State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia
JAMA Ophthalmol. 2017 Dec 1;135(12):1295-1302. doi: 10.1001/jamaophthalmol.2017.3449.
Vision loss is the third most common impairment worldwide. Although cost-effective interventions are available for preventing or curing most causes of vision loss, availability of these interventions varies considerably between countries and districts. Knowledge of the association between vision loss and socioeconomic factors is informative for public health planning.
To explore correlations of the prevalence of visual impairment with socioeconomic factors at country levels and to model and estimate a socioeconomic-adjusted disease burden based on these data.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, the following data were collected from 190 countries and territories: the age-standardized prevalence of moderate to severe visual impairment (MSVI) and blindness from January 1 to December 31, 2010, across countries, human development index (HDI), gross domestic product (GDP) per capita, total health expenditure, total health expenditure as percentage of GDP (total health expenditure/GDP), public health expenditure as percentage of total health expenditure (public/total health expenditure), and out-of-pocket expenditure as percentage of total health expenditure (out-of-pocket/total health expenditure). Countries were divided into 4 levels (low, medium, high, and very high) by HDI. Data analysis was conducted from September 1, 2016, to July 1, 2017.
The correlations between prevalence data and socioeconomic indices were assessed.
A strong negative association between prevalence rates of MSVI and blindness and socioeconomic level of development was observed. The mean (SD) age-standardized prevalence of MSVI decreased from 4.38% (1.32%) in low-HDI regions to 1.51% (1.00%) in very-high-HDI regions (P < .001). The national HDI level was attributable to 56.3% of global variation in prevalence rates of MSVI and 67.1% of global variation in prevalence rates of blindness. Higher prevalence rates were also associated with lower total health expenditure per capita, total health expenditure/GDP (β = −0.236 [95% CI, −0.315 to −0.157] for prevalence of MSVI; β = −0.071 [95% CI, −0.100 to −0.042] for prevalence of blindness), public/total health expenditure (β = −0.041 [95% CI, −0.052 to −0.031] for prevalence of MSVI; β = −0.014 [95% CI, −0.018 to −0.010] for prevalence of blindness), and higher percentage of out-of-pocket/total health expenditure (β = 0.044 [95% CI, 0.032-0.055] for prevalence of MSVI; β = 0.013 [95% CI, 0.009-0.017] for prevalence of blindness). Countries with increased burden of visual impairment and blindness can be easily identified by the results of the linear models. Socioeconomic factors could explain 69.4% of the global variations in prevalence of MSVI and 76.3% of the global variations in prevalence of blindness.
Burden of visual impairment and socioeconomic indicators were closely associated and may help to identify countries requiring greater attention to these issues. The regression modeling described may provide an opportunity to estimate appropriate public health targets that are consistent with a country’s level of socioeconomic development.
视力丧失是全球第三大致残原因。虽然有一些具有成本效益的干预措施可用于预防或治疗大多数视力丧失的原因，但这些干预措施在各国和地区的可用性差异很大。了解视力丧失与社会经济因素之间的关联，有助于进行公共卫生规划。
探讨国家层面上视觉障碍流行率与社会经济因素的相关性，并根据这些数据对社会经济调整后的疾病负担进行建模和估计。
设计、地点和参与者：在这项横断面研究中，从 190 个国家和地区收集了以下数据：2010 年 1 月 1 日至 12 月 31 日期间，各国中度至重度视力障碍（MSVI）和盲的年龄标准化流行率，人类发展指数（HDI）、人均国内生产总值（GDP）、卫生总支出、卫生总支出占 GDP 的百分比（卫生总支出/GDP）、公共卫生支出占总卫生支出的百分比（公共/总卫生支出）以及总卫生支出中自付支出的百分比（自付/总卫生支出）。根据 HDI，国家被分为 4 个水平（低、中、高和极高）。数据分析于 2016 年 9 月 1 日至 2017 年 7 月 1 日进行。
评估了流行率数据与社会经济指数之间的相关性。
观察到 MSVI 和失明的流行率与社会经济发展水平之间存在很强的负相关关系。MSVI 的平均（SD）年龄标准化流行率从低 HDI 地区的 4.38%（1.32%）降至极高 HDI 地区的 1.51%（1.00%）（P<0.001）。国家 HDI 水平对 MSVI 流行率的全球变异的 56.3%和失明流行率的全球变异的 67.1%具有解释作用。更高的流行率也与人均卫生总支出较低、卫生总支出/GDP（β=−0.236[95%CI，−0.315 至−0.157]，用于 MSVI 流行率；β=−0.071[95%CI，−0.100 至−0.042]，用于失明流行率）、公共/总卫生支出（β=−0.041[95%CI，−0.052 至−0.031]，用于 MSVI 流行率；β=−0.014[95%CI，−0.018 至−0.010]，用于失明流行率）和自付/总卫生支出的比例较高（β=0.044[95%CI，0.032 至 0.055]，用于 MSVI 流行率；β=0.013[95%CI，0.009 至 0.017]，用于失明流行率）有关。通过线性模型的结果，可以轻松识别出视觉障碍和失明负担加重的国家。社会经济因素可以解释 MSVI 流行率全球变异的 69.4%和失明流行率全球变异的 76.3%。
视力障碍负担与社会经济指标密切相关，这可能有助于确定需要更多关注这些问题的国家。所描述的回归模型可能提供了一个机会，可以根据国家的社会经济发展水平来估计适当的公共卫生目标。
