{
  "abstract": "Background This study explored the relationship between school-level built environment factors (building density and height) and myopia prevalence.Methods In all 16 districts of Shanghai, students from public schools and kindergartens underwent visual acuity testing and non-cycloplegic refraction between 2019 and 2023. Building density and height within 500-metre and 1,000-metre buffers around the schools were obtained using GIS (Geographic Information System)-based spatial and network analyses from the Tianditu database. Demographic and behavioural covariates, such as age, gender, outdoor activity time and near-work time, were collected through questionnaires. Logistic mixed-effect models were used to analyse the association between the building environment and myopia, adjusting for relevant demographic and behavioural factors.Results Data from 8 647 375 participants were analysed, with 1 116 851 followed consistently. The myopia rate among students was significantly higher during 2020–2021 compared with 2019, 2022 and 2023 (p<0.05). Myopia was more prevalent in students aged 6 to 12, with a higher average age for myopic individuals (8.13 vs 6.64 years). The average building density was higher at schools of myopic students (15.70%) versus non-myopic students (14.90%) (p<0.001). Building density near schools was negatively correlated with spherical equivalent (p<0.05), while no significant association was found with building height. The risk of myopia increased with higher building density (OR: 1.143–1.202, p<0.05), particularly in boys over 12 years old. A stronger association was observed in inner suburban areas (p<0.001).Conclusions Prolonged exposure to high building density may accelerate myopia progression. Urban planning should consider vision health, with regulations on building density near schools to reduce myopia risk.",
  "authors": [
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China",
        "Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China"
      ],
      "name": "Jingjing Wang"
    },
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"
      ],
      "name": "Jun Chen"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Wei Gong"
    },
    {
      "affiliations": [
        "Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China"
      ],
      "name": "Yating Yang"
    },
    {
      "affiliations": [
        "Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China"
      ],
      "name": "Fengge Wang"
    },
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"
      ],
      "name": "Jinliuxing Yang"
    },
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"
      ],
      "name": "Linlin Du"
    },
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"
      ],
      "name": "Yuchen Du"
    },
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"
      ],
      "name": "Sichen Liu"
    },
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"
      ],
      "name": "Bo Zhang"
    },
    {
      "affiliations": [
        "Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China"
      ],
      "name": "Ling Wang"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Xun Xu"
    },
    {
      "affiliations": [
        "Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China",
        "National Clinical Research Center for Eye Diseases, Shanghai, China",
        "Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"
      ],
      "name": "Xiangui He"
    }
  ],
  "title": "Association between building density and screening myopia in children and adolescents: a 5-year longitudinal study from China",
  "uid": "3c26a8a6-8741-539f-8058-846c2a7864d9"
}