{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:03:55Z","timestamp":1790229835993,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the epidemiological characteristics of dry eye disease (DED) in Gansu Province, examine the associations between regional population features and DED, and identify risk factors contributing to disease onset, thereby providing scientific evidence for clinical prevention, diagnosis, and intervention in this region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted from August 2024 to August 2025 using stratified, multi-stage cluster random sampling. A\n                      <jats:italic>post hoc<\/jats:italic>\n                      design-effect analysis was performed to quantify the influence of clustering on prevalence precision, and a mixed-effects logistic regression model was used as a sensitivity analysis to account for the hierarchical sampling structure. A total of 2,000 permanent residents aged 18\u202fyears or older were recruited from five geographic regions of Gansu Province. All participants completed a standardized questionnaire and ophthalmic examinations including tear film break-up time (TFBUT), corneal fluorescein staining (CFS), and the Schirmer I test (SIT). Factors associated with DED were evaluated using conventional multivariable logistic regression, mixed-effects logistic regression, and random forest analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Climate type, elevation, sex, daily screen time, sleep quality, and smoking were associated with DED in the conventional multivariable model (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). The mixed-effects sensitivity analysis yielded generally, but not entirely, consistent findings after accounting for clustering. Based on mean decrease in accuracy, the random forest model ranked climate type as the most influential predictor, followed by daily screen time and sleep quality. The performance of the random forest model was favorable, with an area under the receiver operating characteristic curve (AUC) of 0.832.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of DED in Gansu Province is affected by multiple factors related to regional environment, population characteristics, and lifestyle behaviors. Climate type, daily screen time and sleep quality are key risk factors. Public health interventions should prioritize high-risk regions and high-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1890146","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:44:39Z","timestamp":1790228679000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological study of dry eye disease in Gansu Province based on mathematical modeling: analysis of regional population characteristics and identification of risk factors"],"prefix":"10.3389","volume":"14","author":[{"given":"Lei","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingpan","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanping","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqiong","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First People\u2019s Hospital of Lanzhou","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"107\u2013119","DOI":"10.31348\/2020\/29","article-title":"Dry eye disease. 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