Behavioral patterns and familial factors for myopia prevalence in schoolchildren: a latent class analysis

Objective  To identify the high-risk behavioral patterns and family-related factors associated with myopia prevalence among primary and secondary school students using latent class analysis (LCA).

Methods  A cross-sectional study was conducted, including 2 755 students aged 6-16 years old from the Tianjin Child and Adolescent Research of Eye Study. All participants underwent non-cycloplegic computer refraction and axial length measurement and completed a lifestyle questionnaire covering outdoor activity time, dietary habits, near-work duration, and screen time. A LCA model was constructed to classify students into different behavioral patterns. Multivariate logistic regression was used to analyze the association between these patterns and myopia risk, adjusting for confounding factors such as parental myopia and maternal education level. This study adhered to the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No. 2021KY-16). Written informed consent was obtained from the guardians of all participants.

Results  Three behavioral patterns were identified via LCA: the healthy behavior group (48.7%), the high-load near-work group (16.0%), and the comprehensive risk group (35.2%). Compared with the healthy behavior group, the risk of myopia increased by 1.89 times in the high-load near-work group (odds ratio [ OR]=1.89, 95% confidence interval [ CI]: 1.52-2.37), and the comprehensive risk group had the risk of myopia increased by 1.61 times ( OR=1.61, 95% CI: 1.36-1.91). Compared with children whose mothers had a graduate degree or above, the risk of myopia in those whose mothers had a bachelor’s degree increased by 1.55 times ( OR=1.55, 95% CI: 1.22-1.97); the risk of myopia in children whose mothers had an education level below bachelor’s degree increased by 1.62 times ( OR=1.62, 95% CI: 1.19-2.22). Compared with children whose parents were both non-myopic, when one parent had myopia, the risk of myopia in the child increased by 1.68 times ( OR=1.68, 95% CI: 1.36-2.08); when both parents were myopic, the risk of myopia in the child increased by 2.51 times ( OR=2.51, 95% CI: 1.99-3.16).

Conclusions  Myopia prevalence in primary and secondary school students is closely related to various behavioral patterns, including excessive use of electronic devices, insufficient outdoor activity time, unbalanced diet, and family-related factors.