School of Economics, Peking University, Beijing, China.
School of Finance, Nankai University, Tianjin, China.
PLoS One. 2019 Apr 11;14(4):e0215329. doi: 10.1371/journal.pone.0215329. eCollection 2019.
To examine the impacts of socio-economic status (SES) on visual impairment (VI), and the mediating role of lifestyles in developed rural areas of China.
A cross-sectional study was conducted among people living in rural districts of Tianjin, a developed municipality in China. An interviewer-administered survey along with free eye screenings was conducted with participants. The questionnaire included questions about demographic characteristics, SES, medical histories and lifestyles. Presenting visual acuity (PVA) and main causes of VI were identified by ophthalmologists. χ2 test was undertaken to determine whether significant differences (p<0.05) exist between VI and demographic, SES, medical history and lifestyle factors. A stepwise regression method was conducted to investigate whether lifestyles play mediating roles between SES and VI. Multivariable logistic and ordinal logistic regression were used contingent on different types of dependent variables in each regression, and adjusted odds ratio (OR) values were estimated.
Of the 12,233 participants, 6,233 were male (50.59%); the mean age was 34.61 years; 310 (2.54%) had VI. Hypertension, diabetes and cardiopathy were main medical histories, with 1,640 had hypertension (13.41%), 854 had diabetes (6.98%) and 483 had cardiopathy (3.95%). About SES factors, higher education level (Adjusted OR, 0.84; 95% CI, 0.75-0.95) and higher income level (Adjusted OR, 0.54; 95% CI, 0.39-0.76), were significantly associated with VI in a gradient across severity of VI. Lifestyles including smoking (Adjusted OR, 1.55; 95% CI, 1.31-1.83) and drinking (Adjusted OR, 1.36; 95% CI, 1.06-1.74) played mediating roles between SES and VI when considering the full sample. Besides smoking and drinking, reading every week (Adjusted OR, 2.07; 95% CI, 1.53-2.82) and exercising more than 2h every day (Adjusted OR, 0.39; 95% CI, 0.15-1.00) also played mediating roles between SES and VI when considering the subsample (age≥16).
This study revealed the crucial impacts of SES factors on VI, and the mediating role played by several lifestyles. Targeted public health interventions for reducing VI should thus be proposed in developed rural areas of China.
探讨社会经济地位（SES）对视力障碍（VI）的影响，以及生活方式在中国发达农村地区的中介作用。
本研究在天津市农村地区进行了一项横断面研究。研究对象接受了由调查员进行的问卷调查和免费的眼部筛查。问卷包括人口统计学特征、SES、病史和生活方式等问题。眼科医生确定了目前的视力（PVA）和 VI 的主要原因。采用 χ2 检验确定 VI 与人口统计学、SES、病史和生活方式因素之间是否存在显著差异（p<0.05）。采用逐步回归方法探讨生活方式在 SES 和 VI 之间是否起中介作用。根据每个回归中因变量的不同类型，采用多变量逻辑回归和有序逻辑回归，估计调整后的优势比（OR）值。
在 12233 名参与者中，男性 6233 人（50.59%）；平均年龄为 34.61 岁；310 人（2.54%）有 VI。高血压、糖尿病和心脏病是主要的病史，其中 1640 人患有高血压（13.41%），854 人患有糖尿病（6.98%），483 人患有心脏病（3.95%）。SES 因素方面，较高的教育水平（调整后的 OR，0.84；95%CI，0.75-0.95）和较高的收入水平（调整后的 OR，0.54；95%CI，0.39-0.76）与 VI 呈梯度相关，且 VI 严重程度越重，相关性越强。在考虑全样本时，包括吸烟（调整后的 OR，1.55；95%CI，1.31-1.83）和饮酒（调整后的 OR，1.36；95%CI，1.06-1.74）在内的生活方式在 SES 和 VI 之间起中介作用。除了吸烟和饮酒，每周阅读（调整后的 OR，2.07；95%CI，1.53-2.82）和每天运动超过 2 小时（调整后的 OR，0.39；95%CI，0.15-1.00）在考虑年龄≥16 岁的亚样本时，也在 SES 和 VI 之间起中介作用。
本研究揭示了 SES 因素对 VI 的重要影响，以及生活方式所起的中介作用。因此，在中国发达农村地区应提出有针对性的减少 VI 的公共卫生干预措施。
