Relationship between visual impairment and school entrance age in rural China

ABSTRACT

Clinical relevance

Children with uncorrected visual impairment have lower scores on various motor and cognitive tests. Exploring the association between visual impairment and school entrance age among school children in rural China may assist in enhancing the visual health of early-entry school students.

Background

Educational pressures may play a role in the visual health of students. School entrance age is associated with educational pressures. This study explored whether school entrance age can contribute to visual impairment among younger generations.

Methods

A cross-sectional study was conducted with 17,510 students from 252 primary schools in two prefectures in western China. Information on the sampled students was collected through questionnaires and vision examinations. The relationship between visual impairment and school entrance age was further analysed by multiple regression. The school entrance age was classified as early-entry and late-entry, early-entry was defined as students entering school at the age 6 years.

Results

The results showed that the myopia rate of early-entry students (26.92%) was higher than late-entry students (23.86%). Multiple regression showed that visual impairment increased with the earlier age of school entry (P = 0.044). The prevalence of myopia was also significantly higher in higher grades for children of the same age. The prevalence of myopia in 10-year-old and 11-year-old fourth- and fifth-grade students was 20.6% to 30.5%, 21.7% to 27.4% (P < 0.001). The near work with eyes was significantly different among children of the same age in different grades during this study (P < 0.001).

Conclusion

Myopia is related to the school entrance age of children. Children who start school earlier are more likely to suffer from myopia. Educational pressures and digital screens may play a role in the association. Changes in the current education mode by reducing the study burden in the early years of learning may be significant.

KEYWORDS:

• Myopia
• public health
• rural China school entrance age
• visual impairment

Acknowledgment

The authors thank the support of the National Natural Science Foundation of China (Grant No. 7180310), the 111 Project (Grant No. B16031), soft Science Project of Shaanxi Province (Grant No. 2023-CX-RKX-127). Shaanxi Gender Development Solution (Collective Action Toward Building the Learning Capacity of the Children in Poverty Rural Areas, Grant No. 47568). The authors are also grateful to all respondents who participated in this study and the enumerators for the data collection efforts. Meanwhile, the authors would like to express the sincere gratitude to all project directors, Professor Nathan Congdon, Scott Rozelle and Mattwe Boswell, who have offered constant instruction during the studies.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 7180310), the 111 Project (Grant No. B16031), soft Science Project of Shaanxi Province (Grant No. 2023-CX-RKX-127). Shaanxi Gender Development Solution (Collective Action Toward Building the Learning Capacity of the Children in Poverty Rural Areas, Grant No. 47568).