# Characterisation and risk factors of astigmatism among children and adolescents aged 3–20 years in Northwestern China

## TL;DR

This study finds that astigmatism is very common in children and adolescents in northwestern China, with higher rates in older and male individuals and a need for better early screening.

## Contribution

The study provides new insights into the high prevalence and risk factors of astigmatism in Shaanxi Province, China.

## Key findings

- The overall prevalence of astigmatism was 73.81% among children and adolescents in Shaanxi Province.
- Only 30.73% of those with astigmatism had received refractive correction, with rates increasing with age and education level.
- Older age, male gender, higher education, northern residence, and non-Han ethnicity were identified as independent risk factors for astigmatism.

## Abstract

Astigmatism is a common refractive error in children and adolescents. This study aimed to investigate the prevalence, severity, types, correction status, and associated risk factors of astigmatism among children and adolescents in Shaanxi Province, China.

A cross-sectional study was conducted involving 236 397 children and adolescents aged 3–20 years from Shaanxi Province, selected through multistage stratified cluster random sampling. Demographic information was gathered via structured questionnaires, and refractive status was assessed using an autorefractor without cycloplegia. Astigmatism was defined as cylindrical refractive error ≥0.50 dioptres.

The overall prevalence of astigmatism was 73.81% among the studied population. Age showed a clear positive association with prevalence, which was significantly higher in adolescents compared to younger children. Similar patterns were observed across advancing educational levels. Males showed slightly higher prevalence than females. Geographic distribution revealed a north-to-south gradient, with northern regions having the highest prevalence. Regarding astigmatism types, with-the-rule astigmatism and compound myopic astigmatism were the predominant forms. Only 30.73% of affected subjects had received refractive correction, with correction rates markedly increasing with age and educational level. Multivariate analyses confirmed that older age, higher educational attainment, male gender, northern residence, and non-Han ethnicity were independent risk factors for astigmatism.

Astigmatism prevalence among children in Shaanxi Province is considerably higher than previously reported in other Chinese regions, with significant variations across demographic factors. The low correction rate, particularly among younger children, highlights the need for enhanced early screening and timely intervention programmes to prevent visual function impairment.