Prevalence of poor vision and its associated factors among middle school students: a cross-sectional study.

BACKGROUND

Poor vision is a global public health challenge, with rising prevalence and earlier onset among Chinese adolescents. This study analyzed the prevalence and factors associated with poor vision among middle school students in Nantong.

METHODS

Ophthalmological examinations data were collected from 196,969 students across 32 middle schools (2018 to 2023). The Cochran-Armitage trend test analyzed the temporal and grade-level trends. A multi-stage stratified cluster sampling survey collected psychological and behavioral questionnaire data (2018: 1,392 vs. 2023: 1,380) from 5 out of the 32 schools. Exploratory factor analysis (EFA) identified potential factor structure, multivariate logistic regression quantified adjusted odds ratios (OR), and gender-stratified structural equation model (SEM) examined association pathways.

RESULTS

The prevalence of poor vision increased from 86.95% (2018) to 88.67% (2023), showed upward trends across grade-level (β = 0.027, P-trend < 0.001) and survey years (β = 0.007, P-trend < 0.001). Prevalence among females was higher (P < 0.001). In 2018 students, the eye behavior factor (OR = 1.35, 95%CI: 1.17 to 1.56) and the family heredity and environment factor (OR = 1.21, 95%CI: 1.06 to 1.40) were positively associated with poor vision. By 2023, the family heredity and environment factor (OR = 1.31, 95%CI: 1.14 to 1.50) remained significant, and the psychological factor was significantly associated factor (OR = 1.17, 95%CI: 1.03 to 1.34). Gender-stratified analysis revealed that the adaptive eye regulation factor was inversely associated with poor vision (β = -0.191, P = 0.049) in males, while in females, it showed a direct positive association (β = 0.178, P = 0.013).

CONCLUSION

The psychological factor is significantly associated with poor vision in students, with notable gender-specific pathways. These findings highlight the need for integrated, gender-tailored interventions to address this public health challenge. TRIAL REGISTRATION: This study was approved by the Ethics Committee of Affiliated Hospital of Nantong University (Approval No. 2021-K118-02).