Prevalence and influencing factors of myopia for the Chinese junior high school students
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摘要:
目的 分析中国初中生近视患病率影响因素的作用机制。 方法 以中国教育追踪调查在初中阶段的三轮7 119人为对象。通过问卷收集学生近视患病、近视各影响因素、以及近距离用眼行为和户外活动这两大类近视风险行为的信息，采用Logistic回归模型检验近视风险行为对近视影响因素的中介作用。 结果 初中九年级学生的近视率为66.36%。近距离用眼行为中的写作业时间明显的增加近视患病风险，该行为的比值比（odds ratio，OR）为1.17，95%的置信区间（confidence interval，CI）为1.13~1.21，户外活动中的户外体育活动明显的降低近视患病风险（OR=0.80，95%CI：0.75~0.86）。在模型中引入近视风险行为的前后，女学生近视风险率比OR（95%CI）从1.84（1.66~2.04）趋中变化为1.69（1.51~1.88），城镇户籍学生近视风险率比OR（95%CI）从1.19（1.03~1.37）趋中变化到1.16（1.00~1.34）。独生子女近视发生风险率OR（95%CI）从1.20（1.06~1.36）趋中到了1.18（1.04~1.33）。父母有一方近视的学生近视风险率比OR（95%CI）从2.47（2.12~2.88）趋中到了2.44（2.09~2.85），而父母双方都近视学生近视风险率比OR（95%CI）从4.25（3.09~5.86）趋中到4.13（3.00~5.69）。 结论 性别、城乡、是否独生子女、父母是否近视都是近视患病的影响因素，这些因素可以通过在近距离用眼和户外活动上的差异而对近视患病产生作用。 Abstract:Objective To analyze the mechanism of the influencing factors of myopia for junior high school students in China. Methods Based on the follow-up to 7 119 students in the 3 waves of questionnaire survey of the Chinese Education Panel Survey in junior high school stage, and the variables on students' myopia status, myopia influencing factors, and two kinds of risk behaviors of myopia including near visual activities and outdoor activities, the mediation effects of the myopia risk behaviors were tested by Logistic regression model. Results The myopia prevalence of 9th graders before junior high school graduation was 66.36%. Time on writing homework significantly increased the risk of myopia, the odds ratio (OR) was 1.17, the 95% confidence interval (CI) was 1.13-1.21, and the time on outdoor sports significantly decreased the risk of myopia (OR=0.80, 95% CI: 0.75-0.86). Before and after including the risk behaviors into the model, the myopia risk OR(95% CI) of female centralized from 1.84(1.66-2.04) to 1.69(1.51-1.88), the myopia risk OR(95% CI) of urban students'centralized from 1.19(1.03-1.37) to 1.16(1.00-1.34), the myopia risk OR(95% CI) of only children'centralized from 1.20(1.06-1.36) to 1.18(1.04-1.33). With reference to not myopic for both parents, the myopia risk OR(95% CI) of students having one myopic parent centralized from 2.47(2.12-2.88) to 2.44(2.09-2.85), the myopia risk OR(95% CI) of students having parent without myopic centralized from 4.25(3.09-5.86) to 4.13(3.00-5.69). Conclusions Gender, urban and rural, only child, and myopic parents are influencing factors of myopia. These factors have effects on myopia via two kinds of risk behaviors including outdoor activities and near visual activities. -
Key words:
- Myopia /
- Near visual activity /
- Outdoor activity /
- Mediation effect
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表 1 初中阶段学生的累积近视患病率[n(%)]
Table 1. Students' cumulative myopia rate in junior hight school stage [n(%)]
年级 全体 男性 女性 χ2值 P值 七年级 3 965(55.70) 1 780(50.91) 2 181(60.23) 62.542 < 0.001 八年级 4 389(61.66) 1 948(55.71) 2 438(67.32) 101.326 < 0.001 九年级 4 724(66.36) 2 098(59.99) 2 626(72.50) 124.670 < 0.001 
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表 2 不同社会、经济特征九年级学生的近视患病率
Table 2. Myopia rate of 9th graders by different socio-economic characteristics
特征 调查人数 近视人数[n(%)] χ2值 P值 地区行政级别 94.27 < 0.001 直辖市、省会 2 434 1 710(70.25) 地级市 2 415 1 688(69.90) 县(县级市) 2 270 1 326(58.41) 户籍 100.58 < 0.001 农村 4 143 2 552(61.60) 城镇 2 976 2 172(72.98) 是否为独生子女 77.40 < 0.001 非独生子女 3 856 2 384(61.83) 独生子女 3 263 2 340(71.71) 母亲教育程度 100.60 < 0.001 小学及以下 1 456 841(57.76) 初中 2 905 1 893(65.16) 高中/中专 1 515 1 056(69.70) 大专/本科及以上 1 243 934(75.14) 父亲教育程度 72.63 < 0.001 小学及以下 947 567(59.87) 初中 3 069 1 945(63.38) 高中/中专 1 721 1 188(69.03) 大专/本科及以上 1 382 1 024(74.10) 父母近视情况 296.26 < 0.001 均不近视 5 258 3 191(60.69) 一方近视 1 460 1 181(80.89) 双方近视 401 352(87.78) 居住安排情况 12.32 < 0.001 不与父母同住 676 408(60.36) 与父母一方同住 1 336 887(66.39) 与父母同住 5 107 3 429(67.14) 家庭经济条件 28.60 < 0.001 差 1 307 785(60.06) 中等 5 362 3 630(67.70) 好 450 309(68.67) 性别 124.67 < 0.001 男 3 497 2 098(59.99) 女 3 622 2 626(72.50)
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表 3 不同社会、经济特征九年级学生在近视风险行为上的差异
Table 3. Myopia risk behaviors of 9th graders by different socio-economic characteristic
影响因素 日均写作业时间(小时) 日均户外体育运动时间(小时) x±s F值 P值 x±s F值 P值 地区行政级别 226.93 < 0.001 15.18 < 0.001 直辖市、省会 3.51±1.54 0.94±0.83 地级市 3.10±1.53 0.86±0.73 县(县级市) 2.57±1.42 0.98±0.76 性别 140.71 < 0.001 280.40 < 0.001 男 2.85±1.56 1.08±0.89 女 3.28±1.51 0.78±0.61 户籍 478.25 < 0.001 26.26 < 0.001 农村 2.74±1.48 1.11±0.97 城镇 3.53±1.52 0.95±0.87 是否为独生子女 276.11 < 0.001 8.90 < 0.050 非独生子女 2.80±1.50 0.95±0.79 独生子女 3.40±1.54 0.90±0.75 母亲教育程度 153.94 < 0.001 7.84 < 0.001 小学及以下 2.58±1.46 0.97±0.80 初中 2.91±1.50 0.93±0.77 高中/中专 3.34±1.57 0.95±0.83 大专/本科及以上 3.70±1.46 0.83±0.67 父亲教育程度 168.67 < 0.001 8.71 < 0.001 小学及以下 2.52±1.45 0.92±0.75 初中 2.84±1.48 0.96±0.78 高中/中专 3.24±1.56 0.94±0.82 大专/本科及以上 3.75±1.47 0.83±0.70 父母近视情况 104.81 < 0.001 16.08 < 0.001 均不近视 2.92±1.53 0.96±0.80 一方近视 3.41±1.52 0.84±0.66 双方近视 3.79±1.55 0.82±0.79 居住安排情况 28.78 < 0.001 2.01 0.134 不与父母同住 2.69±1.49 0.98±0.85 与父母一方同住 2.98±1.61 0.94±0.84 与父母同住 3.15±1.53 0.92±0.75 家庭经济条件 30.23 < 0.001 10.47 < 0.001 差 2.79±1.59 0.99±0.87 中等 3.12±1.52 0.90±0.74 好 3.34±1.58 1.01±0.85
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表 4 近视影响因素的Logistic回归模型分析
Table 4. Logistic regression analysis of the influencing factors of myopia
影响因素 单因素分析 中介作用模型 OR(95% CI)值 P值 OR(95% CI)值 P值 近距离用眼行为 写作业时间 1.17(1.13~1.21) < 0.001 1.08(1.04~1.12) < 0.001 纸质书籍阅读时间 1.01(0.94~1.08) 0.814 0.99(0.92~1.07) 0.824 电子设备使用时间 0.97(0.94~1.01) 0.109 0.98(0.95~1.02) 0.387 户外运动 户外体育运动 0.80(0.75~0.86) < 0.001 0.87(0.81~0.94) < 0.001 其他户外活动 0.94(0.89~1.00) < 0.050 0.98(0.92~1.04) 0.435 地区行政级别 直辖市、省会 1.00 1.00 地级市 1.14(1.00~1.31) 0.057 1.12(0.98~1.29) 0.098 县(县级市) 0.83(0.72~0.97) < 0.050 0.85(0.73~1.99) < 0.050 性别 男 1.00 1.00 女 1.84(1.66~2.04) < 0.001 1.69(1.51~1.88) < 0.001 户籍 农村 1.00 1.00 城镇 1.19(1.03~1.37) < 0.050 1.16(1.00~1.34) < 0.050 是否为独生子女 非独生子女 1.00 1.00 独生子女 1.20(1.06~1.36) <0.010 1.18(1.04~1.33) <0.010 母亲教育程度 小学及以下 1.00 1.00 初中 1.16(1.01~1.34) < 0.050 1.15(1.00~1.33) 0.053 高中/中专 1.17(0.97~1.42) 0.103 1.16(0.96~1.40) 0.134 大专/本科及以上 1.10(0.86~1.41) 0.428 1.08(0.84~1.38) 0.555 父亲教育程度 小学及以下 1.00 1.00 初中 0.99(0.84~1.16) 0.857 0.98(0.83~1.16) 0.826 高中/中专 0.98(0.80~1.19) 0.836 0.97(0.79~1.18) 0.739 大专/本科及以上 0.83(0.65~1.07) 0.155 0.79(0.62~1.02) 0.073 父母近视情况 均不近视 1.00 1.00 一方近视 2.47(2.12~2.88) < 0.001 2.44(2.09~2.85) < 0.001 双方近视 4.25(3.09~5.86) < 0.001 4.13(3.00~5.69) < 0.001 居住安排情况 不与父母同住 1.00 1.00 与父母一方同住 1.06(0.86~1.29) 0.583 1.07(0.87~1.30) 0.541 与父母同住 1.02(0.86~1.22) 0.790 1.03(0.86~1.22) 0.786 家庭经济条件 差 1.00 1.00 中等 1.06(0.92~1.21) 0.421 1.06(0.93~1.22) 0.926 好 1.01(0.79~1.30) 0.915 1.04(0.81~1.34) 0.813
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