{
  "abstract": "Purpose: To delineate cross-sectional group-level sex-specific patterns of refractive development in school-aged children and to determine whether sex-related myopic disparities widen across age strata, addressing limitations in current large-scale epidemiological evidence.\n\nMethods: This population-based cross-sectional study analyzed 4.47 million valid vision screening records from 1,623,070 unique students (ages 3–18 years) across Southern Fujian, China (2021–2024). Spherical equivalent (SE) and uncorrected visual acuity (UCVA) were measured via non-cycloplegic autorefraction. Generalized estimating equations (GEE) with an exchangeable correlation structure (ICC = 0.473) were employed to account for repeated measures. A “sex × age” interaction term was incorporated into multivariable models to evaluate whether sex-related disparities widen across age strata. Sensitivity analyses compared encounter-level versus student-level analytic units.\n\nResults: While refractive parameters were comparable between sexes in the preschool group (≤6 years; SE difference: +0.04 D favoring females), a significant female disadvantage emerged in primary school (7–12 years; SE difference: −0.12 D), peaking in junior high school (13–15 years; SE difference: −0.20 D), followed by partial attenuation in senior high-school (≥16 years; SE difference: −0.17 D) in two of three cities. By senior high school (≥16 years), the female myopia prevalence was 88.7% versus 80.4% in males (absolute difference: 8.3 percentage points), despite partial convergence in continuous SE values. Within our limited set of available covariates (adjusted for age and city), GEE models showed female sex was associated with an overall SE difference of β = −0.141 D (95% CI −0.154 to −0.128 D), higher visual-impairment risk (OR = 1.26, 95% CI 1.22–1.30), and higher myopia risk (OR = 1.18, 95% CI 1.11–1.25), with a significant “sex × age” interaction ( p < 0.001). Sensitivity analyses confirmed robustness, with SE differences fluctuating <0.05 D across analytic units.\n\nConclusion: This study reveals distinct sex-related disparities in refractive status across childhood, observed in cross-sectional group-level comparisons. These group-level patterns may reflect developmental influences and potential cohort-related effects from differing historical exposures. These findings underscore the necessity of incorporating sex as a stratification factor in public health strategies. Implementing earlier and more intensive screening protocols for girls is crucial for curbing myopia progression and achieving life-course visual health equity.",
  "abstract_shown": true,
  "affiliations": [
    "Xiamen Eye Center and Eye Institute of Xiamen University, School of Medicine",
    "Xiamen Clinical Research Center for Eye Diseases",
    "Xiamen Key Laboratory of Ophthalmology",
    "Fujian Key Laboratory of Corneal & Ocular Surface Diseases",
    "Xiamen Key Laboratory of Corneal & Ocular Surface Diseases",
    "Translational Medicine Institute of Xiamen Eye Center of Xiamen University"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
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        1,
        2,
        3,
        4,
        5
      ],
      "name": "Dong-kan Li"
    },
    {
      "affs": [
        0,
        1,
        2,
        3,
        4,
        5
      ],
      "name": "Chun-hong Chen"
    },
    {
      "affs": [
        0,
        1,
        2,
        3,
        4,
        5
      ],
      "name": "Xiao-fang Zhan"
    },
    {
      "affs": [
        0,
        1,
        2,
        3,
        4,
        5
      ],
      "name": "Bin Lin"
    },
    {
      "affs": [
        0,
        1,
        2,
        3,
        4,
        5
      ],
      "name": "Xiao-feng Li"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/465q8h0kph30s.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1983884",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727720/?tool=EBI",
  "id": "465q8h0kph30s",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1983884/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2713|Ophthalmology and Visual Impairment Studies"
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  "openalex": "W7223020893",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1983884/pdf",
  "pmcid": "PMC13727720",
  "pmid": "42978923",
  "published": "2026-10-20",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/465q8h0kph30s.ris",
  "sources": [
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      "first_seen": "2026-10-30T12:20:24Z",
      "native_id": "10.3389/fpubh.2026.1983884",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Ophthalmology and Visual Impairment Studies",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Sex-related refractive disparities in school-aged children: a population-based cross-sectional study of 4.47 million screening records",
  "title_text": "Sex-related refractive disparities in school-aged children: a population-based cross-sectional study of 4.47 million screening records",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:51Z",
  "url": "https://research.draconitic.com/paper/465q8h0kph30s",
  "venue": "Frontiers in Public Health",
  "versions": []
}