ArticleJournal of global health2026
Influence of environmental, economic, dietary, and behavioural factors on high myopia onset in children: a 4-year large-scale cohort study.
Article in Journal of global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: High myopia (HM) has become a major global public health concern, leading to irreversible vision loss and a growing socioeconomic burden. Despite rapid urbanisation and education-driven lifestyle changes, few large-scale longitudinal studies have examined how social and environmental factors interact with children's daily behaviours to influence the progression from myopia to HM. Methods: This 4-year population-based cohort study (2021-2024) included 204,238 students (grades 1-9) with baseline myopia from the TCARE programme. Exposures included area-level socioeconomic status (SES), school-based greenness (1 km normalised difference vegetation index (NDVI)), and behavioural factors (daily outdoor activity > two vs.≤2 hours and three dietary patterns: energy-dense, plant-based, and traditional nutrient-rich). Results: Among 204,238 participants (mean age 10.8 ± 4.7 years), 26,879 (13.2%) developed HMs. Children living in low-SES areas had a 54% greater risk than those living in high-SES areas did (hazard ratio (HR) = 1.54; 95% confidence interval (CI) = 1.49-1.59). Protective factors included outdoor activity >2 hours/d (HR = 0.92; 95% CI = 0.90-0.95) and plant-based diets (HR = 0.97; 95% CI = 0.94-1.00). A higher NDVI was associated with a generally lower risk across outdoor activity levels (HR = 0.90 vs. 0.94 in low-NDVI areas, P = 0.01), whereas low SES was associated with a weaker protective association of outdoor activity (HR = 0.96 vs. 0.89 in high-SES areas, P = 0.03). The strongest protective association was observed among children aged 6-12 years (HR = 0.88; 95% CI = 0.82-0.95). Conclusions: High myopia progression among children is driven primarily by socioeconomic inequities, whereas environmental greenness and outdoor behaviour provide measurable protective effects. Integrating SES-targeted resource allocation, urban greening, and early-life behavioural interventions is crucial for mitigating the paediatric HM epidemic.
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