基于健康生态学模型的6~9岁儿童筛查性近视现状及其影响因素研究

Current status and influencing factors of screening myopia among children aged 6 to 9 based on the Health Ecological Model

摘要

目的 基于健康生态学模型(HEM)分析泰安市6~9岁儿童筛查性近视流行特征及影响因素,为低龄儿童近视防控提供依据。方法 2023年10月采用分层整群随机抽样法,对泰安市6区(县)2 813名儿童进行远视力检查、非睫状肌麻痹屈光检测和家长问卷调查。问卷内容包括社会人口学特征、用眼行为、眼保健史等。筛查性近视定义为裸眼视力<5.0且非睫状肌麻痹下球镜当量<-0.50D。运用多因素logistic回归分析HEM 5个层次的因素对低龄儿童筛查性近视的影响,并进行相乘交互作用分析。结果 泰安市6~9岁儿童筛查性近视检出率为22.40%(630/2 813)。多因素回归分析结果显示,年龄增长(OR＝1.696)、父母一方及双方近视(OR=1.382、2.046),平均每天放学后近距离用眼1~2h(OR=1.536),首次眼检查年龄≥4岁、未检查过(OR=1.445、1.491),生活在郊县(OR=1.350)为筛查性近视的独立危险因素(P＜0.05)。交互分析显示:生活在郊县且首次眼检查≥4岁、父母近视且近距离用眼≥1h、父母近视且首次眼检查≥4岁筛查性近视风险更高(OR=1.817、2.413、2.336,P<0.001)。结论 6~9岁儿童筛查性近视受HEM多层级因素交互影响,需重点关注近距离用眼行为管理,对遗传高危家庭进行精准防控,大力推广和普及儿童早期眼保健,特别是在郊县地区。

Abstract

Objective To analyze the the epidemiological characteristics and influencing factors of screening myopia among children aged 6 - 9 years in Tai'an City based on the Health Ecology Model(HEM), so as to provide evidence for the prevention and control of myopia among young children. Methods In October 2023, a stratified cluster random sampling method was employed to recruit 2 813 children from 6 districts (counties) of Tai'an City.Distance visual acuity tests, non-cycloplegic refraction assessments, and parent-reported questionnaires were conducted.The questionnaire included sociodemographic characteristics,visual behaviors,eye exercises,etc.Screening myopia was defined as uncorrected visual acuity<5.0 and spherical equivalent<-0.50D under non-cycloplegic refraction.Multivariate logistic regression and multiplicative interaction analysis were performed to examine the impacts of factors at the five levels of HEM on screening myopia among young children. Results The detection rate of screening myopia among children aged 6 to 9 was 22.40% (630/2 813) in Tai'an City.Multivariate regression revealed that increasing age (OR=1.696), myopia in one parent (OR=1.382), and myopia in both parents (OR=2.046), average daily close-range eye use of 1 - 2 hours after school (OR=1.536), first eye examination at age ≥4 years(OR=1.445) or never examined (OR=1.491), and residing in suburban counties (OR=1.350) were independent risk factors (P<0.05).Interaction analysis revealed that children living in suburban counties with first examination ≥4 years old, those with parental myopia and ≥1 hour of close-range eye use, and those with parental myopia and first eye examination at age ≥4 years old had a higher risk of screening myopia (OR=1.817,2.413,2.336, P＜0.001). Conclusions Screening myopia among children aged 6 - 9 is influenced by the interaction of multi-level factors within the HEM framework.Special attention should be paid to the management of close-range eye use behaviors and precise prevention and control in families at high genetic risk.Early eye care for children should be vigorously promoted and popularized, especially in suburban and rural areas.

关键词

近视低龄化 / 健康生态学 / 交互作用 / 儿童

Key words

early-onset myopia / health ecological model / interaction / children

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基金资助

泰安市农业和社会发展领域科技创新发展项目(2023NS303);山东省人文社科项目(2023JCXK004)