Enthoven Clair A, Haarman Annechien E G, Swierkowska-Janc Joanna, Tideman J Willem L, Polling Jan Roelof, Raat Hein, Verhoeven Virginie J M, Labrecque Jeremy, Klaver Caroline C W
Department of Ophthalmology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
The Generation R Study Group, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
Eur J Epidemiol. 2024 Dec;39(12):1315-1324. doi: 10.1007/s10654-024-01163-z. Epub 2024 Dec 11.
Myopia is becoming an important cause of visual impairment. Determining risk profiles will help to develop targeted prevention strategies. This study aims to explore the difference in myopia development between genders in two cohorts representing different generations, and to assess whether hypothetical interventions targeting education or lifestyle factors would reduce a gender gap. This study included two Dutch population-based cohorts; 11,109 adults aged ≥ 45 years from the Rotterdam Study I-III born between 1887 and 1960, and 7229 children from the birth cohort Generation R study born between 2002 and 2006 at age 9-13 years. Sequential G-estimation was used to estimate changes in gender-specific myopia prevalence, incidence and spherical equivalent if hypothetical interventions such as education and lifestyle changes would have been implemented. Myopia prevalence was 32.3% in men and 29.3% in women in the generation born between 1887 and 1960 (0.23 dioptre difference in spherical equivalent; p < 0.001); while this prevalence was 20.2% in boys and 24.7% in girls born between 2002 and 2006 at age 13 (0.15 dioptre difference in spherical equivalent; p = 0.02). In the older generation, hypothetically intervening to lower education reduced the difference between genders by -52.4% (-108.0%; -13.2%) for spherical equivalent and - 53.0% (-112.0%; -11.6%) for myopia. In children, hypothetically intervening on reducing reading time (-50.0%, 95%CI=-267.5%; 33.8% for spherical equivalent) and number of books read/week (-76.8%, 95% CI=-349.9%; 20.2% for spherical equivalent) was most prominent, but not statistically significant. The results show that men had a higher prevalence of myopia in our study of older generations; while girls had a higher prevalence in the young generation. Our hypothetical interventions suggest that these generation-specific gender preponderances were largely due to education and, possibly, lifestyle factors in youth.
近视正成为视力损害的一个重要原因。确定风险特征将有助于制定有针对性的预防策略。本研究旨在探讨代表不同代际的两个队列中不同性别在近视发展方面的差异，并评估针对教育或生活方式因素的假设性干预措施是否会缩小性别差距。本研究纳入了两个基于荷兰人群的队列；来自鹿特丹研究I - III的11109名年龄≥45岁的成年人，他们出生于1887年至1960年之间，以及来自出生队列R世代研究的7229名儿童，他们出生于2002年至2006年之间，年龄在9 - 13岁。如果实施了诸如教育和生活方式改变等假设性干预措施，采用序贯G估计法来估计特定性别的近视患病率、发病率和球镜当量的变化。在1887年至1960年出生的那代人中，男性近视患病率为32.3%，女性为29.3%（球镜当量相差0.23屈光度；p<0.001）；而在2002年至2006年出生、13岁时的那代人中，男孩近视患病率为20.2%，女孩为24.7%（球镜当量相差0.15屈光度；p = 0.02）。在老一代中，假设性地降低教育程度，球镜当量的性别差异缩小了 - 52.4%（-108.0%；-13.2%），近视为 - 53.0%（-112.0%；-11.6%）。在儿童中，假设性地减少阅读时间（球镜当量为 - 50.0%，95%CI = - 267.5%；33.8%）和每周阅读书籍数量（球镜当量为 - 76.8%，95%CI = - 349.9%；20.2%）的影响最为显著，但无统计学意义。结果表明，在我们对老一代的研究中男性近视患病率较高；而在年轻一代中女孩患病率较高。我们的假设性干预表明，这些特定代际的性别优势很大程度上归因于教育以及可能的青少年生活方式因素。
