Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China.
Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, Tianjin, China.
J Glob Health. 2024 Jun 21;14:04140. doi: 10.7189/jogh.14.04140.
There is increasing evidence on the link between environmental factors and myopia in children and adolescents, yet with inconsistent conclusions. We investigated the associations between socioeconomic inequalities and green space with myopia in school-aged students participating in the Tianjin Child and Adolescent Research of Eye (TCARE) study.
We obtained data from a population-based dynamic cohort study conducted in Tianjin, China, in 2021 and followed up in 2022. We included 1 245 271 participants from 16 districts with an average age of 11.6 years (standard deviation = 3.3) in our analysis. We synthesized their area-level SES through a prediction model that combined economic, educational, and health care variables and assessed the greenness levels surrounding the school using the Normalized Difference Vegetation Index (NDVI) based on data obtained through satellite remote sensing. We performed generalised linear mixed effects analyses for each myopia outcome separately, with adjustments for students' sex, years of education completed, and the school's geographical location.
We observed that students living in low SES areas had the highest prevalence of myopia (60.7%) in the last screening in 2022, as well as a higher incidence of one-year myopia (26.4%) compared to those residing in middle SES areas (22.7%). With a 0.1 increase in the 250, 500, and 1000 m buffer NDVI, the prevalence of myopia dropped by 6.3% (odds ratio (OR) = 0.937; 95% confidence interval (CI) = 0.915, 0.960), 7.7% (OR = 0.923; 95% CI = 0.900, 0.946), and 8.7% (OR = 0.913; 95% CI = 0.889, 0.937), respectively. The interaction analysis showed that low SES and low greenness exacerbate the prevalence of myopia. Findings from longitudinal analyses consistently demonstrated a correlation between higher values of NDVI and a slower progression of myopia. These findings remained robust across sensitivity analyses, including for variables on parental myopia and students' behaviors.
Exposure to green spaces could play a crucial role in slowing the progression of myopia among school-aged students. Myopia control policies should prioritise young populations residing in low SES areas with limited access to green spaces, as they face the highest potential risks.
越来越多的证据表明环境因素与儿童和青少年近视之间存在关联，但结论并不一致。我们调查了社会经济不平等与绿色空间与参与天津儿童青少年眼研究（TCARE）研究的学龄儿童近视之间的关系。
我们从 2021 年在中国天津进行的一项基于人群的动态队列研究中获取数据，并在 2022 年进行了随访。我们对来自 16 个区的 1245271 名参与者进行了分析，他们的平均年龄为 11.6 岁（标准差=3.3）。我们通过一个结合了经济、教育和医疗保健变量的预测模型综合评估了他们的区域社会经济地位，并根据卫星遥感数据评估了学校周围的绿化水平。我们对每个近视结果分别进行了广义线性混合效应分析，调整了学生的性别、完成的教育年限和学校的地理位置。
我们发现，在 2022 年最后一次筛查中，居住在低社会经济地位地区的学生近视患病率最高（60.7%），与居住在中社会经济地位地区的学生相比，一年近视发病率也更高（26.4%）。在 250、500 和 1000 米缓冲区 NDVI 增加 0.1 时，近视的患病率分别降低了 6.3%（优势比（OR）=0.937；95%置信区间（CI）=0.915，0.960）、7.7%（OR=0.923；95%CI=0.900，0.946）和 8.7%（OR=0.913；95%CI=0.889，0.937）。交互分析表明，低社会经济地位和低绿化水平会加剧近视的流行。纵向分析的结果一致表明，NDVI 值较高与近视进展较慢之间存在相关性。这些发现在敏感性分析中仍然稳健，包括对父母近视和学生行为的变量进行分析。
暴露于绿色空间可能在减缓学龄儿童近视进展方面发挥关键作用。近视控制政策应优先考虑居住在社会经济地位较低、绿色空间有限的年轻人群，因为他们面临着最大的潜在风险。
