Risk factors and protective behaviors identified for myopia in Chinese school studentsFactors that increase or decrease myopia risk in students

To assess the prevalence of myopia and its main influencing factors among Chinese primary and secondary school students using meta-analysis. A meta-analysis was conducted. Databases including CNKI, Wanfang Data, China Biology Medicine Database, PubMed and Web of Science Core Collection were electronically searched to collect cross-sectional studies on influencing factors of myopia in Chinese primary and secondary school students published from January 2013 to October 2024. Two researchers independently screened the literature, extracted data and assessed the methodological quality based on the Agency for Healthcare Research and Quality (AHRQ) criteria. Meta-analysis was performed using Stata 18.0 software to calculate the pooled prevalence and the odds ratios () with 95% confidence intervals () for each influencing factor. Heterogeneity test, publication bias assessment and sensitivity analysis were also conducted. A total of 76 studies were included, covering 31 provinces, autonomous regions and municipalities directly under the Central Government of China, with a cumulative sample size of 1, 823, 018 participants. Eight main influencing factors of myopia were analyzed. The meta-analysis results showed that the risk of myopia in female primary and secondary school students was 1.45 times that in male students (=1.45, 95%:1.29-1.63), and the risk in secondary school students was 4.11 times that in primary school students (=4.11, 95%:3.76-4.50). Parental history of myopia (at least one parent affected), excessive daily use of electronic devices, and incorrect eye use posture were identified as risk factors (<0.05). In contrast, performing eye exercises ≥10 times per week, engaging in outdoor activities ≥ 5 hours per week, and sleeping > 8 hours per day were protective factors (<0.05). Sensitivity analysis indicated that the results were robust. The prevalence of myopia among Chinese primary and secondary school students remains high, and the spectrum of influencing factors exhibits distinct "Chinese context" characteristics: the harm of high-intensity near-work driven by academic pressure far outweighs that of isolated electronic screen exposure, while poor reading and writing postures, specifically deviations from the "One Fist, One Chi, One Cun" standardized posture guidelines, significantly elevate myopia risk. Given that the development of myopia is jointly influenced by genetic, behavioral, and environmental factors, it is recommended that while drawing upon international experiences, we fully leverage the strengths of indigenous institutional advantages, such as Chinese eye exercises, and embed standardized posture education into daily classroom routines. Ultimately, the goal is to construct a "society-school-family" trinity prevention and control system with Chinese characteristics, actively guide primary and secondary school students in cultivating healthy eye-use habits, and further strengthen the implementation intensity of comprehensive myopia intervention measures.