Kuper Hannah, Polack Sarah, Eusebio Cristina, Mathenge Wanjiku, Wadud Zakia, Foster Allen
International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS Med. 2008 Dec 16;5(12):e244. doi: 10.1371/journal.pmed.0050244.
The link between poverty and health is central to the Millennium Development Goals (MDGs). Poverty can be both a cause and consequence of poor health, but there are few epidemiological studies exploring this complex relationship. The aim of this study was to examine the association between visual impairment from cataract and poverty in adults in Kenya, Bangladesh, and the Philippines.
A population-based case-control study was conducted in three countries during 2005-2006. Cases were persons aged 50 y or older and visually impaired due to cataract (visual acuity < 6/24 in the better eye). Controls were persons age- and sex-matched to the case participants with normal vision selected from the same cluster. Household expenditure was assessed through the collection of detailed consumption data, and asset ownership and self-rated wealth were also measured. In total, 596 cases and 535 controls were included in these analyses (Kenya 142 cases, 75 controls; Bangladesh 216 cases, 279 controls; Philippines 238 cases, 180 controls). Case participants were more likely to be in the lowest quartile of per capita expenditure (PCE) compared to controls in Kenya (odds ratio = 2.3, 95% confidence interval 0.9-5.5), Bangladesh (1.9, 1.1-3.2), and the Philippines (3.1, 1.7-5.7), and there was significant dose-response relationship across quartiles of PCE. These associations persisted after adjustment for self-rated health and social support indicators. A similar pattern was observed for the relationship between cataract visual impairment with asset ownership and self-rated wealth. There was no consistent pattern of association between PCE and level of visual impairment due to cataract, sex, or age among the three countries.
Our data show that people with visual impairment due to cataract were poorer than those with normal sight in all three low-income countries studied. The MDGs are committed to the eradication of extreme poverty and provision of health care to poor people, and this study highlights the need for increased provision of cataract surgery to poor people, as they are particularly vulnerable to visual impairment from cataract.
贫困与健康之间的联系是千年发展目标（MDGs）的核心。贫困既是健康状况不佳的原因，也是其后果，但很少有流行病学研究探讨这种复杂关系。本研究的目的是调查肯尼亚、孟加拉国和菲律宾成年人中白内障所致视力损害与贫困之间的关联。
2005 - 2006年在三个国家开展了一项基于人群的病例对照研究。病例为年龄在50岁及以上且因白内障导致视力损害（较好眼视力<6/24）的人。对照是从同一群组中选取的年龄和性别与病例参与者匹配且视力正常的人。通过收集详细的消费数据评估家庭支出，同时也测量资产拥有情况和自我评定的财富状况。这些分析共纳入了596例病例和535例对照（肯尼亚142例病例，75例对照；孟加拉国216例病例，279例对照；菲律宾238例病例，180例对照）。与肯尼亚（比值比 = 2.3，95%置信区间0.9 - 5.5）、孟加拉国（1.9，1.1 - 3.2）和菲律宾（3.1，1.7 - 5.7）的对照相比，病例参与者更有可能处于人均支出（PCE）的最低四分位数，并且在PCE的四分位数之间存在显著的剂量反应关系。在对自我评定的健康状况和社会支持指标进行调整后，这些关联依然存在。白内障视力损害与资产拥有情况和自我评定财富之间的关系也观察到类似模式。在这三个国家中，PCE与白内障所致视力损害程度、性别或年龄之间不存在一致的关联模式。
我们的数据表明，在所研究的所有三个低收入国家中，因白内障导致视力损害的人比视力正常的人更贫困。千年发展目标致力于消除极端贫困并为贫困人口提供医疗保健，本研究强调需要增加为贫困人口提供白内障手术，因为他们尤其容易因白内障而导致视力损害。
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