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目的 探究2012 年和2016 年西部农村地区小学生视力不良发生率和配镜率的动态变化,为制定有效的视力不良防控措施提供科学依据.方法 利用2012 年和2016 年2 次抽样调研数据,以陕西和甘肃省23 个县随机抽取的387 所农村小学的35 232 名4～5 年级学生为研究对象,通过 χ2 检验分析不同特征群体视力不良及配镜情况的分布差异,运用logistic 多因素分析学生视力不良及配镜的影响因素.结果 2012 — 2016 年,西部农村小学生视力不良率从28.2 ％ 升至30.8 ％,升高了2.6 ％(P = 0.000);配镜率也从15 ％ 升至17.5 ％,升高了2.5 ％(P = 0.000).综合2012 年与2016 年结果表明,女生(P = 0.000)、5 年级(P = 0.000)、非住校生(P = 0.026)以及父母文化程度为初中及以上(P父 = 0.002,P母 = 0.018)的学生视力不良发生率更高;5 年级(P = 0.000)、父母文化程度为初中及以上(P父 = 0.024,P母 = 0.000)的学生配镜率更高.结论 2012 — 2016 年,西部农村4～5 年级小学生视力不良发生率和配镜率均呈上升趋势;年级、住校、父母文化程度是影响学生视力不良发生率和配镜率的主要因素.“,”Objective To analyze the prevalence rate of poor vision and glasses wearing among rural primary school children in western China, and to provide evidences for effective intervention on poor vision in the students. Methods We extracted data on 35 232 students of grade four and five randomly selected from 387 rural primary schools in 23 counties of Shaanxi and Gansu province from two waves of survey conducted in 2012 and 2016. Chi-square test and logistic regression were utilized to analyze distribution characteristics and determinants of poor vision and glasses wearing among the students. Results During the 3-year period, the prevalence rate of poor vision increased by 2.6％ significantly from 28.2％ in 2012 to 30.8％ in 2016 among the pupils (P ＜ 0.001) and the prevalence rate of glasses wearing among the students with poor vision increased by 2.5％ significantly from 15％ in 2012 to 17.5％ in 2016 (P ＜ 0.001). Logistic regression analyses revealed that the girl students, the students of grade five, non-resident students, and the students with maternal or parental education of 9 years or more were more likely to have poor vision (P ＜ 0.005 for all) and the students of grade 5 and the students with maternal or parental education of 9 years or more were more likely to have glasses wearing (both P ＜ 0.05). Conclusion The prevalence rate of poor vision and glasses wearing increased from 2012 to 2016 and the rates were influenced mainly by schooling grade, whether being a resident student and parental education among rural primary school children in western China.