共卫生学院，云南 650500
2.
云南省疾病预防控制中心学校卫生所

基金项目:

国家自然科学基金项目 81960593

详细信息

作者简介:
李佩谦(1997-)，女，福建莆田人，在读硕士，主要研究方向为儿童青少年健康

通讯作者:
黄莹，E-mail：huangying02@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 G806 R778.1⁺¹
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出版历程
- 收稿日期: 2024-10-16
- 修回日期: 2024-10-28
- 网络出版日期: 2025-01-25
- 刊出日期: 2025-01-25

Effect of outdoor activities and short-distance use of eyes on myopia among primary and secondary school students in Yunnan minority areas

1.
School of Public Health, Kunming Medical University, Kunming (650500), Yunnan Province, China

摘要

摘要: 目的了解云南少数民族地区中小学生近视流行趋势，探讨户外活动及近距离用眼对近视的影响，为早期近视干预提供参考。方法 2020年10月，采用多阶段整群随机抽样方法对云南省3个县/市的1 782名中小学生进行基线视力检查和问卷调查；2021年10月进行第1次随访获取1 691份有效样本；2023年5月进行第2次随访获取1 367份有效样本。采用广义估计方程探讨中小学生近视的影响因素。结果云南少数民族地区中小学生2020，2021及2023年总体近视检出率分别为52.64%，61.62%和69.35%，呈增长趋势(χ_趋势²=91.77，P < 0.05)。广义估计方程进行多因变量回归分析结果显示，基线年龄(OR=1.31)，女生(OR=1.76)，哈尼族(OR=0.75)、白族(OR=0.69)，父母近视(OR=1.97~2.29)，父母因作业/补习挤占经常减少孩子运动时间(OR=1.35)，每周球类运动≤1，2~3次(OR值分别为1.27，1.20)，课间在教室内读写(OR=1.27)，偶尔阳光直射下阅读(OR=1.20)，家中读写仅用台灯(OR=0.71)，近距离用眼≥1 h休息一次(OR=1.23)与中小学生近视均有关(P值均 < 0.05)。结论云南省少数民族地区中小学生户外活动水平及近距离用眼行为习惯不佳，改善相关环境及行为因素可有效预防近视的发生发展。
- 运动活动 /
- 眼 /
- 近视 /
- 学生 /
- 少数民族
Abstract: Objective To understand the prevalence of myopia among primary and secondary school students in minority areas of Yunnan Province, and to explore the influence of outdoor activities and short-distance use of eyes, so as to provide a basis for early myopia intervention. Methods In October 2020, the survey was conducted among 1 782 primary and secondary school students in three cities of Yunnan through a multi-stage random cluster sampling method. All subjects underwent a questionnaire survey and the visual acuity examination at baseline. The first follow-up was conducted in October 2021 to obtain 1 691 valid samples, and the second follow-up was conducted in May 2023 to obtain 1 367 valid samples. Factors associated with myopia among primary and secondary school students were explored by using generalized estimating equations. Results The prevalence rates of myopia in 2020, 2021 and 2023 were 52.64%, 61.62% and 69.35%, respectively, showing an increasing trend (χ_trend²=91.77, P < 0.05). The results of multivariate regression analysis on the generalized estimation equations showed that age at baseline (OR=1.31), girls (OR=1.76), Hani ethnicity (OR=0.75), Bai ethnicity (OR=0.69), parental myopia (OR=1.97-2.29), parents often reducing children's exercise time for homework or tutoring (OR=1.35), less than 1 time or 2-3 times of ball sports per week (OR=1.27, 1.20), reading and writing in the classroom during the break (OR=1.27), reading in direct sunlight occasionally (OR=1.20), using only desk lamp for writing at home (OR=0.71), more than 1 hours of short-distance eye use for a break once (OR=1.23) were associated with myopia among primary and secondary school students (P < 0.05). Conclusions Outdoor activities and short-distance use of eye among primary and middle school students in minority areas in Yunnan province are suboptimal. Enhancing the related environmental and behavioral factors can effectively mitigate the occurrence and progression of myopia.
- Motor activity /
- Eye /
- Myopia /
- Students /
- Minority groups
注释:

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表 1 不同组别中小学生基线及随访调查的近视检出率比较

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

组别	选项	统计值	基线		第一次随访		第二次随访		χ_趋势²值	P值
组别	选项	统计值	人数	近视人数	人数	近视人数	人数	近视人数	χ_趋势²值	P值
性别	男		854	383(44.85)	802	431(53.74)	652	412(63.19)	50.14	< 0.01
	女		928	555(59.81)	889	611(68.73)	715	536(74.97)	43.53	< 0.01
		χ²值		39.91		40.05		22.24
		P值		< 0.01		< 0.01		< 0.01
学段	小学		879	355(40.39)	841	414(49.23)	786	492(62.60)	82.47	< 0.01
	中学		903	583(64.56)	850	628(73.88)	581	456(78.49)	37.54	< 0.01
		χ²值		104.42		108.66		39.68
		P值		< 0.01		< 0.01		< 0.01
民族	汉族		658	361(54.86)	613	401(65.42)	476	337(70.80)	32.60	< 0.01
	哈尼族		311	150(48.23)	296	173(58.45)	227	154(67.84)	20.91	< 0.01
	白族		187	92(49.20)	185	93(50.27)	169	108(63.91)	9.45	0.01
	傣族		312	174(55.77)	293	198(67.58)	218	164(75.23)	20.60	< 0.01
	纳西族		229	122(53.28)	223	134(60.09)	205	143(69.76)	12.38	< 0.01
	其他		85	39(45.88)	81	43(53.09)	72	42(58.33)	2.47	0.29
		χ²值		7.44		22.18		10.74
		P值		0.19		< 0.01		0.06
父母近视	仅父亲近视		233	141(60.52)	217	145(66.82)	186	142(76.34)	11.81	< 0.01
	仅母亲近视		275	157(57.09)	265	178(67.17)	222	168(75.68)	19.15	< 0.01
	父母都近视		156	93(59.62)	153	106(69.28)	130	103(79.23)	12.74	< 0.01
	都不近视		1 118	547(48.93)	1 056	613(58.05)	829	535(64.54)	48.88	< 0.01
		χ²值		17.21		15.42		23.47
		P值		< 0.01		< 0.01		< 0.01
户外活动/分	< 5		795	393(49.43)	683	399(58.42)	717	460(64.16)	34.12	< 0.01
	≥5		987	545(55.22)	1 008	643(63.79)	650	488(75.08)	66.71	< 0.01
		χ²值		5.91		4.97		19.13
		P值		0.02		0.03		< 0.01
近距离用眼/分	< 10		822	387(47.08)	761	416(54.66)	614	399(64.98)	45.47	< 0.01
	≥10		960	551(57.40)	930	626(67.31)	753	549(72.91)	47.37	< 0.01
		χ²值		18.90		28.31		9.99
		P值		< 0.01		< 0.01		< 0.01
注： ()内数字为检出率/%。

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表 2 不同组别中小学生户外活动及近距离用眼风险得分比较[M(P₂₅, P₇₅)]

Table 2. Comparison of risk scores of outdoor activity and short-distance use of eyes in different groups[M(P₂₅, P₇₅)]

组别	选项	统计值	户外活动			近距离用眼
组别	选项	统计值	基线	第一次随访	第二次随访	基线	第一次随访	第二次随访
性别	男		4(3, 6)	4(3, 6)	4(2, 6)	10(7, 14)	10(7, 14)	10(7, 14)
	女		5(4, 7)	6(4, 7)	5(3, 6)	11(7, 16)	11(7, 15)	10(6, 15)
		Z值	48.28	113.50	37.29	9.94	3.69	0.02
		P值	< 0.01	< 0.01	< 0.01	< 0.01	0.06	0.88
学段	小学		4(3, 6)	5(3, 6)	4(2, 6)	8(5, 11)	8(5, 11)	8(5, 11)
	中学		5(3, 7)	5(4, 7)	5(3, 6)	14(10, 18)	13(10, 18)	14(10, 18)
		Z值	52.54	9.12	25.53	505.48	401.05	301.88
		P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
民族	汉族		5(4, 7)	5(4, 7)	5(3, 6)	10(6, 14)	10(6, 14)	9(6, 14)
	哈尼族		4(2, 6)	5(3, 6)	5(3, 6)	12(7, 17)	12(8, 18)	11(8, 16)
	白族		6(4, 7)	5(4, 7)	4(2, 6)	9(6, 12)	8(5, 11)	9(5, 12)
	傣族		4(2, 5)	5(3, 6)	4(3, 6)	12(6, 17)	12(8, 16)	11(8, 15)
	纳西族		5(4, 7)	5(3, 6)	4(3, 6)	11(8, 15)	10(7, 15)	13(7, 17)
	其他		5(4, 7)	5(4, 7)	4(2, 6)	9(7, 12)	10(7, 13)	9(6, 14)
		H值	106.41	17.43	8.69	50.74	80.14	47.12
		P值	< 0.01	< 0.01	0.12	< 0.01	< 0.01	< 0.01
父母近视	都不近视		5(3, 6)	5(3, 7)	4(3, 6)	11(7, 16)	11(7, 16)	11(7, 15)
	仅父亲近视		5(3, 7)	5(4, 7)	5(3, 6)	10(7, 14)	9(6, 13)	10(7, 14)
	仅母亲近视		5(3, 7)	5(3, 6)	4(3, 6)	9(6, 13)	9(6, 13)	9(6, 13)
	父母都近视		5(4, 7)	5(4, 7)	4(3, 6)	9(7, 12)	9(6, 12)	8(5, 12)
		H值	15.61	9.71	4.55	29.86	49.43	44.55
		P值	< 0.01	0.02	0.21	< 0.01	< 0.01	< 0.01

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表 3 中小学生近视影响因素的广义估计方程回归分析

Table 3. Regression analysis of the generalized estimation equation of factors affecting myopia of primary and secondary school students

自变量	选项	β值	Wald χ²值	P值	OR值(95%CI)
基线年龄		0.27	22.44	< 0.01	1.31(1.17~1.47)
性别	女	0.57	36.57	< 0.01	1.76(1.47~2.12)
	男				1.00
民族	其他	-0.35	2.51	0.11	0.71(0.46~1.09)
	纳西族	-0.03	0.03	0.86	0.97(0.73~1.31)
	傣族	0.01	0.01	0.94	1.01(0.76~1.35)
	白族	-0.38	5.76	0.02	0.69(0.51~0.93)
	哈尼族	-0.29	3.93	0.05	0.75(0.56~1.00)
	汉族				1.00
父母近视	父母都近视	0.83	25.65	< 0.01	2.29(1.66~3.15)
	仅母亲近视	0.69	27.68	< 0.01	1.99(1.54~2.56)
	仅父亲近视	0.68	21.47	< 0.01	1.97(1.48~2.63)
	都不近视				1.00
父母因作业/补习挤占	经常	0.30	4.11	0.04	1.35(1.01~1.81)
减少孩子运动时间	有时	-0.10	1.42	0.23	0.91(0.78~1.06)
	没有				1.00
阳光直射下阅读	经常及以上	0.09	0.19	0.67	1.09(0.74~1.61)
	偶尔	0.19	4.83	0.03	1.20(1.02~1.42)
	从不				1.00
家中读写灯光	屋顶灯	-0.12	2.13	0.15	0.89(0.75~1.04)
	台灯	-0.34	8.23	< 0.01	0.71(0.56~0.90)
	台灯+屋顶灯				1.00
近距离用眼休息	≥1	0.21	6.31	0.01	1.23(1.05~1.44)
间隔时间/h	0.5~1	-0.00	0.00	0.97	1.00(0.85~1.17)
	< 0.5				1.00
每周球类运动/次	≤1	0.24	4.33	0.04	1.27(1.01~1.60)
	2~3	0.18	3.91	0.05	1.20(1.00~1.44)
	≥4				1.00
课间活动方式	教室内读写	0.24	7.55	0.01	1.27(1.07~1.51)
	教室内活动	0.10	1.35	0.25	1.11(0.93~1.31)
	教室外活动				1.00
注：基线年龄为连续变量。

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