{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:53:01Z","timestamp":1785433981844,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key Research and Development Program of China","award":["2022YFC3502503"],"award-info":[{"award-number":["2022YFC3502503"]}]},{"DOI":"10.13039\/100009800","name":"Wenzhou Medical University","doi-asserted-by":"publisher","award":["95022006"],"award-info":[{"award-number":["95022006"]}],"id":[{"id":"10.13039\/100009800","id-type":"DOI","asserted-by":"publisher"}]},{"award":["95022006"],"award-info":[{"award-number":["95022006"]}],"id":[{"id":"https:\/\/ror.org\/00rd5t069","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Estimate the prevalence of myopia among children aged 6\u201317 years in county and rural areas across seven geographically diverse provinces of China, and identify demographic, behavioral, and geographic factors associated with myopia, with particular focus on urban\u2013rural and ethnic differences. Methods: A multi-stage stratified cluster sampling design was employed. Seven provinces were randomly selected, one from each of seven geographical regions of China (Southeast, North, Central, South, Southwest, Northwest, and Northeast). In each province, one rural county was randomly chosen. Within each county, one urban survey site (county town) and one rural survey site (village) were selected. From each site, one primary school and one junior high school were included. In each school, approximately 20 \u00b1 2 students per grade (grades 1\u20139) were recruited. Uncorrected visual acuity and non-cycloplegic autorefraction were measured. Multivariable generalized linear mixed models (GLMM) with random intercepts at the class level were used to identify factors associated with myopia, accounting for the cluster sampling design. Results: The overall myopia prevalence was 42.9% (urban 49.6%, rural 36.0%). In the multivariable GLMM, educational stage was the strongest risk factor (grades 7\u20139 vs. 1\u20133: OR = 5.54). A significant district \u00d7 ethnicity interaction was found only for Mongolian children: rural residence was strongly protective (OR = 0.19) compared to Han (OR = 0.65), and the ethnic advantage disappeared in county towns. Only 14.2% of myopic students had adequate correction. Conclusions: In conclusion, myopia is highly prevalent and severely under-corrected in rural China. Educational pressure is the main risk factor, and the rural protective effect is strongest in Mongolians but erodes with urbanization. Urgent public health actions, including vision screening, affordable spectacles, and lifestyle preservation, are needed to address this growing burden.<\/jats:p>","DOI":"10.3390\/jcm15093261","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:28:23Z","timestamp":1777040903000},"page":"3261","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myopia Prevalence Among 6\u201317 Years Students in Rural Areas of Seven Provinces of China"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-9109","authenticated-orcid":false,"given":"Xue","family":"Li","sequence":"first","affiliation":[{"name":"National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huayu","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Fang","sequence":"additional","affiliation":[{"name":"National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5185-7676","authenticated-orcid":false,"given":"Xiaodi","family":"Wu","sequence":"additional","affiliation":[{"name":"National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3259-3969","authenticated-orcid":false,"given":"Qian","family":"Gan","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Nutrition and Health, National Health Commission of the People\u2019s Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Huang","sequence":"additional","affiliation":[{"name":"National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Nutrition and Health, National Health Commission of the People\u2019s Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Chen","sequence":"additional","affiliation":[{"name":"National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhua","family":"Bao","sequence":"additional","affiliation":[{"name":"National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_2","first-page":"101577","article-title":"Myopia and high myopia trends in Chinese children and adolescents over 25 years: A nationwide study with projections to 2050","volume":"59","author":"Pan","year":"2025","journal-title":"Lancet Reg. Health West. Pac."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1136\/bjophthalmol-2017-311266","article-title":"Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: Systematic review, meta-analysis and modelling","volume":"102","author":"Fricke","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cumberland, P.M., Bountziouka, V., Hammond, C.J., Hysi, P.G., and Rahi, J.S. (2022). Temporal trends in frequency, type and severity of myopia and associations with key environmental risk factors in the UK: Findings from the UK Biobank Study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0260993"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1167\/iovs.65.10.42","article-title":"The Onset and Progression of Myopia Slows in Chinese 15-Year-Old Adolescents Following Vocational Rather Than Academic School Pathways","volume":"65","author":"Hu","year":"2024","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1016\/j.ophtha.2021.04.001","article-title":"COVID-19 Quarantine Reveals That Behavioral Changes Have an Effect on Myopia Progression","volume":"128","author":"Xu","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/ICL.0000000000001205","article-title":"Seasonal Variation in the Effect of Controlling Myopia Progression Using Orthokeratology","volume":"51","author":"Tang","year":"2025","journal-title":"Eye Contact Lens"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/OPX.0b013e3181940719","article-title":"Prevalence of myopia in urban and rural children in mainland China","volume":"86","author":"He","year":"2009","journal-title":"Optom. Vis. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/iovs.64.3.7","article-title":"Causal Relationships Between Glycemic Traits and Myopia","volume":"64","author":"Li","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1167\/iovs.03-1051","article-title":"Refractive error and visual impairment in urban children in southern China","volume":"45","author":"He","year":"2004","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.ophtha.2006.08.020","article-title":"Refractive error and visual impairment in school children in rural southern China","volume":"114","author":"He","year":"2007","journal-title":"Ophthalmology"},{"key":"ref_12","unstructured":"National Health Commission of the People\u2019s Republic of China (2021, October 11). Guidelines for Appropriate Techniques for Myopia Prevention and Control Among Children and Adolescents (Updated Edition), Available online: https:\/\/www.nhc.gov.cn\/jkj\/c100062\/202110\/a05ccaf5773a436486d2d79b59c0a5e9.shtml."},{"key":"ref_13","first-page":"561","article-title":"Emphasizing the standardized use of cycloplegics in the epidemiological studies of myopia","volume":"55","author":"Wang","year":"2019","journal-title":"Zhonghua Yan Ke Za Zhi"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI\u2014Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies","volume":"60","author":"Flitcroft","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhao, X., Lu, X., Yu, L., Zhang, Y., Li, J., Liu, Y., Yang, G., Wang, Y., Zhang, W., and Du, Z. (2022). Prevalence of myopia and associated risk factors among key schools in Xi\u2019an, China. BMC Ophthalmol., 22.","DOI":"10.1186\/s12886-022-02735-x"},{"key":"ref_16","unstructured":"National Health Commission of the People\u2019s Republic of China (2019, April 29). Notice on the Children and Adolescent Myopia Survey, Which Is Jointly Issued by the General Office of the National Health Commission, the General Office of the Ministry of Education, and the General Office of the Ministry 2018, Available online: http:\/\/www.scio.gov.cn\/gwyzclxcfh\/cfh\/2019n_15127\/2019n05y10rsw\/xgfbh_15333\/202208\/t20220808_302403.html."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.ophtha.2020.01.054","article-title":"Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students","volume":"127","author":"Wu","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e2424595","DOI":"10.1001\/jamanetworkopen.2024.24595","article-title":"Smartwatch Measures of Outdoor Exposure and Myopia in Children","volume":"7","author":"Chen","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1167\/iovs.66.15.5","article-title":"IMI: The Role of Light in Refractive Development and Myopia: Evidence from Animal and Human Studies","volume":"66","author":"Ashby","year":"2025","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5076454","DOI":"10.1155\/2018\/5076454","article-title":"Myopia Progression Risk: Seasonal and Lifestyle Variations in Axial Length Growth in Czech Children","volume":"2018","author":"Rusnak","year":"2018","journal-title":"J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1111\/opo.13486","article-title":"Seasonal variation in axial elongation in children with orthokeratology treatment","volume":"45","author":"Ding","year":"2025","journal-title":"Ophthalm. Physiol. Opt."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.2147\/IJGM.S462734","article-title":"The Impact of Sunshine Duration on Myopia in Central China: Insights from Populational and Spatial Analysis in Hubei","volume":"17","author":"Ma","year":"2024","journal-title":"Int. J. Gen. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1038\/s41433-019-0469-0","article-title":"Prevalence of and risk factors for refractive error: A cross-sectional study in Han and Mongolian adults aged 40-80 years in Inner Mongolia, China","volume":"33","author":"Wang","year":"2019","journal-title":"Eye"},{"key":"ref_24","first-page":"32","article-title":"Comparative study on the axial length of Mongolian and Han adolescents in Erdos City","volume":"7","author":"Gao","year":"2017","journal-title":"Chin. J. Ophthalmol. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e36354","DOI":"10.1016\/j.heliyon.2024.e36354","article-title":"Prevalence and risk factors for refractive error in older adults in eight ethnicities in China: The China national health survey","volume":"10","author":"Wang","year":"2024","journal-title":"Heliyon"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e229545","DOI":"10.1001\/jamanetworkopen.2022.9545","article-title":"Association of School Education With Eyesight Among Children and Adolescents","volume":"5","author":"Zhang","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1167\/iovs.62.5.3","article-title":"IMI Risk Factors for Myopia","volume":"62","author":"Morgan","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1097\/IAE.0000000000002590","article-title":"Prevalence and Time Trends of Myopia in Children and Adolescents in China: A Systemic Review and Meta-Analysis","volume":"40","author":"Dong","year":"2020","journal-title":"Retina"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7961","DOI":"10.1167\/iovs.12-10402","article-title":"The relationship between growth spurts and myopia in Singapore children","volume":"53","author":"Yip","year":"2012","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1136\/bjo-2021-320940","article-title":"Prevalence of myopia and uncorrected myopia among 721 032 schoolchildren in a city-wide vision screening in southern China: The Shantou Myopia Study","volume":"107","author":"Wang","year":"2023","journal-title":"Br. J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.puhe.2017.11.015","article-title":"Spectacles need and ownership among multiethnic students in rural China","volume":"157","author":"Qian","year":"2018","journal-title":"Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1080\/09286586.2025.2457626","article-title":"Corrected Myopia and Its Association with Mental Health Problems Among Rural Primary School Students in Northwest China","volume":"33","author":"Ding","year":"2026","journal-title":"Ophthalm. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"24244","DOI":"10.1038\/s41598-024-72119-2","article-title":"The association between visual impairment, educational outcomes, and mental health: Insights from eyeglasses usage among junior high school students in rural China","volume":"14","author":"Pang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lyu, P., Shi, J., Wang, J., He, X., and Shi, H. (2025). Optimizing myopia screening referral guidelines for children aged 4 to 18 based on non-cycloplegic indicators. BMC Ophthalmol., 25.","DOI":"10.1186\/s12886-025-04383-3"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Li, N., Jiang, Y., Zhang, X., Huang, W., Zhang, J., Zhang, B., Gao, Z., and Leng, Y. (2026). Combining visual acuity with refraction reduces overestimation of myopia prevalence in school screenings: An age-stratified analysis. Front. Med., 13.","DOI":"10.3389\/fmed.2026.1776604"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3261\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T04:11:52Z","timestamp":1777176712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3261"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093261"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093261","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}