重庆市2018—2021年儿童青少年视力不良检出率变化趋势和健康公平性

  目的  了解重庆市儿童青少年视力不良检出率及变化趋势，分析其健康公平性，为学生视力保护及近视防控提供参考。  方法  采用纵向研究，对2018—2021年度重庆市小学、初中和高中全年级的所有在校生进行裸眼视力检查，分析儿童青少年视力不良检出率及变化趋势。同时于2021年采用分层随机抽样，对重庆市2 302名儿童青少年裸眼视力和屈光度数(等效球镜，SE)进行健康公平性评价。  结果  2018—2021年重庆市儿童青少年视力不良检出率分别为54.12%，58.17%，60.03%和58.20%，视力不良检出率前3年呈增长趋势，2021年较2020年下降1.83%(χ_趋势2=13 870.45，P < 0.01)；小学、初中、高中学生不同年份间视力不良检出率差异均有统计学意义(χ2值分别为17 396.36，2 093.95，771.87，P值均 < 0.01)。2018—2021年，女生视力不良检出率均高于男生(P值均 < 0.01)。裸眼视力基尼系数城市为0.054 57，高于乡村(0.035 94)；SE的基尼系数城市为0.065 82，高于乡村(0.049 30)，即儿童青少年近视在城市中表现得更不公平。  结论  新型冠状病毒肺炎疫情后期近视防控策略的应对调整与重庆市儿童青少年视力不良检出率降低相关。不同学段、性别在视力不良检出率上有差异。应根据变化趋势制定相应的近视防控措施；城市的视力不良检出率较乡村更加不公平，需要针对区域特点实施不同的近视防控措施。

Changes and health equity of low vision among children and adolescents in Chongqing during 2018 to 2021

  Objective  To understand changes and health equity of low vision in children and adolescents in Chongqing, and to provide reference for student myopia prevention and control.  Methods  Using longitudinal studies, all school students in grades 1 to grade 12 in Chongqing were examined for visual acuity during 2018 to 2021, and the prevalence as well as changes of low vision were analyzed. In 2021, stratified random sampling was used to evaluate the health equity of uncorrected visual acuity and diopter(spherical equivalent, SE).  Results  The prevalence of low vision for children and adolescents in Chongqing from 2018 to 2021 was 54.12%, 58.17%, 60.03% and 58.20% respectively. Low vision showed an increasing trend in the first three years and decreased by 1.83% in 2021 as compared with 2020(χ_trend2=13 870.45, P < 0.01). The difference in the detection rate of poor vision among students in different grades was statistically significant(χ2=17 396.36, 2 093.95, 771.87, P < 0.01). From 2018 to 2021, the detection rate of low vision in girls was higher than that of boys(P < 0.01). The Gini coefficient was 0.054 57 for uncorrected visual acuity in urban area, higher than in rural areas (0.035 94). Meanwhile, the Gini coefficient of urban and rural SE was 0.065 82, higher than the country (0.049 30). The results showed that myopia in children and adolescents was more uneven in urban areas.  Conclusion  The adjustment of myopia prevention and control strategies in the late stage of the novel coronavirus pneumonia epidemic is related to the reduction of the detection rate of poor vision in children and adolescents in Chongqing. Low vision varied by grade and gender, suggesting tailored myopia prevention and control strategy. The detection rate of poor vision in cities is more uneven than in rural areas, and different myopia prevention and control measures need to be implemented according to regional characteristics.