Association Between Myopia and Dental Caries of 385844 School-Aged Children and Adolescents in China: A large scale Cross-Sectional Study

Association Between Myopia and Dental Caries of 385844 School-Aged Children and Adolescents in China: A large scale Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Myopia and Dental Caries of 385844 School-Aged Children and Adolescents in China: A large scale Cross-Sectional Study Weina Liu, Bainan Yang, Pascal Geldsetzer, Till Bärnighausen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6302755/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background : Prevalence of dental caries is increasing among children and adolescents, which can delay growth and development. This study aimed to determine the association between dental caries severity and myopia in a large-scale school-based population in China. Methods : The data from the School-Based Chinese Adolescents Health Survey (SCAHS) were collected for all children and adolescents aged from 6 to 18 years students in Zhejiang Province of China from 2020 to 2023. Multinomial logistic regression models were used to estimate the association between dental caries severity and myopia. Results: All children and adolescents with severe dental caries in primary school (OR = 0.72, 95% CI: 0.50-0.94), middle school (OR = 0.86, 95% CI: 0.79-0.94), and high school (OR = 0.80, 95% CI: 0.67-0.95) were less likely to have high myopia compared to those with no dental caries after adjusting for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of eating sweets, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits. Conclusion: Our study found a significant inverse relationship between severe dental caries and high myopia among chinese students, with the strength of the association varying across different educational stages. These results highlight the potential for integrated public health interventions targeting students with low levels of dental caries but at high risk of myopia. Myopia dental caries children and adolescents cross-sectional study Key Points Dental caries severity is inversely associated with myopia in children and adolescent. Students with a low incidence of dental caries should be pay more attention. Strengthening dental caries prevention and providing targeted support to children with fewer dental caries may facilitate early identification and intervention for myopia. Introduction In recent years, myopia has become a rapidly growing public health issue worldwide. It is projected that by 2050, approximately 49.8% of the global population will be affected by myopia[ 1 ], with China expected to experience a particularly high prevalence rate—51.9% among children and adolescents in 2022[ 2 ]. Myopia not only impacts children's learning and quality of life, but it can also lead to serious complications such as retinal detachment, glaucoma, and even permanent blindness[ 3 ]. Concurrently, dental caries are among the most common oral diseases in school-aged children, affecting approximately 60%-90% of children globally[ 4 ]. In China, the prevalence of dental caries among children and adolescents was 48.11%[ 5 ]. Dental caries not only impact oral health but can also result in pain, malnutrition, decreased school performance and delayed growth and development[ 6 ]. Therefore, the prevention of both myopia and dental caries has become a critical public health challenge in children and adolescents. Although there is no clear evidence that myopia and dental caries are dependent in their pathological mechanisms, they may share certain environmental and behavioral risk factors, such as high-sugar diets, lack of outdoor activities, and prolonged screen time[ 7 , 8 ]. These common risk factors may promote occurrence of both myopia and dental caries through physiological pathways such as glucose metabolism[ 9 ] and oral microbiota metabolism[ 10 , 11 ]. However, existing studies on the direct relationship between myopia and dental caries remain inconclusive. Studying the relationship between dental caries and myopia can provide insights into common behavioral or lifestyle factors influencing both conditions, aiding in the development of more precise prevention strategies. Several investigations[ 12 , 13 ] demonstrated significantly elevated caries risk in myopic children, while other studies [ 14 – 16 ] reported no statistically significant associations. Nevertheless, there was still a lack of large-scale population studies on the link between myopia and dental caries in school-aged children. This study aims to examine the association between myopia and dental caries in a large dataset from the School-Based Chinese Children and Adolescents Health Survey (SCCAHS), which includes all children and adolescents aged 6 to 18 years in the Zhejiang province, China from 2020 to 2023, and to provideevidence basis for the integrated prevention and control of myopia and dental caries in children and adolescents. Methods Study Design and Participants This study was based on data from the School-Based Chinese Adolescents Health Survey (SCAHS), which investigated common diseases and health-related behaviors among adolescents in age 5 to 21years old from 2020 to 2023 in Zhejiang Province of China. A total of 482,650 children and adolescents from 177 schools across 11 cities and regions participated in the SCAHS. In this analysis, we excluded 96,806 participants with missing data on dental caries, myopia, height and weight. The final sample consisted of 385,844 participants. All participants’ data wereanonymized before analyses. In accordance with the principle of voluntary participation, all participants and their legal guardians in this study provided written informed consent. Ethical approval was obtained from the Ethics Review Committee of the Zhejiang Provincial Center for Disease Control and Prevention. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Myopia We defined myopia as a spherical equivalent (SE) of -0.50 diopters (D) or less. Low myopia was defined as an SE between − 0.50 D and − 3.00 D (exclusive of -3.00 D), moderate myopia as an SE between − 3.00 D and − 6.00 D (exclusive of -6.00 D), and high myopia as an SE of -6.00 D or less[ 17 ]. Dental Caries We evaluated decayed, missing, and filled teeth (DMFT) in accordance with World Health Organization (WHO) criteria (WHO, 2013). To quantify the severity of dental caries, the DMFT values were categorized into three levels: low (1–3), moderate (4–6), and high (>7)[ 18 ]. Covariates The covariates included in the model included age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of eating sweets, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits. Statistical analysis We described the baseline characteristics of children and adolescents by each myopia category in Table 1 . The differences in characteristics across normal, low, moderate, and high myopia were assessed using analysis of variance (ANOVA) for continuous variables and \(\:{\chi\:}^{2}\) tests for categorical variables. Prevalence estimates with 95% confidence intervals (CIs) were calculated and adjusted for the complex survey design and nonresponse. To examine the associations between dental caries and myopia, we used a multinomial logistic regression model with dental caries as the independent variable and myopia status as the dependent variable (crude model). Odds ratios (ORs) with 95% CIs were estimated. Model I adjusted for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of sugar-sweetened beverage consumption, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, and eye usage habits, while Model II further adjusted for frequency of eating sweets. The heterogeneous effect of dental caries category was analyzed by school type. We used the statistical software R (version 4.2.3) to conduct all analyses. Results A total of 385,844 participants (mean age: 12.1 ± 3.5 years; 52.3% male) were included in this study. The prevalence of myopia was 72.9% (95% CI: 72.8–73.1%), with 41.4% classified as low myopia, 24.5% as moderate myopia, and 7.0% as high myopia. The proportion of participants with low, morderate, and severe dental caries was as follows: 37.1%, 14.8%, and 6.9%, respectively (Table 1 ). In the total sample, a graded inverse association was observed between dental caries severity and myopia. After adjusting for sugar-sweetened beverage consumption and other covariates (Model 2), severe dental caries remained significantly associated with reduced odds of high myopia [OR = 0.81, 95% CI: 0.71–0.92]. When stratified by school level, the inverse association between dental caries severity and high myopia persisted but varied in the magnitude across school level. In primary school, only severe caries significantly reduced high myopia risk (OR = 0.72, 95% CI: 0.50–0.94), while mild and moderate caries showed no significant associations. Among middle school students, moderate (OR = 0.84, 95% CI: 0.77–0.92) and severe caries (OR = 0.78, 95% CI: 0.61–0.98) were both significantly associated with a lower odd of high myopia. In high school students, even mild caries was associated with reduced high myopia risk (OR = 0.75, 95% CI: 0.69–0.82), with severe caries showing a similar protective trend.(Table 2 ) . Discussion This cross-sectional study found that greater dental caries severity was significantly associated with lower odds of high myopia among school children, while educational stage notably modified this association. Even after comprehensive adjustment for confounders, including sugar-sweetened beverage intake, severe dental caries was independently associated with a reduced likelihood of high myopia—a finding consistent across all school levels, though with varying magnitudes. Our study demonstrated that the severity of dental caries is inversely proportional to the severity of myopia, which was not consistent with previous reports. Some studies found no strong correlation[ 12 ], whereas a recent analysis in young adults found that active dental caries and advanced periodontitis were positively associated with Table 1 Characteristics of the study participants Participants, No.(%) Myopia Characteristic Overall (N = 385,844) Normal (n = 104,440) Low (n = 160,100) Moderate (n = 94,544) High (n = 26,760) Age 12.1 ± 3.5 9.3(2.7) 11.9(3.1) 14.4(2.5) 15.5(2.1) Sex Male 201716(52.3) 58248 (55.8) 83388 (52.1) 46724 (49.4) 13356 (49.9) Female 184128(47.7) 46192 (44.2) 76712 (47.9) 47820 (50.6) 13404 (50.1) RDEL High 113100(29.3) 33348(31.9) 46784(29.2) 26032(27.5) 6936(25.9) Middle 204588(53.0) 53328(51.1) 84384(52.7) 51572(54.5) 15304(57.2) Low 68,156(17.7) 17764(17.0) 28932(18.1) 16940(17.9) 4520(16.9) District Urban 216768(56.2) 57244 (54.8) 87080 (54.4) 56096(59.3) 16348 (61.1) Rural 169076(43.8) 47196 (45.2) 73020 (45.6) 38448 (40.7) 10412 (38.9) School type Primary school 197136 (51.1) 87900 (84.2) 88596 (55.3) 18612 (19.7) 2028 (7.6) Middle school 95976 (24.9) 11192 (10.7) 43048 (26.9) 34168(36.1) 7568 (28.3) High school 92732 (24) 5348(5.1) 28456 (17.8) 41764 (44.2) 17164 (64.1) Dental caries Nomal 158,624(41.1) 35088 (33.6) 66048 (41.3) 44488 (47.1) 13000(48.6) Low 143,192(37.1) 39072(37.4) 61512 (38.4) 33600 (35.5) 9008(33.7) Moderate 57,244(14.8) 18140(17.4) 22936(14.3) 12560(13.3) 3608(13.5) Severe 26,784(6.9) 12140(11.6) 9604(6.0) 3896(4.1) 1144(4.2) Family type Nuclear family 135,704(35.2) 18936(18.1) 57560(36.0) 45464(48.1) 13744(51.4) Non-Nuclear 250,140(64.8) 85504(81.9) 102540(64.0) 49080(51.9) 13016(48.6) Academic pressure No 99208(25.7) 16280(15.6) 45044 (28.1) 29828(31.5) 8056(30.1) Yes 173108(44.9) 24132(23.1) 73140 (45.7) 58344(61.7) 17492(65.4) Poor eye habits No 105996(27.5) 18340(17.6) 49272(30.8) 30240 (32.0) 8144(30.4) Yes 166068(43.0) 21988(21.1) 68792 (43.0) 57880 (61.2) 17408 (65.1) Supportive Environment No 60,520(15.7) 8596 (8.23) 26544 (16.6) 19924 (21.1) 5456(20.4) Yes 211,660(54.9) 31764 (30.4) 91580 (57.2) 68224 (72.2) 20092(75.1) Sugar intake Never 72000(18.7) 11800 (11.3) 32588 (20.4) 21480 (22.7) 6132(22.9) ≤Once per day 184084(47.7) 26732 (25.6) 79172 (49.5) 60732 (64.2) 17448(65.2) >Once per day 17288(4.5) 2100 (2.0) 6972(4.3) 6184 (6.5) 2028(7.6 ) Fried foods Never 63216(16.4) 10680 (10.2) 28476 (17.8) 18764 (19.8) 5296 (19.8) ≤Once per day 199288(51.6) 28740 (27.5) 86036 (53.7) 65500 (69.3) 19012 (71.0) >Once per day 10864(2.8) 1212(1.2) 4220(2.6) 4124(4.4) 1308(4.9) Smoking No 268736(69.6) 40020(38.3) 116832 (73.0) 86744 (91.7) 25140 (93.9) Yes 4596(1.2) 596(0.6) 1884 (1.2) 1640(1.8) 476(1.8) Alcohol No 247360(64.1) 37996 (36.4) 109188 (68.2) 78108 (82.6) 22068 (82.5) Yes 25900(6.7) 2600(2.5) 9492(6.0) 10260(10.9) 3548(13.3) Parental myopia Father 38208(9.9) 5160(5.0) 15656(9.8) 13240(14.0) 4112(15.4) Mother 52260(13.5) 6876(6.6) 21696(13.6) 18180(19.2) 5508(20.6) Both 39236(10.2) 3668(3.5) 14900(9.3) 15052(15.9) 5616(21.0) Neither 142852(37.0) 24756(23.7) 66020(41.2) 41752(44.2) 10324(38.6) Outdoortime < 1hour 74,628(19.3) 10576(10.1) 31240(19.5) 24940(26.4) 7872(29.4) ≥ 1hour 19,7932(51.3) 29896(28.6) 87020(54.4) 63280(66.9) 17684(66.1) Sleep time 8.01 ± 2.54 8.38(1.78) 8.21(2.95) 7.72(2.11) 7.49(2.71) Screen time 1.45 ± 2.27 1.42(2.06) 1.46(2.30) 1.46(2.30) 1.44(2.26) BMI classification Nomal 253104(65.6) 66568 (63.7) 105276 (65.8) 63520 (67.2) 17740 (66.3) Overweight 55,260(14.3) 14884 (14.3) 22496 (14.1) 13636 (14.4) 4244 (16.0) Obese 52,572(13.6) 16264 (15.6) 22508 (14.1) 10848 (11.5) 2952(11.0) Underweight 24908(6.5) 6724 (6.4) 9820 (6.1) 6540(6.9) 1824(6.8) Table 2 Associations of Dental caries With myopia OR(95% CI) Dental caries Total Low Myopia Moderate Myopia High Myopia Total Crude a Model1 b Crude Model1 Model2 Crude Model1 Model2 Crude Model1 Model2 Normal 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Low 0.76(0.73–0.77)* 0.94(0.90–0.99)* 0.84(0.81–0.86)* 0.93(0.89–0.98)* 0.93(0.89–0.98)* 0.67(0.65–0.69)* 0.96(0.91–1.01) 0.96(0.91–1.01) 0.42(0.41–0.43)* 0.80(0.75–0.84)* 0.80(0.75–0.84)* Moderate 0.61(0.60–0.63)* 0.95(0.89- 1.02) 0.68(0.67–0.69)* 0.95(0.89–1.02) 0.95(0.88–1.02) 0.55(0.53–0.57)* 0.95(0.87–1.02) 0.95(0.87–1.02) 0.25(0.24–0.26)* 0.89(0.82–0.96)* 0.89(0.82–0.96)* Severe 0.34(0.33–0.35)* 0.83(0.75–0.93)* 0.62(0.61–0.63)* 0.92(0.82–1.04) 0.92(0.82–1.04) 0.54(0.53–0.55)* 0.93(0.83–1.05) 0.93(0.83–1.05) 0.25( 0.24–0.27)* 0.81(0.71–0.92)* 0.81(0.71–0.92)* Primary school Normal 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Low 0.85(0.82–0.88)* 0.94(0.90–0.99)* 0.80(0.86,0.91)* 0.95(0.91-1.00) 0.95(0.91-1.00) 0.83(0.79–0.86)* 0.94(0.85–1.04) 0.94(0.85–1.04) 0.75(0.68–0.83)* 1.02(0.87–1.19) 1.02(0.87–1.19) Moderate 0.78(0.74–0.82)* 0.89(0.83–0.96)* 0.77(0.73–0.81)* 0.93(0.87-1.00) 0.93(0.87-1.00) 0.67(0.63–0.72)* 0.89(0.83–0.95)* 0.90(0.84–0.95)* 0.52(0.43–0.62)* 1.02(0.77–1.36) 1.03(0.78–1.37) Severe 0.69(0.63–0.76)* 1.05(0.92–1.20) 0.70(0.64–0.77)* 0.83(0.72–0.96)* 0.83(0.73–0.96)* 0.52(0.45–0.59)* 0.69(0.56–0.85)* 0.69(0.56–0.85)* 0.76(0.56–1.02) 0.73(0.52–0.94)* 0.72(0.0.50–0.94)* Middle school Normal 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Low 0.97(0.93–1.01) 0.97(0.91–1.03) 0.98(0.94–1.02) 0.95(0.89–1.01) 0.85(0.89–1.01) 1.00(0.95–1.05) 0.95(0.89–1.01) 0.95(0.89–1.02) 0.86(0.80–0.91)* 1.02(0.90–1.15) 0.79(0.62-1.00) Moderate 1.00(0.94–1.07) 0.95(0.87–1.03) 0.96(0.90–1.03) 0.99(0.91–1.09) 0.99(0.91–1.09) 0.99(0.93–1.06) 0.93(0.84–1.02) 0.93(0.85–1.02) 0.93(0.84–1.01) 0.84(0.77–0.92)* 1.03(0.91–1.17) Severe 0.89(0.80–0.99)* 0.91(0.78–1.07) 0.92(0.82–1.04) 0.97(0.82–1.14) 0.98(0.83–1.15) 1.07(0.95–1.20) 1.04(0.88–1.23) 1.04(0.88–1.23) 0.87(0.74–1.03) 0.78(0.61–0.98)* 0.86(0.79–0.94)* High school Normal 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Low 1.04(0.98–1.11) 0.95(0.87–1.02) 1.03(0,97 − 1.10) 0.94(0.86–1.02) 0.94(0.86–1.02) 1.08(1.01–1.15)* 0.98(0.90–1.07) 0.98(0.91(1.07) 0.98(0.91–1.05) 0.75(0.69–0.82)* 0.75(0.69–0.82)* Moderate 1.08(0.99–1.17) 0.98(0.88–1.09) 1.05(0.97–1.15) 0.96(0.86–1.07) 0.96(0.86–1.07) 1.10(1.01–1.20)* 0.99(0.89–1.11) 1.00(0.89–1.11) 1.09(1.00-1.20) 0.82(0.73–0.92)* 0.82(0.73–0.92)* Severe 1.04(0.91–1.19) 0.79(0.68–0.93)* 1.03(0.90–1.19) 0.93(0.79–1.10) 0.94(0.79–1.11) 1.01(0.88–1.16) 0.93(0.79–1.09) 0.93(0.79–1.09) 1.03(0.89–1.20) 0.80(0.67–0.95)* 0.80(0.67–0.95)* a: Unadjusted logistic regression results. b: Adjusted for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits c: Adjusted for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of sugar-sweetened beverage consumption, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits myopia[ 19 ]. Several potential mechanisms might explain this inverse association. Firstly, dietary factors play a critical role. High sugar intake could increase bloodglucose levels and affect insulin and growth hormone secretion, which may increase Insulin-like Growth Factor-1 (IGF-1) levels[ 20 , 21 ]. When IGF-1 binds to the IGF-1 receptor (IGF-1R) on the cell membrane, it activates signaling pathways such as PI3K/AKT and RAS/MAPK kinases, influencing scleral remodeling and thereby increasing the risk of myopia[ 22 , 23 ]. Children with severe dental caries may adopt dietary changes to alleviate dental discomfort, reducing their sugar intake and, consequently, glycemic load[ 24 , 25 ]. Thus, behavioral adjustments linked to severe caries could inadvertently protect against myopia by limiting hyperglycemia-driven ocular changes. Secondly, the observed inverse relationship between dental caries severity and myopia risk may be partially mediated by socioeconomic and lifestyle-related behavioral patterns. Children from lower socioeconomic backgrounds, who are disproportionately affected by untreated dental caries due to limited access to dental care, may also face reduced exposure to near-vision activities associated with educational engagement [ 26 , 27 ]. Importantly, our study revealed notable age-dependent variations. In primary school children, only severe dental caries significantly lowered the risk of high myopia, whereas in middle and high school students, both moderate and severe caries showed protective effects. This result may be explained by that students in the high school stage might have experienced a longer period of influence from various lifestyle habits. Even in cases of mild or moderate dental caries, the dietary and lifestyle habits they represent (such as higher sugar intake, less outdoor activity, etc.) may have already had a long-term cumulative effect on axial length, ultimately leading to a stronger correlation with myopia. These lifestyle modifications could indirectly lower myopia progression risks, especially in older students who are typically exposed to intensive educational pressures[ 28 , 29 ]. Furthermore, parental differences in health awareness, educational investment, and socioeconomic status may simultaneously influence the occurrence of dental caries and myopia. Severe dental caries might reflect neglect of family oral hygiene and general health management, possibly correlating with lower academic stress, thus reducing the risk of myopia. Several limitations should be noted. Due to the cross-sectional design, causality cannot be inferred. Additionally, unmeasured confounders, such as genetic factors, socioeconomic status, and detailed nutritional intake, could potentially bias the results. Future research, particularly longitudinal studies incorporating objective biomarkers of diet, inflammation, and detailed behavioral assessments, is necessary to clarify the causal nature and underlying mechanisms of the observed associations. In conclusion, our findings highlight a robust inverse relationship between dental caries severity and high myopia in children and adolescents, with significant variations across age groups. Understanding this interplay could provide new insights into integrated public health interventions aimed at students with low levels of dental caries but at high risk of myopia among school-aged populations. Declarations Funding This study was funded by National Natural Science Fundation of China (Grant number 82404291). Conflicts of interest The authors have declared no conflicts of interest. Acknowledgements We are grateful to Zhejiang Provincial Center for Disease Control and Prevention for using these data.They are not responsible for the analysis or interpretation of these data. Ethical approval This research was approved by the institutional review board of Zhejiang Provincial Center for Disease Control and Prevention, and the ethics approval number is 2024-026-01. Our study only had access to deidentified data. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–42. 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BMC Oral Health. 2022;22(1):384. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346(11):802–10. Jeffcoate W. Growth hormone therapy and its relationship to insulin resistance, glucose intolerance and diabetes mellitus: a review of recent evidence. Drug Saf. 2002;25:199–212. Jung HJ, Suh Y. Regulation of IGF-1 signaling by microRNAs. Front Genet. 2015;5:472. Galvis V, López-Jaramillo P, Tello A, Castellanos-Castellanos YA, Camacho PA, Cohen DD, Gómez-Arbeláez D, Merayo-Lloves J. Is myopia another clinical manifestation of insulin resistance? Med Hypotheses. 2016;90:32–40. Morgan IG, Ohno-Matsui K, Saw S-M, Myopia. Lancet. 2012;379(9827):1739–48. Chiu C-J, Taylor A. Dietary hyperglycemia, glycemic index and metabolic retinal diseases. Prog Retin Eye Res. 2011;30(1):18–53. Hu M, Zhou Y, Huang S, Congdon N, Jin L, Wang X, Hogg R, Zhang H, Cun Y, Yang L. Population prevalence of myopia, glasses wear and free glasses acceptance among minority versus Han schoolchildren in China. PLoS ONE. 2019;14(4):e0215660. Li X, Li L, Qin W, Cao Q, Mu X, Liu T, Li Z, Zhang W. Urban living environment and myopia in children. JAMA Netw open. 2023;6(12):e2346999–2346999. Xu L, Li J, Cui T, Hu A, Zheng Y, Li Y, Sun B, Ma B, Jonas J. Visual acuity in northern China in an urban and rural population: the Beijing Eye Study. Br J Ophthalmol. 2005;89(9):1089–93. Yu X. Cultural reproduction: an analysis on the educational difference between the Urban and the Rural in China. J East Chin Norm Univ. 2006;2:18–26. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Sep, 2025 Reviews received at journal 27 May, 2025 Reviews received at journal 23 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers agreed at journal 14 May, 2025 Reviews received at journal 13 May, 2025 Reviewers agreed at journal 13 May, 2025 Reviewers invited by journal 06 May, 2025 Editor assigned by journal 29 Apr, 2025 Editor invited by journal 07 Apr, 2025 Submission checks completed at journal 04 Apr, 2025 First submitted to journal 04 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6302755","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452637367,"identity":"822294d3-29fa-43db-a336-1f74269ca433","order_by":0,"name":"Weina Liu","email":"","orcid":"","institution":"Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Weina","middleName":"","lastName":"Liu","suffix":""},{"id":452637368,"identity":"a017583c-2393-4db7-a2b1-c11a562dbd3e","order_by":1,"name":"Bainan Yang","email":"","orcid":"","institution":"Zhongda Hospital Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Bainan","middleName":"","lastName":"Yang","suffix":""},{"id":452637369,"identity":"27af29e0-35bd-4eaf-83f4-ed3fbcce72e2","order_by":2,"name":"Pascal Geldsetzer","email":"","orcid":"","institution":"Heidelberg University","correspondingAuthor":false,"prefix":"","firstName":"Pascal","middleName":"","lastName":"Geldsetzer","suffix":""},{"id":452637370,"identity":"d159d878-43b4-4405-89fd-57569a0861c7","order_by":3,"name":"Till Bärnighausen","email":"","orcid":"","institution":"Heidelberg University","correspondingAuthor":false,"prefix":"","firstName":"Till","middleName":"","lastName":"Bärnighausen","suffix":""},{"id":452637371,"identity":"f4401ced-d39e-4c3f-b9da-a340bbdd0d0d","order_by":4,"name":"Shiyong Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACPmYGNoYEEEv+YPODDwY2cgS1sMG1SDC3Gc4oSDMmrAWMwFrYG6R5PhxOJKyFnf3Zg4dtNnny0Y0NxjYGzAkM7IePbsDvMB5zg8S2tGLDOwcbHucYsOUx8KSl3SCghU0ise1w4saGxAbjHAOeYgYJHjMCWtifwbVIWxhIJDYQ1sJgBtYyH6hYmsHAgBgtPGYSCefSEjfwHGwz7DFIMGYj5Bd+/uPPJH+U2STOb29//ODHn/9y/OyHj+HVAgaMwKgxOACzl6ByMPgDTC8NxCkdBaNgFIyCEQgAwPFHEkwUQiQAAAAASUVORK5CYII=","orcid":"","institution":"The Fourth Affiliated Hospital of Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shiyong","middleName":"","lastName":"Li","suffix":""},{"id":452637372,"identity":"9389d668-c31c-46bc-8ea3-737710f2660f","order_by":5,"name":"Simiao Chen","email":"","orcid":"","institution":"Heidelberg University","correspondingAuthor":false,"prefix":"","firstName":"Simiao","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-03-25 10:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6302755/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6302755/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82359913,"identity":"93cac100-c6ed-4789-90b1-eadb6fa99401","added_by":"auto","created_at":"2025-05-09 11:34:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":982610,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6302755/v1/6aa5bda7-e5cf-4610-9c36-7c5a00d134e6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Myopia and Dental Caries of 385844 School-Aged Children and Adolescents in China: A large scale Cross-Sectional Study","fulltext":[{"header":"Key Points","content":"\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eDental caries severity is inversely associated with myopia in children and adolescent.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eStudents with a low incidence of dental caries should be pay more attention.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eStrengthening dental caries prevention and providing targeted support to children with fewer dental caries may facilitate early identification and intervention for myopia.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eIn recent years, myopia has become a rapidly growing public health issue worldwide. It is projected that by 2050, approximately 49.8% of the global population will be affected by myopia[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], with China expected to experience a particularly high prevalence rate\u0026mdash;51.9% among children and adolescents in 2022[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Myopia not only impacts children's learning and quality of life, but it can also lead to serious complications such as retinal detachment, glaucoma, and even permanent blindness[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Concurrently, dental caries are among the most common oral diseases in school-aged children, affecting approximately 60%-90% of children globally[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In China, the prevalence of dental caries among children and adolescents was 48.11%[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Dental caries not only impact oral health but can also result in pain, malnutrition, decreased school performance and delayed growth and development[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, the prevention of both myopia and dental caries has become a critical public health challenge in children and adolescents.\u003c/p\u003e \u003cp\u003eAlthough there is no clear evidence that myopia and dental caries are dependent in their pathological mechanisms, they may share certain environmental and behavioral risk factors, such as high-sugar diets, lack of outdoor activities, and prolonged screen time[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These common risk factors may promote occurrence of both myopia and dental caries through physiological pathways such as glucose metabolism[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and oral microbiota metabolism[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, existing studies on the direct relationship between myopia and dental caries remain inconclusive. Studying the relationship between dental caries and myopia can provide insights into common behavioral or lifestyle factors influencing both conditions, aiding in the development of more precise prevention strategies. Several investigations[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] demonstrated significantly elevated caries risk in myopic children, while other studies [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported no statistically significant associations. Nevertheless, there was still a lack of large-scale population studies on the link between myopia and dental caries in school-aged children. This study aims to examine the association between myopia and dental caries in a large dataset from the School-Based Chinese Children and Adolescents Health Survey (SCCAHS), which includes all children and adolescents aged 6 to 18 years in the Zhejiang province, China from 2020 to 2023, and to provideevidence basis for the integrated prevention and control of myopia and dental caries in children and adolescents.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThis study was based on data from the School-Based Chinese Adolescents Health Survey (SCAHS), which investigated common diseases and health-related behaviors among adolescents in age 5 to 21years old from 2020 to 2023 in Zhejiang Province of China. A total of 482,650 children and adolescents from 177 schools across 11 cities and regions participated in the SCAHS. In this analysis, we excluded 96,806 participants with missing data on dental caries, myopia, height and weight. The final sample consisted of 385,844 participants. All participants\u0026rsquo; data wereanonymized before analyses. In accordance with the principle of voluntary participation, all participants and their legal guardians in this study provided written informed consent. Ethical approval was obtained from the Ethics Review Committee of the Zhejiang Provincial Center for Disease Control and Prevention. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMyopia\u003c/h3\u003e\n\u003cp\u003eWe defined myopia as a spherical equivalent (SE) of -0.50 diopters (D) or less. Low myopia was defined as an SE between \u0026minus;\u0026thinsp;0.50 D and \u0026minus;\u0026thinsp;3.00 D (exclusive of -3.00 D), moderate myopia as an SE between \u0026minus;\u0026thinsp;3.00 D and \u0026minus;\u0026thinsp;6.00 D (exclusive of -6.00 D), and high myopia as an SE of -6.00 D or less[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eDental Caries\u003c/h3\u003e\n\u003cp\u003eWe evaluated decayed, missing, and filled teeth (DMFT) in accordance with World Health Organization (WHO) criteria (WHO, 2013). To quantify the severity of dental\u003c/p\u003e \u003cp\u003ecaries, the DMFT values were categorized into three levels: low (1\u0026ndash;3), moderate (4\u0026ndash;6), and high (\u0026gt;7)[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eThe covariates included in the model included age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of eating sweets, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe described the baseline characteristics of children and adolescents by each myopia category in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The differences in characteristics across normal, low, moderate, and high myopia were assessed using analysis of variance (ANOVA) for continuous variables and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\chi\\:}^{2}\\)\u003c/span\u003e\u003c/span\u003e tests for categorical variables. Prevalence estimates with 95% confidence intervals (CIs) were calculated and adjusted for the complex survey design and nonresponse.\u003c/p\u003e \u003cp\u003eTo examine the associations between dental caries and myopia, we used a multinomial logistic regression model with dental caries as the independent variable and myopia status as the dependent variable (crude model). Odds ratios (ORs) with 95% CIs were estimated. Model I adjusted for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of sugar-sweetened beverage consumption, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, and eye usage habits, while Model II further adjusted for frequency of eating sweets. The heterogeneous effect of dental caries category was analyzed by school type. We used the statistical software R (version 4.2.3) to conduct all analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 385,844 participants (mean age: 12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 years; 52.3% male) were included in this study. The prevalence of myopia was 72.9% (95% CI: 72.8\u0026ndash;73.1%), with 41.4% classified as low myopia, 24.5% as moderate myopia, and 7.0% as high myopia. The proportion of participants with low, morderate, and severe dental caries was as follows: 37.1%, 14.8%, and 6.9%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the total sample, a graded inverse association was observed between dental caries severity and myopia. After adjusting for sugar-sweetened beverage consumption and other covariates (Model 2), severe dental caries remained significantly associated with reduced odds of high myopia [OR\u0026thinsp;=\u0026thinsp;0.81, 95% CI: 0.71\u0026ndash;0.92].\u003c/p\u003e \u003cp\u003eWhen stratified by school level, the inverse association between dental caries severity and high myopia persisted but varied in the magnitude across school level. In primary school, only severe caries significantly reduced high myopia risk (OR\u0026thinsp;=\u0026thinsp;0.72, 95% CI: 0.50\u0026ndash;0.94), while mild and moderate caries showed no significant associations. Among middle school students, moderate (OR\u0026thinsp;=\u0026thinsp;0.84, 95% CI: 0.77\u0026ndash;0.92) and severe caries (OR\u0026thinsp;=\u0026thinsp;0.78, 95% CI: 0.61\u0026ndash;0.98) were both significantly associated with a lower odd of high myopia. In high school students, even mild caries was associated with reduced high myopia risk (OR\u0026thinsp;=\u0026thinsp;0.75, 95% CI: 0.69\u0026ndash;0.82), with severe caries showing a similar protective trend.(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e .\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study found that greater dental caries severity was significantly associated with lower odds of high myopia among school children, while educational stage notably modified this association. Even after comprehensive adjustment for confounders, including sugar-sweetened beverage intake, severe dental caries was independently associated with a reduced likelihood of high myopia\u0026mdash;a finding consistent across all school levels, though with varying magnitudes.\u003c/p\u003e\n\u003cp\u003eOur study demonstrated that the severity of dental caries is inversely proportional to the severity of myopia, which was not consistent with previous reports. Some studies found no strong correlation[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e], whereas a recent analysis in young adults found that active dental caries and advanced periodontitis were positively associated with\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of the study participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eParticipants, No.(%) Myopia\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;385,844)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;104,440)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;160,100)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;94,544)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26,760)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.3(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.4(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.5(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e201716(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58248 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83388 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46724 (49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13356 (49.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e184128(47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46192 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76712 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47820 (50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13404 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRDEL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113100(29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33348(31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46784(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26032(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6936(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e204588(53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53328(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84384(52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51572(54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15304(57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68,156(17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17764(17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28932(18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16940(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4520(16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistrict\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e216768(56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57244 (54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87080 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56096(59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16348 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169076(43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47196 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73020 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38448 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10412 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e197136 (51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87900 (84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88596 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18612 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2028 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95976 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11192 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43048 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34168(36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7568 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92732 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5348(5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28456 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41764 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17164 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental caries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNomal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158,624(41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35088 (33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66048 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44488 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13000(48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143,192(37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39072(37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61512 (38.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33600 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9008(33.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57,244(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18140(17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22936(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12560(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3608(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26,784(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12140(11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9604(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3896(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1144(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNuclear family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135,704(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18936(18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57560(36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45464(48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13744(51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-Nuclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e250,140(64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85504(81.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102540(64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49080(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13016(48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003epressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99208(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16280(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45044 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29828(31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8056(30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173108(44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24132(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73140 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58344(61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17492(65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor eye habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105996(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18340(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49272(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30240 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8144(30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166068(43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21988(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68792 (43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57880 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17408 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupportive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60,520(15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8596 (8.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26544 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19924 (21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5456(20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e211,660(54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31764 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91580 (57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68224 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20092(75.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSugar intake\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72000(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11800 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32588 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21480 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6132(22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;Once per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e184084(47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26732 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79172 (49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60732 (64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17448(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Once per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17288(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2100 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6972(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6184 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2028(7.6 )\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFried foods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63216(16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10680 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28476 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18764 (19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5296 (19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;Once per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e199288(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28740 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86036 (53.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65500 (69.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19012 (71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Once per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10864(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1212(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4220(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4124(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1308(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e268736(69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40020(38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e116832 (73.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86744 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25140 (93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4596(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e596(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1884 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1640(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e476(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e247360(64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37996 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109188 (68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78108 (82.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22068 (82.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25900(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2600(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9492(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10260(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3548(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eParental myopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38208(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5160(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15656(9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13240(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4112(15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52260(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6876(6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21696(13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18180(19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5508(20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39236(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3668(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14900(9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15052(15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5616(21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeither\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e142852(37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24756(23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66020(41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41752(44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10324(38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutdoortime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;1hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74,628(19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10576(10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31240(19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24940(26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7872(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;1hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,7932(51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29896(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87020(54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63280(66.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17684(66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.38(1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.21(2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.72(2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.49(2.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eScreen time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.42(2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.46(2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.46(2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.44(2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNomal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e253104(65.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66568 (63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105276 (65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63520 (67.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17740 (66.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55,260(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14884 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22496 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13636 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4244 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52,572(13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16264 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22508 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10848 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2952(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24908(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6724 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9820 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6540(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1824(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAssociations of Dental caries With myopia\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 4.2521%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"11\" style=\"width: 60.6563%;\"\u003e\n \u003cp\u003eOR(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental caries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow Myopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate Myopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh Myopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eCrude\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eModel1\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003eCrude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eModel1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eModel2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eCrude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eModel1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003eModel2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eCrude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eModel1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003eModel2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.76(0.73\u0026ndash;0.77)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.94(0.90\u0026ndash;0.99)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.84(0.81\u0026ndash;0.86)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.89\u0026ndash;0.98)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.89\u0026ndash;0.98)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.67(0.65\u0026ndash;0.69)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.96(0.91\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.96(0.91\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.42(0.41\u0026ndash;0.43)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.80(0.75\u0026ndash;0.84)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.80(0.75\u0026ndash;0.84)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.61(0.60\u0026ndash;0.63)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.89- 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.68(0.67\u0026ndash;0.69)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.89\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.88\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.55(0.53\u0026ndash;0.57)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.87\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.95(0.87\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.25(0.24\u0026ndash;0.26)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.89(0.82\u0026ndash;0.96)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.89(0.82\u0026ndash;0.96)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.34(0.33\u0026ndash;0.35)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.83(0.75\u0026ndash;0.93)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.62(0.61\u0026ndash;0.63)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.92(0.82\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.92(0.82\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.54(0.53\u0026ndash;0.55)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.83\u0026ndash;1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.93(0.83\u0026ndash;1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.25( 0.24\u0026ndash;0.27)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.81(0.71\u0026ndash;0.92)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.81(0.71\u0026ndash;0.92)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary school\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.85(0.82\u0026ndash;0.88)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.94(0.90\u0026ndash;0.99)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.80(0.86,0.91)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.91-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.91-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.83(0.79\u0026ndash;0.86)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.94(0.85\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.94(0.85\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.75(0.68\u0026ndash;0.83)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.02(0.87\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.02(0.87\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.78(0.74\u0026ndash;0.82)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.89(0.83\u0026ndash;0.96)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.77(0.73\u0026ndash;0.81)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.87-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.87-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.67(0.63\u0026ndash;0.72)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.89(0.83\u0026ndash;0.95)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.90(0.84\u0026ndash;0.95)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.52(0.43\u0026ndash;0.62)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.02(0.77\u0026ndash;1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.03(0.78\u0026ndash;1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.69(0.63\u0026ndash;0.76)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.05(0.92\u0026ndash;1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.70(0.64\u0026ndash;0.77)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.83(0.72\u0026ndash;0.96)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.83(0.73\u0026ndash;0.96)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.52(0.45\u0026ndash;0.59)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.69(0.56\u0026ndash;0.85)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.69(0.56\u0026ndash;0.85)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.76(0.56\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.73(0.52\u0026ndash;0.94)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.72(0.0.50\u0026ndash;0.94)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMiddle school\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.97(0.93\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.97(0.91\u0026ndash;1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.98(0.94\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.89\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.85(0.89\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.00(0.95\u0026ndash;1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.89\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.95(0.89\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.86(0.80\u0026ndash;0.91)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.02(0.90\u0026ndash;1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.79(0.62-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.00(0.94\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.87\u0026ndash;1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.96(0.90\u0026ndash;1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.99(0.91\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.99(0.91\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.99(0.93\u0026ndash;1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.84\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.93(0.85\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.84\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.84(0.77\u0026ndash;0.92)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.03(0.91\u0026ndash;1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.89(0.80\u0026ndash;0.99)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.91(0.78\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e0.92(0.82\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.97(0.82\u0026ndash;1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.98(0.83\u0026ndash;1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.07(0.95\u0026ndash;1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.04(0.88\u0026ndash;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e1.04(0.88\u0026ndash;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.87(0.74\u0026ndash;1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.78(0.61\u0026ndash;0.98)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.86(0.79\u0026ndash;0.94)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh school\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.04(0.98\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.95(0.87\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e1.03(0,97\u0026thinsp;\u0026minus;\u0026thinsp;1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.94(0.86\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.94(0.86\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.08(1.01\u0026ndash;1.15)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.98(0.90\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.98(0.91(1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.98(0.91\u0026ndash;1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.75(0.69\u0026ndash;0.82)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.75(0.69\u0026ndash;0.82)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.08(0.99\u0026ndash;1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.98(0.88\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e1.05(0.97\u0026ndash;1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.96(0.86\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.96(0.86\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.10(1.01\u0026ndash;1.20)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.99(0.89\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e1.00(0.89\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.09(1.00-1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.82(0.73\u0026ndash;0.92)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.82(0.73\u0026ndash;0.92)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.2521%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.04(0.91\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.79(0.68\u0026ndash;0.93)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.3083%;\"\u003e\n \u003cp\u003e1.03(0.90\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.79\u0026ndash;1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.94(0.79\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.01(0.88\u0026ndash;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.93(0.79\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8432%;\"\u003e\n \u003cp\u003e0.93(0.79\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e1.03(0.89\u0026ndash;1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.80(0.67\u0026ndash;0.95)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7138%;\"\u003e\n \u003cp\u003e0.80(0.67\u0026ndash;0.95)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003ea: Unadjusted logistic regression results.\u003c/p\u003e\n\u003cp\u003eb: Adjusted for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits\u003c/p\u003e\n\u003cp\u003ec: Adjusted for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of sugar-sweetened beverage consumption, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits\u003c/p\u003e\n\u003cp\u003emyopia[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Several potential mechanisms might explain this inverse association. Firstly, dietary factors play a critical role. High sugar intake could increase bloodglucose levels and affect insulin and growth hormone secretion, which may increase Insulin-like Growth Factor-1 (IGF-1) levels[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. When IGF-1 binds to the IGF-1 receptor (IGF-1R) on the cell membrane, it activates signaling pathways such as PI3K/AKT and RAS/MAPK kinases, influencing scleral remodeling and thereby increasing the risk of myopia[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. Children with severe dental caries may adopt dietary changes to alleviate dental discomfort, reducing their sugar intake and, consequently, glycemic load[\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Thus, behavioral adjustments linked to severe caries could inadvertently protect against myopia by limiting hyperglycemia-driven ocular changes. Secondly, the observed inverse relationship between dental caries severity and myopia risk may be partially mediated by socioeconomic and lifestyle-related behavioral patterns. Children from lower socioeconomic backgrounds, who are disproportionately affected by untreated dental caries due to limited access to dental care, may also face reduced exposure to near-vision activities associated with educational engagement [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eImportantly, our study revealed notable age-dependent variations. In primary school children, only severe dental caries significantly lowered the risk of high myopia, whereas in middle and high school students, both moderate and severe caries showed protective effects. This result may be explained by that students in the high school stage might have experienced a longer period of influence from various lifestyle habits. Even in cases of mild or moderate dental caries, the dietary and lifestyle habits they represent (such as higher sugar intake, less outdoor activity, etc.) may have already had a long-term cumulative effect on axial length, ultimately leading to a stronger correlation with myopia. These lifestyle modifications could indirectly lower myopia progression risks, especially in older students who are typically exposed to intensive educational pressures[\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]. Furthermore, parental differences in health awareness, educational investment, and socioeconomic status may simultaneously influence the occurrence of dental caries and myopia. Severe dental caries might reflect neglect of family oral hygiene and general health management, possibly correlating with lower academic stress, thus reducing the risk of myopia.\u003c/p\u003e\n\u003cp\u003eSeveral limitations should be noted. Due to the cross-sectional design, causality cannot be inferred. Additionally, unmeasured confounders, such as genetic factors, socioeconomic status, and detailed nutritional intake, could potentially bias the results. Future research, particularly longitudinal studies incorporating objective biomarkers of diet, inflammation, and detailed behavioral assessments, is necessary to clarify the causal nature and underlying mechanisms of the observed associations.\u003c/p\u003e\n\u003cp\u003eIn conclusion, our findings highlight a robust inverse relationship between dental caries severity and high myopia in children and adolescents, with significant variations across age groups. Understanding this interplay could provide new insights into integrated public health interventions aimed at students with low levels of dental caries but at high risk of myopia among school-aged populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by National Natural Science Fundation of China (Grant number 82404291).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have declared no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to \u0026nbsp;Zhejiang Provincial Center for Disease Control and Prevention for using these data.They are not responsible for the analysis or interpretation of these data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was approved by the institutional review board of Zhejiang Provincial Center for Disease Control and Prevention, and the ethics approval number is 2024-026-01. Our study only had access to deidentified data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHolden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe overall myopia. rate among children and adolescents has reached 51.9 percent as various regions explore effective prevention and control strategies [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://news.cctv.com/2024/06/19/ARTIjKDAQohqI4TOtiZq7q7B240619.shtml\u003c/span\u003e\u003cspan address=\"https://news.cctv.com/2024/06/19/ARTIjKDAQohqI4TOtiZq7q7B240619.shtml\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkuno Y. Overview of the complications of high myopia. Retina. 2017;37(12):2347\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKassebaum NJ, Smith AG, Bernab\u0026eacute; E, Fleming TD, Reynolds AE, Vos T, Murray C, Marcenes W, Collaborators GOH. 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J Oral Microbiol. 2023;15(1):2213112.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldstein JH, Vukcevich WM, Kaplan D, Paolino J, Diamond HS. Myopia and dental caries. JAMA. 1971;218(10):1572\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirsch MJ, Levin JM. Myopia and dental caries. Optom Vis Sci. 1973;50(6):484\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUstianowska M, Czepita D, Lisiecka K. Does a correlation exist between myopia and dental caries? In: \u003cem\u003eAnnales Academiae Medicae Stetinensis\u003c/em\u003e: 2009; 2009: 20\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdwards M, Chan J. Is there a difference in dental caries between myopic and nonmyopic children? Optom Vis Sci. 1995;72(8):573\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKELLER JT. Evaluation of the relation between myopia and dental caries. Optom Vis Sci. 1978;55(10):661\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYam JC, Tang SM, Kam KW, Chen LJ, Yu M, Law AK, Yip BH, Wang YM, Cheung CY, Ng DS. High prevalence of myopia in children and their parents in Hong Kong Chinese Population: the Hong Kong Children Eye Study. Acta Ophthalmol. 2020;98(5):e639\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOral health surveys-basic methods Geneva. World Health Organization [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/bitstream/handle/10665/97035/9789241548649_eng.pdf?sequence=1]\u003c/span\u003e\u003cspan address=\"https://iris.who.int/bitstream/handle/10665/97035/9789241548649_eng.pdf?sequence=1]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsai K-Z, Liu P-Y, Lin Y-P, Pao S-I, Tai M-C, Chen J-T, Lin G-M. Dental caries and periodontitis and the risk of myopia in young adults: CHIEF oral health study. BMC Oral Health. 2022;22(1):384.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346(11):802\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeffcoate W. Growth hormone therapy and its relationship to insulin resistance, glucose intolerance and diabetes mellitus: a review of recent evidence. Drug Saf. 2002;25:199\u0026ndash;212.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung HJ, Suh Y. Regulation of IGF-1 signaling by microRNAs. Front Genet. 2015;5:472.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalvis V, L\u0026oacute;pez-Jaramillo P, Tello A, Castellanos-Castellanos YA, Camacho PA, Cohen DD, G\u0026oacute;mez-Arbel\u0026aacute;ez D, Merayo-Lloves J. Is myopia another clinical manifestation of insulin resistance? Med Hypotheses. 2016;90:32\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan IG, Ohno-Matsui K, Saw S-M, Myopia. Lancet. 2012;379(9827):1739\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu C-J, Taylor A. Dietary hyperglycemia, glycemic index and metabolic retinal diseases. Prog Retin Eye Res. 2011;30(1):18\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu M, Zhou Y, Huang S, Congdon N, Jin L, Wang X, Hogg R, Zhang H, Cun Y, Yang L. Population prevalence of myopia, glasses wear and free glasses acceptance among minority versus Han schoolchildren in China. PLoS ONE. 2019;14(4):e0215660.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi X, Li L, Qin W, Cao Q, Mu X, Liu T, Li Z, Zhang W. Urban living environment and myopia in children. JAMA Netw open. 2023;6(12):e2346999\u0026ndash;2346999.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu L, Li J, Cui T, Hu A, Zheng Y, Li Y, Sun B, Ma B, Jonas J. Visual acuity in northern China in an urban and rural population: the Beijing Eye Study. Br J Ophthalmol. 2005;89(9):1089\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu X. Cultural reproduction: an analysis on the educational difference between the Urban and the Rural in China. J East Chin Norm Univ. 2006;2:18\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Myopia, dental caries, children and adolescents, cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-6302755/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6302755/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Prevalence of dental caries is increasing among children and adolescents, which can delay growth and development. This study aimed to determine the association between dental caries severity and myopia in a large-scale school-based population in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The data from the School-Based Chinese Adolescents Health Survey (SCAHS) were collected for all children and adolescents aged from 6 to 18 years students in Zhejiang Province of China from 2020 to 2023. Multinomial logistic regression models were used to estimate the association between dental caries severity and myopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e All children and adolescents with severe dental caries in primary school (OR = 0.72, 95% CI: 0.50-0.94), middle school (OR = 0.86, 95% CI: 0.79-0.94),\u003c/p\u003e\n\u003cp\u003eand high school (OR = 0.80, 95% CI: 0.67-0.95) were less likely to have high myopia compared to those with no dental caries after adjusting for age, gender, family structure, academic pressure, regional classification, regional economic level, environmental support, frequency of eating sweets, frequency of eating fried foods, alcohol consumption, smoking status, internet usage time, sleep duration, weight status, parental myopia, outdoor activity time, eye usage habits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eOur study found a significant inverse relationship between severe dental caries and high myopia among chinese students, with the strength of the association varying across different educational stages. These results highlight the potential for integrated public health interventions targeting students with low levels of dental caries but at high risk of myopia.\u003c/p\u003e","manuscriptTitle":"Association Between Myopia and Dental Caries of 385844 School-Aged Children and Adolescents in China: A large scale Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 11:26:37","doi":"10.21203/rs.3.rs-6302755/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-16T04:47:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-27T18:49:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-23T20:19:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233068315473423602796516407491062588518","date":"2025-05-21T15:29:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183627861844101842144471191684420657086","date":"2025-05-14T09:03:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T04:20:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240964389234823840004354346713783233306","date":"2025-05-13T04:09:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-06T10:07:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T17:46:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-07T06:26:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-04T08:11:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-04-04T08:10:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b584b792-6f48-4422-bea5-617ad1599703","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-30T07:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 11:26:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6302755","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6302755","identity":"rs-6302755","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}