Trends in the morbidity of children and adolescents in Russia in the process of digital school renewal

Introduction

The formation of a child's growth, development, and health depends to a certain extent on their living conditions, and the school educational environment plays a substantial role in this. For over three decades now, a gradual transformation of the educational environment has been underway – the digital modernization of educational institutions and the learning process. This involves the ever-increasing use of electronic learning tools and various electronic devices (gadgets) with screens by children and adolescents during lessons, extracurricular activities, and especially during leisure time. Numerous studies indicate a high probability of adverse effects from the digital transformation of education on the health of the younger generation [1-4].

According to leading education specialists I.V. Dvoretskaya and A.Yu. Uvarov (2025) [5], four stages can be distinguished in the digital modernization of Russian schools. The first stage, from the mid-1990s, involved the gradual technological upgrading of general education organizations – equipping specialized computer science classrooms with computers and training teachers to teach this subject. This allowed for the instruction of senior students, and later younger schoolchildren, in the basics of computer literacy and programming. The second period, termed the period of "early informatization," lasted approximately through the first decade of the 21st century. During this period, the number of computers in schools increased significantly, multimedia projectors and interactive whiteboards appeared, and necessary teaching materials and teacher training were conducted. Computer technology began to be used not only in computer science lessons but also in teaching other subjects. Specialists consider the second decade of the 21st century as the third stage – the period of "mature informatization," when information technologies (presentations, tests, simulators) and teaching materials were widely used by subject teachers and even primary school teachers in teaching various subjects, not just computer science [5].

The beginning of the fourth stage of school digital modernization – essentially the period of "digital transformation" of education – can be conditionally dated to 2020, with the publication of the Decree of the President of the Russian Federation V.V. Putin dated July 21, 2020, No. 474 "On National Development Goals of the Russian Federation for the Period up to 2030." This decree states that the digital transformation of key sectors of the economy and the social sphere, including education, is one of the national development goals. From this point on, modern digital technologies, computer equipment (including interactive panels), network services, and specialized teaching materials began to be widely used in the educational process of many general education organizations. Furthermore, a developed digital environment began to be used for school management tasks [5].

The development of the digital environment has significantly altered the lifestyle of schoolchildren: practically throughout the day, except during lessons, children and adolescents use smartphones; during school lessons and many types of supplementary education – desktop computers or laptops; while doing homework and during leisure time – again computers, laptops, often concurrently with smartphones. Children's fascination with computer games and social media communication leads to a significant reduction in sleep duration. When doing homework, students in grades 8-11, undergoing pre-professional and specialized training, are often forced to independently search for information on the Internet, write essays, reports, solve mathematical, physical, and chemical problems, constantly and simultaneously using computers and smartphones. Thus, the daily time spent working with screen-equipped devices exceeds 16-18 hours for some students [6-9].

The adverse effect of constant visual strain on the development of eye pathology has been proven. Disruptions in daily routine and nutrition, reduced physical activity, prolonged sedentary posture combined with neuro-emotional stress, caused by the constant increase in the volume of study material and reduced time for its mastery, lead to the formation and progression of so-called school-related functional disorders and diseases [6-11].

School-related health disorders, similar to occupational diseases, have varied etiology and pathogenesis. However, among schoolchildren, they are the most common, excluding acute respiratory diseases, which suggests a negative influence of "school" factors, including factors of the digital environment, on the development of a number of diseases.
The criteria for classifying diseases as school-related are:

• Frequency of occurrence among schoolchildren of 5% or more;

• Increase in prevalence from lower grades to higher grades;

• Increasing severity of pathological processes also from lower to higher grades.
  School-related diseases reduce the quality of life of schoolchildren and can impair the quality of students' knowledge, and subsequently limit the range of accessible professions and specialties [10-11].

Based on the above criteria, school-related diseases and functional disorders in children, especially adolescents, can include myopia, neurotic reactions and neuroses, autonomic dysfunction syndrome, as well as circulatory system diseases with elevated blood pressure, which are to some extent associated with high visual and neuro-emotional stress caused by the school learning process. Elevated BP is more common in adolescent boys than in girls. Postural disorders and scoliosis are conditionally classified as school-related functional disorders and diseases, the formation of which is facilitated by low physical activity and the prolonged static posture of students when working at a computer. Schoolchildren's hypodynamia can also lead to the development of obesity. Furthermore, considering the high neuro-emotional stress of schoolchildren, gastritis, duodenitis, and peptic ulcer disease can be viewed (without denying the Helicobacter pylori etiology) as pathologies partly being psychosomatic disorders [1, 6, 8-11].

To study the influence of digital environment factors, it is advisable to examine the morbidity rates of schoolchildren at different stages of the digital modernization of general education, as the prevalence of electronic screen devices among students (computers, laptops, tablets, smartphones) and the duration of their use during school time and especially during non-school time gradually increased, and the use of collective electronic learning tools – interactive whiteboards and panels – intensified.

Objective

To study the main trends in the morbidity of students with school-related diseases across the four stages of the digital modernization of the Russian school system.

Materials and Methods

Official data on primary (diagnoses established for the first time in life) and overall morbidity of children and adolescents seeking medical help in healthcare organizations, published in the collections of the Federal State Budgetary Institution "Central Research Institute of Organization and Informatization of Healthcare" of the Ministry of Health of the Russian Federation, were used for the analysis. Morbidity rates for children (0-14 years inclusive) and adolescents (15-17 years inclusive) in 1995, 2000, 2010, 2019, and 2023 were considered. In the comparative analysis of morbidity, the period from 1995 to 2000 was considered the first stage of school digital modernization, from 2000 to 2010 as the second, from 2010 to 2019 as the third, and from 2019 to 2023 as the beginning of the fourth stage.
Morbidity rates are presented per 100,000 population of the corresponding age in "per ten thousand" (⁰/₀₀₀₀).
Official statistical yearbooks lack data on the morbidity of such mental and nervous system disorders as neuroses and autonomic dysfunction syndrome, which could be considered school-related diseases. In this regard, a comparative analysis of the morbidity of children and adolescents for the entire class of mental and behavioral disorders (class F00-F99 according to ICD-10) and for the entire class of diseases of the nervous system (class G00-G99 according to ICD-10) during the four stages of school digital modernization was conducted.
In addition to the above diseases, an analysis of morbidity for myopia (H52.1), diseases characterized by elevated blood pressure (I10.0), obesity (E66.0), gastric and duodenal ulcer (K25.0, K26.0), gastritis and duodenitis (K29.0) was performed.
Relatively recently, deforming dorsopathies (M40-M43), which include scoliosis (M41), appeared in statistical yearbooks under the class of diseases of the musculoskeletal system and connective tissue (M00-M99). Therefore, the morbidity of children and adolescents with deforming dorsopathies was considered only for the fourth period of digital school modernization, from 2019 to 2023.
Data accumulation, systematization, and statistical analysis were performed in Microsoft Office Excel 2020 spreadsheets.

Results

Table 1. Incidence and Overall Morbidity of Children (0-14 years old inclusive) with School-Related Diseases at Different Stages of Digital School Transformation (⁰/₀₀₀₀)

Morbidity of Children with School-Related Diseases

The primary morbidity of children increased by 55.9% from 1995 to 2023 inclusive (from 109,499.6 ⁰/₀₀₀₀ to 170,740.1 ⁰/₀₀₀₀). During the first and second stages of digital school modernization, the rates increased by 33.6% and 29.0%, respectively, while during the third and fourth stages, they decreased by 8.6% and 1.0%, respectively. The overall morbidity of children during the specified period also increased by 46.9% (from 150,500.0 ⁰/₀₀₀₀ to 221,015.6 ⁰/₀₀₀₀). Growth was observed during the first, second, and fourth stages of digital school modernization (by 24.1%, 26.5%, and 0.5%, respectively), with a decrease of 6.9% during the third stage.

From 1995 to 2023, the primary morbidity of children for endocrine, nutritional and metabolic diseases increased by 69.8%, and the overall morbidity by 62.1%. Primary and overall morbidity for obesity could only be analyzed starting from 2000, as data before this period in official statistical yearbooks were not presented with obesity as a separate category. During the second, third, and fourth stages, the primary morbidity for obesity increased by 206.3%, and the overall morbidity by 232.6%.

For the class of mental and behavioral disorders, unidirectional trends are observed in the dynamics of primary and overall morbidity – a decrease in rates. Overall, the primary morbidity for mental and behavioral disorders decreased by 28.3% during the period 1995-2023 (from 747.3 ⁰/₀₀₀₀ to 535.6 ⁰/₀₀₀₀), and the overall morbidity decreased by 7.0% (from 2,982.1 ⁰/₀₀₀₀ to 2,774.4 ⁰/₀₀₀₀). The significant difference (4-5 times) between primary and overall morbidity is noteworthy, indicating, according to M.N. Bantieva et al. (2019), significant chronicity of pathological processes [12].

An increase in primary and overall morbidity for the class of nervous system diseases was identified from 2000 to 2023: primary morbidity increased by 9.4% (from 2,764.5 ⁰/₀₀₀₀ to 3,025.1 ⁰/₀₀₀₀), and overall morbidity more significantly: by 44.9% (from 6,287.2 ⁰/₀₀₀₀ to 9,110.1 ⁰/₀₀₀₀). The 1995 data were not included in the analysis because until 2000, according to ICD-9, the class of diseases of the nervous system and sense organs included not only nervous system diseases but also diseases of the eye and adnexa, as well as diseases of the ear and mastoid process. A significant increase in primary and overall morbidity for nervous system diseases in children was noted during the second stage from 2000 to 2010: by 54.9% and 49.7%, respectively. Conversely, during the third stage, a decrease in primary morbidity by 19.9% and overall morbidity by 3.5% was observed. During the fourth stage, an increase in primary morbidity by 11.8% and almost stable overall morbidity rates were noted.

From 2000 to 2023, the primary morbidity for eye diseases decreased by 8.1% (from 4,671.0 ⁰/₀₀₀₀ to 4,292.5 ⁰/₀₀₀₀), but the overall morbidity increased by 24.7% (from 10,020.0 ⁰/₀₀₀₀ to 12,492.7 ⁰/₀₀₀₀), indicating significant chronicity of diseases [12]. The dynamics of myopia morbidity can only be analyzed from 2000, when this nosology was выделена as a separate line in statistical yearbooks. The primary morbidity for myopia decreased by 6.4% during the second stage of digital school modernization, but increased by 3.7% and 6.6% during the third and fourth stages, respectively. A similar dynamic was observed for overall morbidity: a decrease of 4.9% in the second stage and an increase of 6.4% in the third stage, as well as a more substantial increase in the fourth stage (by 18.3%). Overall, the primary morbidity for myopia increased by 3.5% during the period 2000-2023 (from 1,050.0 ⁰/₀₀₀₀ to 1,087.2 ⁰/₀₀₀₀), and the overall morbidity increased by 19.7% (from 3,660.0 ⁰/₀₀₀₀ to 4,382.1 ⁰/₀₀₀₀). The significantly higher rates and percentage increase in overall myopia morbidity compared to primary morbidity confirm the chronicity of pathological processes.

The primary morbidity of children for circulatory system diseases increased by 30.1% during the period from 1995 to 2023 inclusive (from 397.8 ⁰/₀₀₀₀ to 517.7 ⁰/₀₀₀₀), and the overall morbidity increased by 72.1% (from 1,039.4 ⁰/₀₀₀₀ to 1,789.2 ⁰/₀₀₀₀). Statistical recording of diseases characterized by elevated blood pressure has been maintained for over 30 years. Therefore, it was established that during the first stage, a substantial increase in primary morbidity for diseases with elevated BP occurred – by 406.5% (from 3.1 ⁰/₀₀₀₀ to 15.7 ⁰/₀₀₀₀) and overall morbidity – by 343.2% (from 8.1 ⁰/₀₀₀₀ to 35.9 ⁰/₀₀₀₀). During the second stage, the growth continued: the increase in primary morbidity was 55.4% and overall morbidity was 128.7%. However, during the third stage, the rates decreased by 41.0% and 39.1%, respectively, and during the fourth stage, the primary morbidity practically stabilized (increase only 2.1%), while the overall morbidity continued to decrease (by 11.6%). Overall, for the period 1995-2023, a significant increase in primary morbidity by 374.2% and overall morbidity by 445.7% was revealed.

For the entire class of digestive system diseases, from 1995 to 2023, a unidirectional trend of decreasing morbidity in children is visible: primary morbidity decreased by 24.7%, and overall morbidity by 4.9%. The dynamics of morbidity for peptic ulcer disease and gastritis/duodenitis can be traced from 2000. The primary morbidity for gastric and duodenal ulcer increased by 84.4% during the second stage (from 7.0 ⁰/₀₀₀₀ to 12.7 ⁰/₀₀₀₀), but decreased by 44.1% and 14.1% during the third and fourth stages, respectively. Overall, during the period 2000-2023, the primary morbidity for peptic ulcer disease decreased by 12.9%. The overall morbidity for this pathology decreased at all stages and over the period 2000-2023 decreased by 67.3% (from 70.0 ⁰/₀₀₀₀ to 22.9 ⁰/₀₀₀₀). The primary morbidity of children for gastritis and duodenitis also decreased at all stages and over the period 2000-2023 decreased by 54.4% (from 960.0 ⁰/₀₀₀₀ to 437.7 ⁰/₀₀₀₀). Changes in the overall morbidity of children for gastritis/duodenitis had a similar trend – a decrease of 48.8% (from 2,700.0 ⁰/₀₀₀₀ to 1,382.3 ⁰/₀₀₀₀).

An increase in primary and overall morbidity for the class of musculoskeletal system and connective tissue diseases was revealed from 1995 to 2023: primary morbidity increased by 57.9% (from 1,577.9 ⁰/₀₀₀₀ to 2,490.7 ⁰/₀₀₀₀), overall morbidity – more significantly: by 159.6% (from 3,244.6 ⁰/₀₀₀₀ to 8,423.3 ⁰/₀₀₀₀). Morbidity for deforming dorsopathies can only be analyzed for the fourth period of digital school modernization from 2019 to 2023. The primary morbidity of children for this group of diseases decreased by 16.3%, and the overall morbidity by only 0.7%.

Thus, the assessment of morbidity dynamics in children indicates the following: during the first and second stages of digital modernization of educational organizations, there was mainly an increase in primary and overall morbidity among children, associated with the adverse influence of many socio-economic factors, including the "early informatization" of schools; during the third stage – the "stage of mature informatization" – primary and overall morbidity decreased for most of the considered disease classes and individual nosologies; at the beginning of the fourth stage – the "stage of digital transformation of education" – an unstable trend towards stabilization of primary and overall morbidity is noted. Particular concern is caused by the steady increase in morbidity for myopia and obesity in children, which is to a certain extent due to increasing visual strain and decreasing physical activity.

Morbidity of Adolescents with School-Related Diseases

Table 2. Incidence and Overall Morbidity of Adolescents (15-17 years old inclusive) with School-Related Diseases at Different Stages of Digital School Transformation (⁰/₀₀₀₀)

A comparative analysis of the indicators indicates that while the primary morbidity of adolescents is lower than that of children, it increased more significantly over the same period from 1995 to 2023 – by 106.5% (from 71,010.1 ⁰/₀₀₀₀ to 146,650.5 ⁰/₀₀₀₀). During the first and second stages of digital school modernization, the rates increased by 47.3% and 29.8%, respectively; during the third and fourth stages, they increased to a lesser extent – by 1.0% and 6.9%, respectively. The overall morbidity of adolescents during the specified period also increased by 105.3% (from 113,498.2 ⁰/₀₀₀₀ to 233,016.8 ⁰/₀₀₀₀). Substantial growth in overall morbidity was observed during the first and second stages of digital school modernization (by 52.4% and 28.2% respectively), then during the third and fourth stages the growth rate decreased and amounted to 0.3% and 4.7% respectively.

From 1995 to 2023, the incidence of new cases (incidence rate) of endocrine, nutritional, and metabolic diseases among adolescents increased significantly—by 162.0% (from 1,149.8 to 3,011.9 per 100,000). The prevalence rate (total morbidity) showed an even more pronounced increase of 414.8% (from 2,172.0 to 11,182.0 per 100,000). As mentioned previously, incidence and prevalence data for obesity specifically are only available from 2000 onwards. During the second, third, and fourth stages of the school's digital modernization, the increase in obesity rates among adolescents was more substantial than among children. The incidence of adolescent obesity rose by 452.4% (from 156.4 to 864.0 per 100,000), while the prevalence increased by 343.8% (from 830.0 to 3,683.4 per 100,000).

For the category of mental and behavioral disorders, the trends in incidence and prevalence among adolescents were unidirectional: an increase during the first and second stages, followed by a decrease in the third and fourth stages. Overall, from 1995 to 2023, the incidence of mental and behavioral disorders changed only marginally, increasing by just 1.0% (from 759.9 to 767.2 per 100,000), while the prevalence increased by 19.6% (from 4,508.1 to 5,390.5 per 100,000). Similar to the child population, a notable finding is the significant disparity (a 5 to 6-fold difference) between incidence and prevalence rates, indicating a chronicity of mental disorders.

Both the incidence and prevalence of diseases of the nervous system among adolescents increased from 2000 to 2023: incidence by 59.3% (from 2,420.0 to 3,855.9 per 100,000) and prevalence by 49.7% (from 8,206.5 to 12,285.3 per 100,000). It should be reiterated that 1995 data were not included in this comparative analysis. It was found that during the second and third stages of digital modernization, both the incidence and prevalence of nervous system diseases increased, with a slight decrease observed in the fourth stage.

As indicated earlier, the dynamics of diseases of the eye and adnexa can only be analyzed from 2000. The data show that from 2000 to 2023, the incidence of these diseases among adolescents rose by 29.2% (from 4,340.0 to 5,607.4 per 100,000), while the prevalence increased by 39.2% (from 16,860.1 to 23,472.5 per 100,000). The fourfold difference between prevalence and incidence rates points to a significant degree of chronicity. Both the incidence and prevalence of myopia in adolescents increased from 2000 to 2023. The incidence of myopia increased by 43.6%, and the prevalence by 51.5%. The substantially higher prevalence rates compared to incidence rates confirm the chronic nature of this pathological process.

From 1995 to 2023, the incidence of diseases of the circulatory system among adolescents increased by 128.8% (from 643.2 to 1,471.8 per 100,000), while the prevalence rose by 145.1% (from 1,997.6 to 4,896.0 per 100,000). Over the period 1995–2023, a substantial increase was observed in the incidence of diseases characterized by elevated blood pressure, which rose by 158.4% (from 57.7 to 149.1 per 100,000), and in the prevalence, which increased by 172.1% (from 179.2 to 487.6 per 100,000). The morbidity rates for diseases with elevated blood pressure were higher among adolescents than among children.

It is important to note that while the overall morbidity from diseases of the digestive system in children showed a declining trend, the opposite was true for adolescents. The incidence among adolescents increased by 23.7% from 1995 to 2023 (from 4,263.4 to 5,275.3 per 100,000), and the prevalence increased by 31.9% (from 11,157.5 to 14,722.2 per 100,000). However, in the period from 2000 to 2023, the incidence of gastric and duodenal ulcers in adolescents decreased by 71.1% (from 160.0 to 46.2 per 100,000), and the prevalence decreased by 69.9% (from 590.0 to 177.7 per 100,000). The incidence of gastritis and duodenitis in adolescents increased by 46.8% during the second stage but subsequently decreased by 13.8% in the third stage and 23.4% in the fourth stage. Overall, the incidence of gastritis and duodenitis decreased by 3.0% from 2000 to 2023 (from 1,260.0 to 1,222.1 per 100,000), and the prevalence of these diseases among adolescents decreased by 21.8% (from 5,690.1 to 4,447.0 per 100,000). The rise in digestive system diseases among adolescents was therefore not attributable to ulcers, gastritis, or duodenitis, but rather to pathologies of other segments of the gastrointestinal tract.

An assessment of the dynamics of diseases of the musculoskeletal system and connective tissue from 1995 to 2023 indicates a substantial growth in both incidence and prevalence: the incidence increased by 153.3% (from 2,073.0 to 5,250.4 per 100,000), and the prevalence increased even more markedly—by 281.5% (from 4,962.2 to 18,933.1 per 100,000). The incidence of deforming dorsopathies in adolescents decreased slightly (by 1.5%), while the prevalence increased by 5.5%.

Thus, the analysis of morbidity dynamics in older adolescents established that, similar to the child population, the first and second stages of the school's digital modernization were associated with an increase in both incidence and prevalence for nearly all the disease classes and specific nosologies considered, which is linked to the adverse influence of numerous socio-economic factors. During the third stage, the rate of increase in adolescent morbidity slowed, indicating an emerging favorable trend. However, at the beginning of the fourth stage—the "stage of digital transformation of education"—the incidence and prevalence among adolescents began to gradually rise again. Also mirroring the child population, the steady increase in myopia and obesity among adolescents is a cause for concern, largely attributable to increasing visual strain and declining physical activity. On a positive note, a decrease in the incidence and prevalence of gastric and duodenal ulcers, gastritis, and duodenitis among adolescents was observed.

Discussion

The study of trends in the incidence and prevalence of diseases among children and adolescents indicates that over the 28-year period (1995-2023), the health status of the child-adolescent population deteriorated: the incidence rate in children increased by 55.9%, and the prevalence by 46.9%; the incidence and prevalence among adolescents doubled, increasing by 106.5% and 105.3%, respectively. It would be incorrect to assert that the digital modernization of schools and/or the digital transformation of schoolchildren's entire lifestyle is the sole adverse factor in the deteriorating health of the younger generation. A multitude of socio-economic, psychological-pedagogical, familial, behavioral, and other factors contribute to the development of health disorders. However, the obtained data indicate a steady rise in the incidence and prevalence of myopia in children and adolescents, a condition driven by visual strain and other factors. Furthermore, the increased morbidity from myopia, obesity, and musculoskeletal diseases may be associated with growing physical inactivity among schoolchildren and prolonged sedentary postures while using computers, laptops, and smartphones [8-11].

A prevalence rate that exceeds the incidence rate by four to five times or more for the same disease class or specific nosology indicates a chronicity of pathological processes [12]. Such trends were identified for obesity, myopia, the entire class of diseases of the eye and adnexa, the class of mental and behavioral disorders, as well as gastritis and duodenitis.

To identify correlations and dependencies between factors of the digital environment affecting schoolchildren and the development of health disorders, it is necessary to incorporate additional statistical data on the incidence and prevalence of specific diseases into statistical forms and publicly available statistical reports. For instance, within the class of mental and behavioral disorders (ICD-10 Class F), data on the following pathologies should be listed separately: "Neurotic, stress-related and somatoform disorders (F40-F48)". Within the class of diseases of the nervous system (Class G), morbidity data for "Disorders of the autonomic nervous system (G90)" should be listed separately. Within the class of diseases of the musculoskeletal system and connective tissue (Class M), data on the prevalence of scoliosis (M41) should be listed separately. This data is submitted by medical organizations and recorded in Form 12 "Data on the number of diseases registered in patients residing in the service area of the medical organization".

Currently, during the individual examination and diagnosis of the most common diseases among schoolchildren (myopia, obesity, neurotic reactions and neuroses, autonomic vascular dysregulation, arterial hypertension, postural disorders and scoliosis, psychosomatic disorders of the digestive system), physicians should take into account the duration of electronic device use at school, in supplementary education, and at home, both on weekdays and weekends.

Conclusions

During the period of the school's digital modernization from 1995 to 2023, the health status of the child-adolescent population deteriorated: the incidence rate in children increased by 55.9%, and the prevalence by 46.9%; the incidence and prevalence among adolescents increased even more significantly—by 106.5% and 105.3%, respectively.

Health disorders considered to be school-related include myopia, neurotic reactions and neuroses, somatoform dysfunction and autonomic vascular disturbances, including those with elevated blood pressure, as well as conditions partly associated with physical inactivity and prolonged forced sedentary postures—scoliosis and obesity. A steady increase in the morbidity of myopia and obesity among children and adolescents was identified, and morbidity for the entire class of musculoskeletal system diseases also increased.

During the first two stages of the school's digital modernization (1995-2000 and 2000-2010), a significant increase in morbidity was observed for almost all analyzed diseases. The third stage (2010-2019) was marked by a favorable trend of a slight decrease in child morbidity (by 7-8%) and a stabilization of adolescent rates. During the fourth stage of digital modernization (2019-2023), child morbidity remained largely unchanged, but adolescent morbidity began to rise again.