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- Title
Association of Visual Impairment With Economic Development Among Chinese Schoolchildren.
- Authors
Jan, Catherine; Xu, Rongbin; Luo, Dongmei; Xiong, Xiuqin; Song, Yi; Ma, Jun; Stafford, Randall S.
- Abstract
This time series analysis of Chinese schoolchildren examines whether economic development is associated with increasing child and adolescent visual impairment. Key Points: Question: Is economic development associated with increasing child and adolescent visual impairment? Findings: This time series analysis of 7 successive cross-sectional surveys of 1 951 084 participants found that the increasing prevalence of visual impairment in Chinese schoolchildren was associated with indicators of economic development. Girls and children living in urban areas had the highest prevalence of visual impairment, although the most rapid relative increases were in rural areas. Meaning: Future exacerbation of a vision crisis in school-aged children may occur as economic development continues in China, a process that has global implications. Importance: Few studies have reported the association of economic growth with trends of visual impairment in schoolchildren in China or elsewhere. Objectives: To describe 30-year trends and patterns in visual impairment in China and to explore the association between visual impairment and economic development. Design, Setting, and Participants: In this time series analysis of 7 successive cross-sectional surveys from 1985 to 2014, a total of 1 951 084 schoolchildren aged 7 to 18 years from all provinces and autonomous regions of mainland China, excluding Tibet, were studied. In 1985, the survey was conducted between March to June; In 1991-2014, the surveys were conducted between September and November. Data analysis was performed from April 1, 2018, to January 31, 2019. Exposures: The province-level gross domestic product (GDP) per capita was extracted from the China Statistical Yearbook. Main Outcomes and Measures: Visual impairment, defined as unaided distance visual acuity of worse than 6/7.5 (20/25 Snellen equivalent), and moderate to severe visual impairment, defined as unaided distance visual acuity of worse than 6/18 (20/63 Snellen equivalent), in the worse eye. Results: A total of 1 951 084 participants (mean [SD] age, 12.6 [3.4] years; 50.5% male) were included in the analysis. Among students aged 7 to 18 years, the prevalence of visual impairment increased from 23.7% (95% CI, 23.6%-23.8%) in 1985 to 35.1% (95% CI, 34.9%-35.3%) in 1995 to 55.0% (95% CI, 54.8%-55.3%) in 2014. In 2014, the prevalence was higher among girls (58.3%; 95% CI, 54.8%-55.3%) vs boys (51.8%; 95% CI, 51.5%-52.1%) (prevalence ratio [PR] girls vs boys, 1.12; 95% CI, 1.11-1.13) and among students living in urban (59.9%; 95% CI, 59.6%-60.2%) vs rural (50.2%; 95% CI, 49.9%-50.5%) areas (PR urban vs rural, 1.17; 95% CI, 1.16-1.18), although a more rapid relative increase in prevalence occurred in rural areas (15.3% in 1985 to 50.2% in 2014) than in urban areas (31.5% in 1985 to 59.9% in 2014). From 1995 to 2014, the GDP in China increased from $1263 to $7594 (in 2014 US$ constant price). After demographic characteristics (cluster effect of school, age, sex, urban vs rural location, and relative socioeconomic status within province) were adjusted for, the regression model revealed that every 100% increase in GDP was associated with a 20% (PR, 1.20; 95% CI, 1.20-1.21) increase in the relative risk of visual impairment and a 27% (PR, 1.27; 95% CI, 1.26-1.27) increase in the relative risk of moderate to severe visual impairment. The association was stronger in male (PR, 1.22; 95% CI, 1.21-1.23 for male [as reference] vs 1.19; 95% CI, 1.18-1.19 for female; P <.001), rural (PR, 1.32; 95% CI, 1.31-1.33 for rural [as reference] vs 1.12; 95% CI, 1.12,-1.33 for urban; P <.001), and younger age groups (PR, 1.27; 95% CI, 1.24-1.29 for 7-9 years of age [as reference] vs 1.34; 95% CI, 1.32-1.36 for 10-12 years of age; P <.001; 1.21; 95% CI, 1.20-1.22 for 13-15 years of age; P <.001; and 1.12; 95% CI, 1.11,-1.13 for 16-18 years of age; P <.001). Conclusions and Relevance: The rapid increase of visual impairment prevalence and the association between GDP and visual impairment over time suggest that further exacerbation of childhood visual impairment may occur as economic development continues in China.
- Subjects
CHINA; AGE distribution; CHILDREN'S health; CONFIDENCE intervals; METROPOLITAN areas; REGRESSION analysis; RISK assessment; RURAL conditions; SEX distribution; STATISTICS; STUDENT health; SURVEYS; ADOLESCENT health; DATA analysis; VISION disorders; SOCIOECONOMIC factors; RELATIVE medical risk; DISEASE prevalence; CROSS-sectional method; SEVERITY of illness index; DISEASE exacerbation; DISEASE risk factors
- Publication
JAMA Pediatrics, 2019, Vol 173, Issue 7, pe190914
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2019.0914