儿童青少年近视的危险因素及其累积风险研究

Research on the risk factors and cumulative risk of myopia in children and adolescents

目的研究儿童青少年近视的危险因素及其累积风险,为防控近视提供累积危险因素识别的依据。方法采用在内蒙古自治区建立的儿童青少年多病共防身心健康队列的基线资料,通过分层随机整群抽样方法,选择小学四年级至高三年级的138974名学生作为研究对象,对其进行远视力检查与屈光度检查及问卷调查。通过logistic回归评估各危险因素对近视患病率的影响。将危险因素个数累加后,形成累积风险得分,并使用logistic回归分析累积风险得分与近视患病的关联,利用广义估计方程分析近视学生累积风险得分与屈光度的关联。结果基线儿童青少年近视患病率较高(70.2%),女生近视患病率(74.8%)高于男生(65.6%),城区(74.3%)高于郊县(68.6%),高中(80.3%)高于初中(75.3%)、初中高于小学(57.7%)(均P<0.05)。危险因素分析结果显示,不当的读写距离(OR=1.10,95%CI:1.07~1.13)、课后作业时间过长(OR=1.09,95%CI:1.06~1.12)、睡眠不足(OR=1.10,95%CI:1.07~1.13)、父亲近视(OR=1.98,95%CI:1.91~2.05)、母亲近视(OR=2.04,95%CI:1.97~2.10)、课桌椅与身高不匹配(OR=1.04,95%CI:1.01~1.07)是儿童青少年近视患病的危险因素。近视患病率随累积风险得分的增加而增加,累积风险得分每增加1个单位,右眼屈光度减少0.10 D。结论多种近视相关的危险因素及其累积效应均会增加儿童青少年的近视风险。

Objective To investigate the risk factors and cumulative risk of myopia in children and adolescents,providing a basis for identifying cumulative risk factors in preventing and controlling myopia.Methods Baseline data from the mental and physical health cohort of children and adolescents established in Inner Mongolia Autonomous Region were used.A stratified random cluster sampling method was adopted to select 138974 students from fourth to twelfth grade as participants.Distance visual exams,refractive assessments,and questionnaires were conducted on the included students.Logistic regression analysis was used to evaluate each risk factor's impact on myopia's prevalence.The number of risk factors was summed to form a cumulative risk score,and logistic regression analysis was conducted to examine the association between the cumulative risk score and the prevalence of myopia.Additionally,the association between the cumulative risk score of myopic students and their degree of refractivity was analyzed using a generalized estimating equation.Results The study found a high prevalence of myopia among children and adolescents at baseline(70.2%).Girls exhibited a higher prevalence(74.8%)than boys(65.6%),urban areas(74.3%)surpassed suburban ones(68.6%),and the incidence was greater in high schools(80.3%)compared to middle schools(75.3%),which,in turn,was higher than in elementary schools(57.7%)(all P<0.05).Analysis of risk factors revealed that children and adolescents experiencing improper reading and writing distances(OR=1.10,95%CI:1.07-1.13),excessive homework(OR=1.09,95%CI:1.06-1.12),insufficient sleep(OR=1.10,95%CI:1.07-1.13),having myopic father(OR=1.98,95%CI:1.91-2.05),having myopic mother(OR=2.04,95%CI:1.97-2.10),or using classroom chairs not matched to their height faced(OR=1.04,95%CI:1.01-1.07)increased myopia risks.Additionally,the prevalence and significant odds ratio of myopia increased with the increase in cumulative risk score,with every additional unit of cumulative risk score increasing the right eye's refractive error by-0.10 D.Conclusion The presence of multiple factors and their comprehensive score increases the prevalence of myopia in children and adolescents.