Abnormal spinal curvature and influencing factors in children and adolescents in Hangzhou

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Methods Using a stratified cluster random sampling method, 5,652 students of primary and junior high school from 24 schools were investigated via questionnaires and abnormal spinal curvature screening in Hangzhou. Univariate and multivariate logistic regression were used to screen possible risk factors of abnormal spinal curvature. Results The overall abnormal spinal curvature rate was 2.23%, with the increase of the school period, the prevalence of abnormal spinal curvature among students showing upward trend (χ 2 = 90.679, P <0.001). The abnormal spinal curvature prevalence in boys is higher than that in girls (χ 2 = 0.507, P = 0.477); the prevalence of abnormal spinal curvature in urban students is higher than that in suburban students (χ 2 = 49.954, P <0.001). Accommodation at school is independently associated with higher prevalence of abnormal spinal curvature. Moreover, outdoor activity time ≥ 2h per day in the past one week, overweight, always maintain correct sitting and standing posture are protective factors for abnormal spinal curvature. Conclusions The abnormal spinal curvature prevalence among children and adolescents in Hangzhou is at a relatively low level, and is affected by most factors such as accommodation at school, outdoor activity time, Body Mass Index, sitting and standing posture, needing collaboration of school, students and parents to strengthen screening and prevention. Spinal curvatures Prevalence Regression analysis Child Adolescent Introduction Abnormal Spinal Curvature (ASC) is the curvature of the spine beyond the normal physiological curvature range, mainly including scoliosis and abnormal anterior and posterior curvature of the spine. ASC is one of the major health problems in children and adolescents. Idiopathic scoliosis is the most common, accounting for more than 80%, which with an prevalence of approximately 2%~4% according to international reports [ 1 – 3 ] and 2% ~ 3% in developed countries [ 4 ] . Based on the huge population, inconsistent measurement methods, and uneven technical levels, previous reported scoliosis prevalence among primary and secondary school students in mainland China was generally low, ranging from 0.11–2.64%. A 2014 systematic review involving 697,043 children and adolescents showed that the average scoliosis prevalence in mainland China was 1.02% [ 5 ] . The monitoring results among students nationwide in 2019 showed that the detection rate of ASC in primary and secondary school students was 2.8% [ 6 ] . The meta-analysis of Xu Shuai published in 2021 showed that the positive rate of scoliosis screening in mainland China primary and secondary school students was as high as 4.4% [ 7 ] . In recent years, the ASC detection rate in children and adolescents in China has increased. According to the results of the seventh national census of China in 2020, the total population of children and adolescents aged 0–14 is about 250 million, accounting for 17.95% of China's total population, and there may be a large number of potential scoliosis patients [ 8 ] . Adolescent scoliosis is often underdiagnosed due to lack of professional monitoring [ 9 ] . If not actively treated, it will not only affect the patient's body shape seriously, but also cause abnormal cardiopulmonary function, premature spinal degeneration, idiopathic pain and trunk imbalance and other symptoms, which bring serious impact on the mental and physical health of adolescents [ 10 – 13 ] . Previous studies have emphasized that the scoliosis prevalence is affected by multiple factors, such as age, gender, and even physical and mental factors [ 14 , 15 ] . Furthermore, different from the diagnosis by imaging, primary screening in schools is of great significance for the detection of potentially positive patients, and it can also provide evidence support for the calculation of the sample size of epidemiological surveys and the estimation of prevalence [ 7 ] . With increasing ASC prevalence worldwide in recent years, our goal, therefore, was to conduct an analysis of the ASC prevalence and its influencing factors among children and adolescents in Hangzhou city, which is critical for formulating targeted prevention and control intervention programs thereby reducing the ASC prevalence. Methods Study population Present study is a school-based cross-sectional study. In accordance with the requirements of the “Student Common Diseases and Health Influencing Factors Monitoring and Intervention Project Workbook of 2021”, an investigation was conducted using the stratified cluster random sampling method among 4 districts and counties (2 urban areas and 2 suburban areas) in Hangzhou city from September to November 2021. Specifically, we selected 7 schools (2 primary schools, 2 junior high schools, 1 ordinary high school, and 1 vocational high school) in the urban area; while 5 schools (2 primary schools, 2 junior high schools, and 1 ordinary high school) were selected in the suburban area. In primary schools, junior high schools and high schools, surveys were conducted by class, meanwhile with at least 80 students in each grade. Present effective sample size of the survey is 5,652 (12 students were excluded due to missing questionnaire information), including 1,813 primary school students, 1,910 junior high school students, and 1,929 senior high school students. Present study obtained the informed consent of the respondents themselves or their guardians. Questionnaire surveys Using the special questionnaire about refractive errors, ASC and its influencing factors of students in “The National Student Common Diseases and Health Influencing Factors Monitoring Program (2019 Edition)” issued by National Health Commission of the People’s Republic of China [ 16 ] . The questionnaire covered 41 items, including eyes usage environment, reading and writing posture, situation of outdoor activities and sleep, ASC-related behaviors. In theory, students from grade 4 and above in primary schools participated in the questionnaire survey, students under grade three are filled by their parents. ASC screening methods and judgments Physical examination includes height, weight measurement and screening for ASC, and the screening for ASC is based on the "Screening of abnormal spinal curvature abnormality of children and adolescents" (GB/T 16133 − 2014) [ 17 ] . Through observation and forward flexion test, each segment of the back (thoracic segment, thoracolumbar segment, and lumbar segment) was measured with a scoliometer, and postural scoliosis and postural kyphosis were mainly detected, so that distinguish it from the normal spine and other spinal curvature abnormalities. Sleep situation judgment and overweight screening criteria According to the "Health requirements of daily learning time for secondary and Elementary school students (GB/T 17223 − 2012)" [ 18 ] , the sleep time of primary school students < 10 h, junior high school students' sleep time < 9 h, and high school students' sleep time < 8 h are defined as insufficient sleep. The nutritional status of students was determined according to the Screening Standard for Malnutrition of School-aged Children and Adolescents (WS/T 456–2014) [ 19 ] , and the Screening for Overweight and Obesity among School-aged Children and Adolescents (WS/T 586–2018) [ 20 ] . Quality control Investigators and medical examiners were unified trained by experts invited by Hangzhou Center For Disease Control and Prevention, and has passed the on-site practical examinations. In the on-site investigation, a random sampling of 5% will be used for retesting during the daily testing. It is necessary to study the reasons and improvement measures when the error rate > 5%, and re-test, re-examine and correct the indicators which exceed the allowable error range; if the error rate > 10%, all the test data of the day are invalid and the test must be repeated. The questionnaire survey was carried out by the investigators with the cooperation of the teachers. The returned questionnaires were reviewed, and the questionnaires with many missing items (missing rate > 15%) and logical errors were eliminated. After receiving the questionnaire and physical examination data, each survey site will systematically enter and verify the data, and then feed the data back to the Hangzhou Center for Disease Control and Prevention for data integration. Finally, a unified data verification scheme is formulated by Hangzhou Center for Disease Control and Prevention to ensure the scientific, integrity and accuracy of the survey data. Statistical analysis Statistical description and analyses were conducted using MS Excel and SPPS version 25. Single factor statistical analysis method: enumeration data were described by rate and composition ratio, and the comparison was performed by chi-square test or Fisher probabilities method. Univariate or multivariate logistic regression is used to analyze the occurrence of myopia between different groups. Meanwhile, the odds ratio (OR) and 95% confidence interval (CI) were used to describe and compare the associations between factors at different levels. Statistical tests were declared significant for a two-tailed P value not exceeding 0.05, except where otherwise specified. Results Overall ASC distribution A total of 126 children and adolescents with ASC were detected, and the overall ASC rate was 2.23% (126/5,652), including 0.06% in primary schools (1/1,813), 1.88% in junior high schools (36/1,910), and 4.61% in senior high schools (89/1,929). With the increase of the school period, the prevalence of ASC among students showing upward trend (χ 2 = 90.679, P <0.001). The prevalence of ASC in boys (2.36%, 70/2,963) is higher than that in girls (2.08%, 56/2,689) (χ 2 = 0.507, P = 0.477); ASC prevalence in urban students (3.49%, 108/3,093) is higher than that in suburban students (0.70%, 18/2,559) (χ 2 = 49.954, P <0.001). Classification of ASC Abnormal curvature of the spine is divided into scoliosis (thoracic, thoracolumbar, lumbar) and abnormal anteroposterior curvature of the spine. A total of 124 students with scoliosis were detected, and the detection rate was 2.19%. Among them, the abnormal detection rate of thoracic scoliosis was 1.22% (69 students), thoracolumbar scoliosis was 0.94% (53 students), and the lumbar scoliosis was 1.10% (62 students). Abnormal anteroposterior curvature of the spine was detected in 2 students, with a detection rate of 0.02% (Table 1 ). Table 1 Classification of ASC in children and adolescents Variables Number of students Number of ASC and prevalence (%) Thoracic scoliosis (%) Thoracolumbar scoliosis (%) lumbar scoliosis (%) Abnormal anteroposterior curvature of spine (%) Education Primary school 1813 1 (0.06) 1 (0.06) 0 0 0 Junior high school 1910 36 (1.88) 18 (0.94) 19 (0.99) 16 (0.84) 1 (0.05) Senior high school 1929 89 (4.61) 50 (2.59) 34 (1.76) 46 (2.38) 0 Gender Boys 2963 70 (2.36) 37 (1.25) 35 (1.18) 34 (1.15) 1 (0.03) Girls 2689 56 (2.08) 32 (1.19) 18 (0.67) 28 (1.04) 0 Total 5652 126 (2.23) 69 (1.22) 53 (0.94) 62 (1.10) 1 (0.02) Univariate analysis of related factors of ASC Univariate analysis indicated that school location, accommodation at school, the distance between chest and the edge of the table is more than one fist while reading or writing, the distance between the eyes and book is more than one foot (33cm) while reading or writing, outdoor activity time per day in the past one week, overweight, obesity, class seat swap left and right, requirements for your sitting and standing posture are the influencing factors of ASC in children and adolescents (all P <0.05). The univariate analysis of related factors of ASC are summarized in Table 2 . Table 2 Univariate analysis of related factors of ASC in children and adolescents Influencing factors Number of students Number of ASC (%) Univariate analysis Unadjusted OR (95% CI) Gender Boys 2963 70 (2.36) χ 2 = 0.507, P = 0.477 1 Girls 2689 56 (2.08) 0.88 (0.62–1.25) School location Urban 3093 108 (3.49) χ 2 = 49.954, P <0.001 1 Suburban 2559 18 (0.70) 0.20 (0.12–0.32) Accommodation at school No 3657 59 (1.61) χ 2 = 18.035, P <0.001 1 Yes 1995 67 (3.36) 2.12 (1.49–3.02) Adjusted the height of desks and chairs according to the height of students Never 1139 33 (2.90) χ 2 = 2.920, P = 0.087 1 Regularly 4513 93 (2.06) 0.71 (0.47–1.06) The distance between chest and the edge of the table is more than one fist while reading or writing Never or occasionally 2451 66 (2.69) χ 2 = 4.265, P = 0.039 1 Often or always 3201 60 (1.87) 0.69 (0.49–0.98) The distance between the eyes and book is more than one foot (33cm) while reading or writing Never or occasionally 2368 65 (2.74) χ 2 = 4.971, P = 0.026 1 Often or always 3284 61 (1.86) 0.67 (0.47–0.96) The distance between the finger and the tip is more than 3cm while reading or writing Never or occasionally 2051 50 (2.44) χ 2 = 0.642, P = 0.423 1 Often or always 3601 76 (2.11) 0.86 (0.60–1.24) Teacher reminds the reading and writing posture to be incorrect Never or occasionally 2870 73 (2.54) χ 2 = 2.642, P = 0.104 1 Often or always 2782 53 (1.91) 0.74 (0.52–1.06) Parents reminds the reading and writing posture to be incorrect Never or occasionally 2009 51 (2.54) χ 2 = 1.368, P = 0.242 1 Often or always 3643 75 (2.06) 0.81 (0.56–1.16) Outdoor activity time per day in the past one week <2h 3906 105 (2.69) χ 2 = 12.215, P <0.001 1 ≥ 2h 1746 21 (1.20) 0.44 (0.28–0.71) Sleeping time per day Adequate 1890 39 (2.06) χ 2 = 0.358, P = 0.550 1 Insufficient 3762 87 (2.31) 0.89 (0.61–1.30) Body Mass Index (BMI) Normal 3704 97 (2.62) χ 2 = 8.414, P = 0.038 1 Emaciation 327 7 (2.14) 0.81 (0.38–1.77) Overweight 943 14 (1.48) 0.75 (0.56–0.99) Obesity 678 8 (1.18) 0.76 (0.60–0.97) Habit of endorsement package On the back 4991 115 (2.30) χ 2 = 1.097, P = 0.295 1 On one side/chest 661 11 (1.66) 0.72 (0.38–1.34) Bag weight Light 1377 27 (1.96) χ 2 = 4.031, P = 0.133 1 Medium 3147 65 (2.07) 1.06 (0.67–1.66) Heavy 1128 34 (3.01) 1.55 (0.93–2.59) Class seat swap left and right No 1216 17 (1.40) χ 2 = 4.912, P = 0.027 1 Yes 4436 109 (2.46) 1.78 (1.06–2.97) Mattress softness Moderate 4541 97 (2.14) χ 2 = 1.462, P = 0.481 1 Soft 529 12 (2.27) 1.06 (0.58–1.95) Hard 582 17 (2.92) 1.38 (0.82–2.33) Situation of left and right sole wear No difference 5279 119 (2.25) χ 2 = 0.228, P = 0.633 1 Severely worn on one side 373 7 (1.88) 0.83 (0.38–1.79) Situation of inside and outside sole wear No difference 4809 109 (2.27) χ 2 = 0.206, P = 0.650 1 Severely worn on one side 843 17 (2.02) 0.89 (0.53–1.49) Requirements for your sitting and standing posture No requirement, just be comfortable 3562 101 (2.84) χ 2 = 16.240, P <0.001 1 Always maintain correct posture 2090 25 (1.20) 0.42 (0.27–0.65) OR: odds ratio; CI: confidence interval. Multiple logistic regression analysis of related factors of ASC Taking ASC as dependent variable, the statistically significant factors in the univariate analysis as independent variables into the binary logistic regression model. The results showed that, accommodation at school is significantly increase the risk of ASC in students. However, school in suburban, outdoor activity time ≥ 2h per day in the past one week, overweight, always maintain correct sitting and standing posture are protective factors for ASC in children and adolescents. The multiple logistic regression analysis of related factors are summarized in Table 3 . Table 3 Multiple logistic regression analysis of influencing factors of ASC in students Influencing factors Wald χ 2 value P Unadjusted OR (95% CI) School in suburban 40.955 <0.001 0.18 (0.11–0.31) Accommodation at school 25.917 <0.001 2.68 (1.83–3.92) The distance between chest and the edge of the table is more than one fist while reading or writing 0.150 0.698 0.91 (0.56–1.47) The distance between the eyes and book is more than one foot (33cm) while reading or writing 0.046 0.830 1.05 (0.65–1.70) Outdoor activity time ≥ 2h per day in the past one week 4.987 0.026 0.56 (0.34–0.93) Body Mass Index (overweight) 4.580 0.032 0.54 (0.31–0.95) Body Mass Index (obesity) 3.701 0.054 0.49 (0.24–1.01) Class seat swap left and right 2.329 0.127 1.52 (0.89–2.61) Always maintain correct sitting and standing posture 4.383 0.036 0.60 (0.37–0.97) OR: odds ratio; CI: confidence interval. Discussion ASC is one of the common diseases that endanger the health of children and adolescents. In severe cases, it can cause chest deformity, affect the pulmonary function system, and increase the risk of shortness of breath [ 21 , 22 ] . Severe abnormal curvature of the spine is one of the important reasons for the restriction of students' professional registration (such as college entrance examination, mining, sailing, etc.) and the unqualified military medical examination. Present study shows that the detection rate of ASC among students in Hangzhou was 2.23%, which is lower than the results of the meta-analysis of Xu Shuai and the survey results of Qi deyun and Sun yunfen [ 7 , 23 , 24 ] . Specifically, senior high school students with the highest detection rate (4.61%), and primary school students had the lowest detection rate (0.06%), which were mainly related to the rapid growth of height, more organic components in bones while relatively insufficient calcium and phosphorus content, Immature muscles and ligaments around the spine, and have a heavy learning burden so that habitual have poor sitting posture. The prevalence of ASC in girls is lower than that in boys, which is inconsistent with domestic research results [ 7 , 23 ] . But the gender difference was not statistically significant. It suggests that in addition to being related to muscle and ligaments tension on both sides of the spine, scoliosis is also affected by exercise time, nutritional status, reading or electronic screen posture [ 25 ] . Present survey found that emaciation students had the highest detection rate of ASC at 2.14%, and being overweight was a protective factor for ASC, which is different from Maria's findings [ 26 ] . Accommodation at school increases the risk of ASC, while always maintain correct sitting and standing posture can effectively reduce the incidence of scoliosis. The length of time spent outdoors during the day also affected the prevalence of ASC, with the longer the outdoor activity, the lower the incidence of ASC. Present study did not find the relationship between ASC and students' backpacks, mattress softness, and shoes sole wear. This may be related to reporting bias caused by the fact that the questionnaires were self-reported by the respondents, and needing further research. Generally speaking, ASC is the result of a variety of factors. In addition to genetic factors, from the internal factors, many children have picky eaters or partial eclipses, and the unbalanced nutrition can easily lead to ASC. Besides, incorrect reading and writing posture, prolonged use of electronic products, heavy load on schoolbags and insufficient time on outdoor exercise are also important reasons for ASC [ 27 – 29 ] . Judging from external factors, there are many students living in school dormitories, causing parents cannot supervise at any time. Educational tasks are becoming more and more onerous, and students are under great learning pressure [ 30 ] . Furthermore, there is still a certain gap between the actual situation of teaching environment and living environment and the national standard. At present, most scoliosis patients in clinic have a late time to seek medical treatment, which leads to increased treatment difficulty, increased treatment cost, and poor treatment effect [ 13 ] . Therefore, early detection, early diagnosis, and early treatment are with great significance for scoliosis patients and the society [ 31 ] . The prevention and control of ASC in children and adolescents cannot only rely on the unilateral strength of families, schools or individuals, but a systematic project. It is necessary to form a joint effort of individuals, families, schools, medical institutions, government agencies, and society to jointly manage and jointly build a friendly environment that protects the spine of children and adolescents [ 32 ] . For example, the ASC should be listed as a routine item of students' physical examination for early detection, early diagnosis and early intervention. Parents should urge students to develop correct body posture and correct bad posture in time, encourage children to bask in the sun, strengthen outdoor activities, provide high-quality dietary nutrition, improve bone density and enhance spinal stability. Once ASC is found, seek medical attention as soon as possible. The whole society should fully understand the harm and complexity of ASC in children and adolescents, integrate the health of children and adolescents into all policies, and escort the spine health of children and adolescents. Conclusions In conclusion, our study found that ASC is very common in school-aged students, reaching alarming high in senior high school students. Increasing grade and higher school workload were associated with higher ASC prevalence. Health departments, governments, school and parents should be jointly participate in the formulation of the intervention strategies to prevent or slow down the progression of myopia. Declarations Acknowledgments The authors would like to thank the editors, reviewers for their suggestions, all of the participants for their cooperation, and all colleagues working in Department of Health Hazard Factors Monitoring, Hangzhou Center For Disease Control and Prevention. Ethics approval and consent to participate This study was approved by the Medical Ethics Clerks Association of Hangzhou Center for Disease Control and Prevention (approval no.2022-HS07). we certify that the study was performed in accordance with the 1964 declaration of HELSINKI and later amendments. Written informed consent was obtained from all participants themselves and their guardians prior to the enrollment of this study. Consent for publication Not applicable. Availability of Data and Materials Data cannot be shared publicly because of contains a wealth of data on adolescent health. Data are available from the corresponding author on reasonable request for researchers who meet the criteria for access to confidential data. Funding This work was supported by the Medical and Health Science and Technology Project of Hangzhou (grant number: A20220246). Conflict of Interest The authors declare that they have no conflict of interest. References Yilmaz H, Zateri C, Kusvuran OA, et al. 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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-3844968","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267971074,"identity":"bfad83d2-49be-41d7-bf6d-bc3578523269","order_by":0,"name":"Lijuan Zhao","email":"","orcid":"","institution":"Hangzhou Center For Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Lijuan","middleName":"","lastName":"Zhao","suffix":""},{"id":267971075,"identity":"8fdd096b-1df1-4b75-b218-7f66547d0efa","order_by":1,"name":"Xiujun Jiang","email":"","orcid":"","institution":"Fuyang College","correspondingAuthor":false,"prefix":"","firstName":"Xiujun","middleName":"","lastName":"Jiang","suffix":""},{"id":267971076,"identity":"6887e8b3-b33f-4b84-b9f4-973ba3fd344d","order_by":2,"name":"Wenhui Zhang","email":"","orcid":"","institution":"Hangzhou Center For Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Wenhui","middleName":"","lastName":"Zhang","suffix":""},{"id":267971077,"identity":"ad4832ee-c595-43d2-8835-6a08a432b587","order_by":3,"name":"Li Hao","email":"","orcid":"","institution":"Hangzhou Center For Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Hao","suffix":""},{"id":267971078,"identity":"c6410563-b9b8-4c18-8b46-98558d3d2909","order_by":4,"name":"Shangxi Wu","email":"","orcid":"","institution":"Hangzhou Center For Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Shangxi","middleName":"","lastName":"Wu","suffix":""},{"id":267971079,"identity":"7296a9b1-3659-498b-9fa5-751a5be54278","order_by":5,"name":"Yuting Zhang","email":"","orcid":"","institution":"Hangzhou Center For Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Yuting","middleName":"","lastName":"Zhang","suffix":""},{"id":267971080,"identity":"67d3200b-5d1d-4156-a647-acf01a143985","order_by":6,"name":"Hong Xu","email":"","orcid":"","institution":"Hangzhou Center For Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Xu","suffix":""},{"id":267971081,"identity":"0afe4132-ea68-4214-85e7-6ba4d6ae9eb8","order_by":7,"name":"Bing Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACAyCWYGyQAFI8DAwfDGzsSNPCOKMgLZlYLQxgLcw8Hw5B2PiAOf/hhzd+7rDIk/c/e0zaxuAAMwP74aMb8GmxbDhmbNl7RqLY8MC5NOkcgzt8DDxpaTfwOuxgD5s0Y5tE4sbGHjOglmfMDBI8Zvi1HOaBamnmMZO2MDgMDApCWo5BtcxnA2phIErLGTawXxI38PAYW/YYpCWzEfTLeXCI1SXO7z9jeOPHHxs7fvbDx/BqQeg9AGWwEaUcBOQbiFY6CkbBKBgFIw0AADebRzt8hnBuAAAAAElFTkSuQmCC","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":true,"prefix":"","firstName":"Bing","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2024-01-08 09:14:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3844968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3844968/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-22883-1","type":"published","date":"2025-05-13T15:58:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83067860,"identity":"1f19ab29-ad90-47cf-9efc-e9415fc027e3","added_by":"auto","created_at":"2025-05-19 16:07:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1029633,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3844968/v1/f0f1c781-04e5-4df3-a812-14a5ead1a271.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Abnormal spinal curvature and influencing factors in children and adolescents in Hangzhou","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAbnormal Spinal Curvature (ASC) is the curvature of the spine beyond the normal physiological curvature range, mainly including scoliosis and abnormal anterior and posterior curvature of the spine. ASC is one of the major health problems in children and adolescents. Idiopathic scoliosis is the most common, accounting for more than 80%, which with an prevalence of approximately 2%~4% according to international reports \u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e and 2% ~ 3% in developed countries \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Based on the huge population, inconsistent measurement methods, and uneven technical levels, previous reported scoliosis prevalence among primary and secondary school students in mainland China was generally low, ranging from 0.11\u0026ndash;2.64%. A 2014 systematic review involving 697,043 children and adolescents showed that the average scoliosis prevalence in mainland China was 1.02% \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The monitoring results among students nationwide in 2019 showed that the detection rate of ASC in primary and secondary school students was 2.8% \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. The meta-analysis of Xu Shuai published in 2021 showed that the positive rate of scoliosis screening in mainland China primary and secondary school students was as high as 4.4% \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn recent years, the ASC detection rate in children and adolescents in China has increased. According to the results of the seventh national census of China in 2020, the total population of children and adolescents aged 0\u0026ndash;14 is about 250\u0026nbsp;million, accounting for 17.95% of China's total population, and there may be a large number of potential scoliosis patients \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Adolescent scoliosis is often underdiagnosed due to lack of professional monitoring \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. If not actively treated, it will not only affect the patient's body shape seriously, but also cause abnormal cardiopulmonary function, premature spinal degeneration, idiopathic pain and trunk imbalance and other symptoms, which bring serious impact on the mental and physical health of adolescents \u003csup\u003e[\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrevious studies have emphasized that the scoliosis prevalence is affected by multiple factors, such as age, gender, and even physical and mental factors \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Furthermore, different from the diagnosis by imaging, primary screening in schools is of great significance for the detection of potentially positive patients, and it can also provide evidence support for the calculation of the sample size of epidemiological surveys and the estimation of prevalence \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. With increasing ASC prevalence worldwide in recent years, our goal, therefore, was to conduct an analysis of the ASC prevalence and its influencing factors among children and adolescents in Hangzhou city, which is critical for formulating targeted prevention and control intervention programs thereby reducing the ASC prevalence.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003ePresent study is a school-based cross-sectional study. In accordance with the requirements of the \u0026ldquo;Student Common Diseases and Health Influencing Factors Monitoring and Intervention Project Workbook of 2021\u0026rdquo;, an investigation was conducted using the stratified cluster random sampling method among 4 districts and counties (2 urban areas and 2 suburban areas) in Hangzhou city from September to November 2021. Specifically, we selected 7 schools (2 primary schools, 2 junior high schools, 1 ordinary high school, and 1 vocational high school) in the urban area; while 5 schools (2 primary schools, 2 junior high schools, and 1 ordinary high school) were selected in the suburban area. In primary schools, junior high schools and high schools, surveys were conducted by class, meanwhile with at least 80 students in each grade. Present effective sample size of the survey is 5,652 (12 students were excluded due to missing questionnaire information), including 1,813 primary school students, 1,910 junior high school students, and 1,929 senior high school students. Present study obtained the informed consent of the respondents themselves or their guardians.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire surveys\u003c/h2\u003e \u003cp\u003eUsing the special questionnaire about refractive errors, ASC and its influencing factors of students in \u0026ldquo;The National Student Common Diseases and Health Influencing Factors Monitoring Program (2019 Edition)\u0026rdquo; issued by National Health Commission of the People\u0026rsquo;s Republic of China \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. The questionnaire covered 41 items, including eyes usage environment, reading and writing posture, situation of outdoor activities and sleep, ASC-related behaviors. In theory, students from grade 4 and above in primary schools participated in the questionnaire survey, students under grade three are filled by their parents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eASC screening methods and judgments\u003c/h2\u003e \u003cp\u003ePhysical examination includes height, weight measurement and screening for ASC, and the screening for ASC is based on the \"Screening of abnormal spinal curvature abnormality of children and adolescents\" (GB/T 16133\u0026thinsp;\u0026minus;\u0026thinsp;2014) \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Through observation and forward flexion test, each segment of the back (thoracic segment, thoracolumbar segment, and lumbar segment) was measured with a scoliometer, and postural scoliosis and postural kyphosis were mainly detected, so that distinguish it from the normal spine and other spinal curvature abnormalities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSleep situation judgment and overweight screening criteria\u003c/h2\u003e \u003cp\u003eAccording to the \"Health requirements of daily learning time for secondary and Elementary school students (GB/T 17223\u0026thinsp;\u0026minus;\u0026thinsp;2012)\" \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, the sleep time of primary school students\u0026thinsp;\u0026lt;\u0026thinsp;10 h, junior high school students' sleep time\u0026thinsp;\u0026lt;\u0026thinsp;9 h, and high school students' sleep time\u0026thinsp;\u0026lt;\u0026thinsp;8 h are defined as insufficient sleep. The nutritional status of students was determined according to the Screening Standard for Malnutrition of School-aged Children and Adolescents (WS/T 456\u0026ndash;2014) \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, and the Screening for Overweight and Obesity among School-aged Children and Adolescents (WS/T 586\u0026ndash;2018) \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eQuality control\u003c/h2\u003e \u003cp\u003eInvestigators and medical examiners were unified trained by experts invited by Hangzhou Center For Disease Control and Prevention, and has passed the on-site practical examinations. In the on-site investigation, a random sampling of 5% will be used for retesting during the daily testing. It is necessary to study the reasons and improvement measures when the error rate \u0026gt; 5%, and re-test, re-examine and correct the indicators which exceed the allowable error range; if the error rate \u0026gt; 10%, all the test data of the day are invalid and the test must be repeated. The questionnaire survey was carried out by the investigators with the cooperation of the teachers. The returned questionnaires were reviewed, and the questionnaires with many missing items (missing rate\u0026thinsp;\u0026gt;\u0026thinsp;15%) and logical errors were eliminated. After receiving the questionnaire and physical examination data, each survey site will systematically enter and verify the data, and then feed the data back to the Hangzhou Center for Disease Control and Prevention for data integration. Finally, a unified data verification scheme is formulated by Hangzhou Center for Disease Control and Prevention to ensure the scientific, integrity and accuracy of the survey data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical description and analyses were conducted using MS Excel and SPPS version 25. Single factor statistical analysis method: enumeration data were described by rate and composition ratio, and the comparison was performed by chi-square test or Fisher probabilities method. Univariate or multivariate logistic regression is used to analyze the occurrence of myopia between different groups. Meanwhile, the odds ratio (OR) and 95% confidence interval (CI) were used to describe and compare the associations between factors at different levels. Statistical tests were declared significant for a two-tailed \u003cem\u003eP\u003c/em\u003e value not exceeding 0.05, except where otherwise specified.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eOverall ASC distribution\u003c/h2\u003e \u003cp\u003eA total of 126 children and adolescents with ASC were detected, and the overall ASC rate was 2.23% (126/5,652), including 0.06% in primary schools (1/1,813), 1.88% in junior high schools (36/1,910), and 4.61% in senior high schools (89/1,929). With the increase of the school period, the prevalence of ASC among students showing upward trend (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;90.679, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). The prevalence of ASC in boys (2.36%, 70/2,963) is higher than that in girls (2.08%, 56/2,689) (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.507, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.477); ASC prevalence in urban students (3.49%, 108/3,093) is higher than that in suburban students (0.70%, 18/2,559) (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;49.954, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClassification of ASC\u003c/h2\u003e \u003cp\u003eAbnormal curvature of the spine is divided into scoliosis (thoracic, thoracolumbar, lumbar) and abnormal anteroposterior curvature of the spine. A total of 124 students with scoliosis were detected, and the detection rate was 2.19%. Among them, the abnormal detection rate of thoracic scoliosis was 1.22% (69 students), thoracolumbar scoliosis was 0.94% (53 students), and the lumbar scoliosis was 1.10% (62 students). Abnormal anteroposterior curvature of the spine was detected in 2 students, with a detection rate of 0.02% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification of ASC in children and adolescents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of students\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of ASC and prevalence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThoracic scoliosis (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThoracolumbar scoliosis (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003elumbar scoliosis (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAbnormal anteroposterior curvature of spine (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (1.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (4.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50 (2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (1.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46 (2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (0.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56 (2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32 (1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126 (2.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69 (1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 (0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62 (1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (0.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate analysis of related factors of ASC\u003c/h2\u003e \u003cp\u003eUnivariate analysis indicated that school location, accommodation at school, the distance between chest and the edge of the table is more than one fist while reading or writing, the distance between the eyes and book is more than one foot (33cm) while reading or writing, outdoor activity time per day in the past one week, overweight, obesity, class seat swap left and right, requirements for your sitting and standing posture are the influencing factors of ASC in children and adolescents (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The univariate analysis of related factors of ASC are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of related factors of ASC in children and adolescents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfluencing factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of students\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of ASC (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.507,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.477\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56 (2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88 (0.62\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (3.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;49.954,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (0.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.20 (0.12\u0026ndash;0.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccommodation at school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (1.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;18.035,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (3.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.12 (1.49\u0026ndash;3.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAdjusted the height of desks and chairs according to the height of students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (2.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.920,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.087\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71 (0.47\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe distance between chest and the edge of the table is more than one fist while reading or writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever or occasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.265,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften or always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69 (0.49\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe distance between the eyes and book is more than one foot (33cm) while reading or writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever or occasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65 (2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.971,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften or always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61 (1.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67 (0.47\u0026ndash;0.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe distance between the finger and the tip is more than 3cm while reading or writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever or occasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (2.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.642,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.423\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften or always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86 (0.60\u0026ndash;1.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher reminds the reading and writing posture to be incorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever or occasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.642,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.104\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften or always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74 (0.52\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents reminds the reading and writing posture to be incorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever or occasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.368,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.242\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften or always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81 (0.56\u0026ndash;1.16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOutdoor activity time per day in the past one week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;2h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105 (2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.215,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44 (0.28\u0026ndash;0.71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleeping time per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.358,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.550\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89 (0.61\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97 (2.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;8.414,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmaciation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81 (0.38\u0026ndash;1.77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75 (0.56\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76 (0.60\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHabit of endorsement package\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn the back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115 (2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.097,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.295\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn one side/chest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72 (0.38\u0026ndash;1.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBag weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.031,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.133\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65 (2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06 (0.67\u0026ndash;1.66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeavy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (3.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.55 (0.93\u0026ndash;2.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass seat swap left and right\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.912,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109 (2.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.78 (1.06\u0026ndash;2.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMattress softness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97 (2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.462,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.481\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06 (0.58\u0026ndash;1.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (2.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.38 (0.82\u0026ndash;2.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSituation of left and right sole wear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119 (2.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.228,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.633\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverely worn on one side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.83 (0.38\u0026ndash;1.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSituation of inside and outside sole wear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109 (2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.206,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.650\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverely worn on one side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89 (0.53\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRequirements for your sitting and standing posture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo requirement, just be comfortable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101 (2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;16.240,\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways maintain correct posture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42 (0.27\u0026ndash;0.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOR: odds ratio; CI: confidence interval.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultiple logistic regression analysis of related factors of ASC\u003c/h2\u003e \u003cp\u003eTaking ASC as dependent variable, the statistically significant factors in the univariate analysis as independent variables into the binary logistic regression model. The results showed that, accommodation at school is significantly increase the risk of ASC in students. However, school in suburban, outdoor activity time\u0026thinsp;\u0026ge;\u0026thinsp;2h per day in the past one week, overweight, always maintain correct sitting and standing posture are protective factors for ASC in children and adolescents. The multiple logistic regression analysis of related factors are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple logistic regression analysis of influencing factors of ASC in students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfluencing factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWald χ\u003csup\u003e2\u003c/sup\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnadjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool in suburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40.955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.18 (0.11\u0026ndash;0.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccommodation at school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.68 (1.83\u0026ndash;3.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe distance between chest and the edge of the table is more than one fist while reading or writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91 (0.56\u0026ndash;1.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe distance between the eyes and book is more than one foot (33cm) while reading or writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05 (0.65\u0026ndash;1.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutdoor activity time\u0026thinsp;\u0026ge;\u0026thinsp;2h per day in the past one week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.56 (0.34\u0026ndash;0.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mass Index (overweight)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.54 (0.31\u0026ndash;0.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mass Index (obesity)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.49 (0.24\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass seat swap left and right\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.52 (0.89\u0026ndash;2.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways maintain correct sitting and standing posture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.60 (0.37\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOR: odds ratio; CI: confidence interval.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eASC is one of the common diseases that endanger the health of children and adolescents. In severe cases, it can cause chest deformity, affect the pulmonary function system, and increase the risk of shortness of breath \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Severe abnormal curvature of the spine is one of the important reasons for the restriction of students' professional registration (such as college entrance examination, mining, sailing, etc.) and the unqualified military medical examination.\u003c/p\u003e \u003cp\u003ePresent study shows that the detection rate of ASC among students in Hangzhou was 2.23%, which is lower than the results of the meta-analysis of Xu Shuai and the survey results of Qi deyun and Sun yunfen \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Specifically, senior high school students with the highest detection rate (4.61%), and primary school students had the lowest detection rate (0.06%), which were mainly related to the rapid growth of height, more organic components in bones while relatively insufficient calcium and phosphorus content, Immature muscles and ligaments around the spine, and have a heavy learning burden so that habitual have poor sitting posture. The prevalence of ASC in girls is lower than that in boys, which is inconsistent with domestic research results \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. But the gender difference was not statistically significant. It suggests that in addition to being related to muscle and ligaments tension on both sides of the spine, scoliosis is also affected by exercise time, nutritional status, reading or electronic screen posture \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePresent survey found that emaciation students had the highest detection rate of ASC at 2.14%, and being overweight was a protective factor for ASC, which is different from Maria's findings \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Accommodation at school increases the risk of ASC, while always maintain correct sitting and standing posture can effectively reduce the incidence of scoliosis. The length of time spent outdoors during the day also affected the prevalence of ASC, with the longer the outdoor activity, the lower the incidence of ASC. Present study did not find the relationship between ASC and students' backpacks, mattress softness, and shoes sole wear. This may be related to reporting bias caused by the fact that the questionnaires were self-reported by the respondents, and needing further research.\u003c/p\u003e \u003cp\u003eGenerally speaking, ASC is the result of a variety of factors. In addition to genetic factors, from the internal factors, many children have picky eaters or partial eclipses, and the unbalanced nutrition can easily lead to ASC. Besides, incorrect reading and writing posture, prolonged use of electronic products, heavy load on schoolbags and insufficient time on outdoor exercise are also important reasons for ASC \u003csup\u003e[\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Judging from external factors, there are many students living in school dormitories, causing parents cannot supervise at any time. Educational tasks are becoming more and more onerous, and students are under great learning pressure \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Furthermore, there is still a certain gap between the actual situation of teaching environment and living environment and the national standard.\u003c/p\u003e \u003cp\u003eAt present, most scoliosis patients in clinic have a late time to seek medical treatment, which leads to increased treatment difficulty, increased treatment cost, and poor treatment effect \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Therefore, early detection, early diagnosis, and early treatment are with great significance for scoliosis patients and the society \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. The prevention and control of ASC in children and adolescents cannot only rely on the unilateral strength of families, schools or individuals, but a systematic project. It is necessary to form a joint effort of individuals, families, schools, medical institutions, government agencies, and society to jointly manage and jointly build a friendly environment that protects the spine of children and adolescents \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. For example, the ASC should be listed as a routine item of students' physical examination for early detection, early diagnosis and early intervention. Parents should urge students to develop correct body posture and correct bad posture in time, encourage children to bask in the sun, strengthen outdoor activities, provide high-quality dietary nutrition, improve bone density and enhance spinal stability. Once ASC is found, seek medical attention as soon as possible. The whole society should fully understand the harm and complexity of ASC in children and adolescents, integrate the health of children and adolescents into all policies, and escort the spine health of children and adolescents.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, our study found that ASC is very common in school-aged students, reaching alarming high in senior high school students. Increasing grade and higher school workload were associated with higher ASC prevalence. Health departments, governments, school and parents should be jointly participate in the formulation of the intervention strategies to prevent or slow down the progression of myopia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the editors, reviewers for their suggestions, all of the participants for their cooperation, and all colleagues working in Department of Health Hazard Factors Monitoring, Hangzhou Center For Disease Control and Prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Clerks Association of Hangzhou Center for Disease Control and Prevention (approval no.2022-HS07). we certify that the study was performed in accordance with the 1964 declaration of HELSINKI and later amendments. Written informed consent was obtained from all participants themselves and their guardians prior to the enrollment of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData cannot be shared publicly because of contains a wealth of data on adolescent health. Data are available from the corresponding author on reasonable request for researchers who meet the criteria for access to confidential data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Medical and Health Science and Technology Project of Hangzhou (grant number: A20220246).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYilmaz H, Zateri C, Kusvuran OA, et al. Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study[J]. Spine J,2020,20(6):947-955.\u003c/li\u003e\n\u003cli\u003eKomang-Agung IS, Dwi-Purnomo SB, Susilowati A. Prevalence Rate of Adolescent Idiopathic Scoliosis: Results of School-based Screening in Surabaya, Indonesia[J]. Malays Orthop J,2017,11(3):17-22.\u003c/li\u003e\n\u003cli\u003eKamtsiuris P, Atzpodien K, Ellert U, et al. [Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)][J]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2007,50(5-6):686-700.\u003c/li\u003e\n\u003cli\u003eThompson JY, Williamson EM, Williams MA, et al. Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis[J]. Physiotherapy,2019,105(2):214-234.\u003c/li\u003e\n\u003cli\u003eZhang H, Guo C, Tang M, et al. Prevalence of scoliosis among primary and middle school students in Mainland China: a systematic review and meta-analysis[J]. Spine (Phila Pa 1976),2015,40(1):41-49.\u003c/li\u003e\n\u003cli\u003ePublicity Department of National Health Commission of the PRC. Transcript of press conference on July 13, 2021 [EB/OL]. ( 2021-07-13)［2022-07-06］. http://www.nhc.gov.cn/xcs/s3574/202107/2fef24a3b77246fc9fb36dc8943af700.shtml\u003c/li\u003e\n\u003cli\u003eXU Shuai, SU Yongjia, WANG Zhenbo, et al. The prevalence and characteristics of primary and middle-school students in China: a Meta-analysis based on 72 epidemiological research [J]. Chinese Journal of Spine and Spinal Cord, 2021, 31(10): 901-910. DOI：10.3969/j.issn.1004-406X.2021.10.05\u003c/li\u003e\n\u003cli\u003eOffice of the Leading Group Office for the Seventh National Census of the State Council. Main data of the seventh nationalcensus in 2020 [M]. Beijing: China Statistics Press, 2021:22.\u003c/li\u003e\n\u003cli\u003eSedrez JA, Da RM, Noll M, et al. [Risk factors associated with structural postural changes in the spinal column of children and adolescents][J]. Rev Paul Pediatr,2015,33(1):72-81.\u003c/li\u003e\n\u003cli\u003eHsu PC, Feng CK, Huang SH, et al. Health-related quality of life in children and adolescent with different types of scoliosis: A cross-sectional study[J]. J Chin Med Assoc,2019, 82(2):161-165.\u003c/li\u003e\n\u003cli\u003eDunn J, Henrikson NB, Morrison CC, et al. Screening for Adolescent Idiopathic Scoliosis: Evidence Report and Systematic Review for the US Preventive Services Task Force[J]. JAMA,2018,319(2):173-187.\u003c/li\u003e\n\u003cli\u003eLi SS, Chow DH. Effects of asymmetric loading on lateral spinal curvature in young adults with scoliosis: A preliminary study[J]. Prosthet Orthot Int,2018,42(5):554-562.\u003c/li\u003e\n\u003cli\u003eZHANG Yinchang, SHA Shifu, JIANG Enze, et al. Comparison of the pulmonary function between adolescent patients with Chiari malformation associated scoliosis and idiopathic scoliosis [J]. National Medical Journal of China, 2018,98(06):418-421. DOI: 10.3760/cma.j.issn.0376-2491.2018.06.004\u003c/li\u003e\n\u003cli\u003eFong DY, Cheung KM, Wong YW, et al. A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening[J]. Spine J,2015,15(5):825-833.\u003c/li\u003e\n\u003cli\u003eZheng Y, Dang Y, Yang Y, et al. A Case-Control Study of Body Composition, Prevalence, and Curve Severity of the Patients With Adolescent Idiopathic Scoliosis in the East Part of China[J]. Spine Deform,2017,5(6):374-380.\u003c/li\u003e\n\u003cli\u003eNational Health Commission of the People\u0026rsquo;s Republic of China. Notice on printing and distributing the National Student Common Diseases and Health Influencing Factors Monitoring and Intervention Program [EB/OL]. [2019-03-26]. http://www.nhc.gov.cn/jkj/s5898bm/201903/1bcbac21e1864377ad24984fac014c7d.shtml\u003c/li\u003e\n\u003cli\u003eNational Health Commission of the People\u0026apos;s Ｒepublic of China．Screening of abnormal spinal curvature abnormality of children and adolescents: GB/T 16133-2014 [S]. Beijing: China Standards Press, 2014: 1－5. http://www.nhc.gov.cn/ewebeditor/uploadfile/2015/04/20150429164259881.pdf\u003c/li\u003e\n\u003cli\u003eMinistry of Health of the People\u0026apos;s Republic of China, Standardization Administration of China. Health requirements of daily learning time for secondary and Elementary school students (GB/T 17223-2012) [S]. 2012-12-31. http://www.nhc.gov.cn/ewebeditor/uploadfile/2013/03/20130313091400151.pdf\u003c/li\u003e\n\u003cli\u003eNational Health Commission of the People\u0026apos;s Ｒepublic of China．Screening standard for malnutrition of shool-age children and adolescents: WS /T 456－2014［S］．Beijing: China Standards Press，2014: 3－4. http://www.nhc.gov.cn/ewebeditor/uploadfile/2014/07/20140704142652587.pdf\u003c/li\u003e\n\u003cli\u003eNational Health Commission of the People\u0026apos;s Ｒepublic of China．Screening for overweight and obesity among school-age children and adolescents: WS /T 586－2018 [S]. Beijing: China Standards Press，2018: 1－3. http://www.nhc.gov.cn/ewebeditor/uploadfile/2018/03/20180330094031236.pdf\u003c/li\u003e\n\u003cli\u003eRenganathan G, Manaswi N, Ghionea I, et al. Automatic Vertebrae Localization and Spine Centerline Extraction in Radiographs of Patients with Adolescent Idiopathic Scoliosis[J]. Stud Health Technol Inform,2021,281:288-292.\u003c/li\u003e\n\u003cli\u003eWeinstein SL, Dolan LA, Spratt KF, et al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study[J]. JAMA,2003,289(5):559-567.\u003c/li\u003e\n\u003cli\u003eQI Deyun, LI Liping, JIANG Yanwei, et al. Abnormal spinal curvature and influencing factors in children and adolescents in Hongkou District, Shanghai [J]. Chin J Sch Health, 2021,42(03):444-447. DOI: 10.16835 /j.cnki.1000－9817.2021.03.030\u003c/li\u003e\n\u003cli\u003eSUN Yunfen, ZHENG Zhijun, SUN Lijuan, et al. Abnormal spinal curvature and poor vision of primary and middle school students in Caofeidian district, Tangshan city [J]. Henan J Prev Med,2021,32(08):637-639. DOI:10.13515/j.cnki.hnjpm.1006- 8414.2021.08.021\u003c/li\u003e\n\u003cli\u003eLuk KD, Lee CF, Cheung KM, et al. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study[J]. Spine (Phila Pa 1976),2010,35(17):1607-1614.\u003c/li\u003e\n\u003cli\u003eCiaccia M, Castro JS, Rahal MA, et al. PREVALENCE OF SCOLIOSIS IN PUBLIC ELEMENTARY SCHOOL STUDENTS[J]. Rev Paul Pediatr,2017,35(2):191-198.\u003c/li\u003e\n\u003cli\u003eSahli S, Rebai H, Ghroubi S, et al. The effects of backpack load and carrying method on the balance of adolescent idiopathic scoliosis subjects[J]. Spine J,2013,13(12):1835-1842.\u003c/li\u003e\n\u003cli\u003eDockrell S, Simms C, Blake C. Schoolbag carriage and schoolbag-related musculoskeletal discomfort among primary school children[J]. Appl Ergon,2015,51:281-290.\u003c/li\u003e\n\u003cli\u003eJanakiraman B, Ravichandran H, Demeke S, et al. Reported influences of backpack loads on postural deviation among school children: A systematic review[J]. J Educ Health Promot,2017,6:41.\u003c/li\u003e\n\u003cli\u003eSuh SW, Modi HN, Yang JH, et al. Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children[J]. Eur Spine J,2011,20(7):1087-1094.\u003c/li\u003e\n\u003cli\u003eBettany-Saltikov J, Weiss HR, Chockalingam N, et al. Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis[J]. Cochrane Database Syst Rev,2015(4):D10663.\u003c/li\u003e\n\u003cli\u003eAulisa AG, Giordano M, Guzzanti V, et al. Effectiveness of school scoliosis screening and the importance of this method in measures to reduce morbidity in an Italian territory[J]. J Pediatr Orthop B,2019,28(3):271-277.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"Spinal curvatures, Prevalence, Regression analysis, Child, Adolescent","lastPublishedDoi":"10.21203/rs.3.rs-3844968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3844968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eTo investigate the prevalence and influencing factors of abnormal spinal curvature among primary and secondary school students in Hangzhou city, and provide ideas for the formulation of abnormal spinal curvature prevention and control measures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing a stratified cluster random sampling method, 5,652 students of primary and junior high school from 24 schools were investigated via questionnaires and abnormal spinal curvature screening in Hangzhou. Univariate and multivariate logistic regression were used to screen possible risk factors of abnormal spinal curvature.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall abnormal spinal curvature rate was 2.23%, with the increase of the school period, the prevalence of abnormal spinal curvature among students showing upward trend (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;90.679, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). The abnormal spinal curvature prevalence in boys is higher than that in girls (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.507, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.477); the prevalence of abnormal spinal curvature in urban students is higher than that in suburban students (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;49.954, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Accommodation at school is independently associated with higher prevalence of abnormal spinal curvature. Moreover, outdoor activity time\u0026thinsp;\u0026ge;\u0026thinsp;2h per day in the past one week, overweight, always maintain correct sitting and standing posture are protective factors for abnormal spinal curvature.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe abnormal spinal curvature prevalence among children and adolescents in Hangzhou is at a relatively low level, and is affected by most factors such as accommodation at school, outdoor activity time, Body Mass Index, sitting and standing posture, needing collaboration of school, students and parents to strengthen screening and prevention.\u003c/p\u003e","manuscriptTitle":"Abnormal spinal curvature and influencing factors in children and adolescents in Hangzhou","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-22 11:39:27","doi":"10.21203/rs.3.rs-3844968/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-19T13:30:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-04T15:59:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-04T11:39:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184268915774354552939662294968785106891","date":"2024-10-27T04:15:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-26T13:45:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335618416498854131062775752740734955088","date":"2024-10-26T10:42:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173966210404718474339546521358625307770","date":"2024-10-24T14:06:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323658444343357844257898545731257185244","date":"2024-10-22T19:53:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-04T08:00:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296256666011182304523277018369995990890","date":"2024-05-26T06:18:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-02T10:03:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-02T04:31:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-19T04:21:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-19T04:18:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-01-08T09:08:12+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":"fff5077f-0c94-4405-8084-7f4d771b0f0e","owner":[],"postedDate":"January 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T16:02:40+00:00","versionOfRecord":{"articleIdentity":"rs-3844968","link":"https://doi.org/10.1186/s12889-025-22883-1","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-05-13 15:58:03","publishedOnDateReadable":"May 13th, 2025"},"versionCreatedAt":"2024-01-22 11:39:27","video":"","vorDoi":"10.1186/s12889-025-22883-1","vorDoiUrl":"https://doi.org/10.1186/s12889-025-22883-1","workflowStages":[]},"version":"v1","identity":"rs-3844968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3844968","identity":"rs-3844968","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}