Objective: To assess the prevalence of myopia and its main influencing factors among Chinese primary and secondary school students using meta-analysis. Methods: A meta-analysis was conducted. Databases including CNKI, Wanfang Data, China Biology Medicine Database, PubMed and Web of Science Core Collection were electronically searched to collect cross-sectional studies on influencing factors of myopia in Chinese primary and secondary school students published from January 2013 to October 2024. Two researchers independently screened the literature, extracted data and assessed the methodological quality based on the Agency for Healthcare Research and Quality (AHRQ) criteria. Meta-analysis was performed using Stata 18.0 software to calculate the pooled prevalence and the odds ratios (OR) with 95% confidence intervals (CI) for each influencing factor. Heterogeneity test, publication bias assessment and sensitivity analysis were also conducted. Results: A total of 76 studies were included, covering 31 provinces, autonomous regions and municipalities directly under the Central Government of China, with a cumulative sample size of 1, 823, 018 participants. Eight main influencing factors of myopia were analyzed. The meta-analysis results showed that the risk of myopia in female primary and secondary school students was 1.45 times that in male students (OR=1.45, 95%CI:1.29-1.63), and the risk in secondary school students was 4.11 times that in primary school students (OR=4.11, 95%CI:3.76-4.50). Parental history of myopia (at least one parent affected), excessive daily use of electronic devices, and incorrect eye use posture were identified as risk factors (P<0.05). In contrast, performing eye exercises ≥10 times per week, engaging in outdoor activities ≥ 5 hours per week, and sleeping > 8 hours per day were protective factors (P<0.05). Sensitivity analysis indicated that the results were robust. Conclusions: The prevalence of myopia among Chinese primary and secondary school students remains high, and the spectrum of influencing factors exhibits distinct "Chinese context" characteristics: the harm of high-intensity near-work driven by academic pressure far outweighs that of isolated electronic screen exposure, while poor reading and writing postures, specifically deviations from the "One Fist, One Chi, One Cun" standardized posture guidelines, significantly elevate myopia risk. Given that the development of myopia is jointly influenced by genetic, behavioral, and environmental factors, it is recommended that while drawing upon international experiences, we fully leverage the strengths of indigenous institutional advantages, such as Chinese eye exercises, and embed standardized posture education into daily classroom routines. Ultimately, the goal is to construct a "society-school-family" trinity prevention and control system with Chinese characteristics, actively guide primary and secondary school students in cultivating healthy eye-use habits, and further strengthen the implementation intensity of comprehensive myopia intervention measures. 目的： 探讨中国中小学生近视眼患病率和主要影响因素。 方法： 荟萃分析。检索中国知网、万方数据知识服务平台、中国生物医学数据库、PubMed及Web of Science核心合集，收集2013年1月至2024年10月发表的中国中小学生近视眼影响因素相关横断面研究。由2名研究者独立筛选文献、提取数据并基于美国医疗保健研究与质量局标准进行方法学质量评价，采用Stata 18.0软件进行荟萃分析，计算合并患病率及各影响因素的优势比（OR）与95%置信区间（CI），并行异质性检验、发表偏倚评估及敏感性分析。 结果： 共纳入76篇文献，文献来源涵盖我国31个省、自治区、直辖市，累计调查人数1 823 018人，分析了8种近视眼的主要影响因素。分析结果显示，我国中小学生女生近视风险是男生的1.45倍（OR=1.45，95%CI：1.29~1.63），中学生近视风险是小学生的4.11倍（OR=4.11，95%CI：3.76~4.50）。父母至少一方有近视史、每天过度使用电子产品、不正确的用眼姿势是危险因素（P<0.05）；坚持我国特有的眼保健操制度（每周≥10次）、每周户外活动≥5 h、每天睡眠>8 h是保护因素（P<0.05）。敏感性分析显示结果稳健。 结论： 我国中小学生近视率处于较高水平，升学压力驱动下的高负荷用眼模式危害远大于单一电子屏幕暴露，不良读写姿势对“一拳一尺一寸”规范的背离显著推高风险。近视眼的发生受遗传、行为与环境因素共同影响，建议在借鉴国际经验的同时，充分发挥眼保健操等本土制度优势，将标准化姿势教育下沉至日常课堂，构建具有中国特色的“社会-学校-家庭”联动防控体系，积极引导中小学生养成良好的用眼习惯，并进一步加大近视眼综合干预措施的实施力度。.
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arXiv · 2022-04-06
arXiv · 2013-12-06