Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
World Health Organization Collaborating Center for Prevention of Blindness, Centre for Eye Research Australia (CERA), University of Melbourne, Melbourne, Australia.
Clin Exp Ophthalmol. 2019 May;47(4):453-460. doi: 10.1111/ceo.13430. Epub 2018 Dec 2.
Cataract is the leading cause of blindness and the second leading cause of vision impairment. The majority of people with vision impairment reside in low-resource settings with limited access to cataract surgery and services.
Cataract surgery rate (CSR) is a proxy measure for eye care service delivery and estimating the burden of cataract disease. This research aims to evaluate the longitudinal changes of CSR inequality globally and by income groups.
Systematic review.
Studies published from January 2000 to December 2015 were considered for inclusion into the review.
CSR data were retrieved from a systematic review of published literature (OVID Medline, Embase, PubMed, ISI, Web of Science), unpublished reports and data repositories.
Inequality of CSR was measured on a global scale and between countries grouped by income levels using the Gini coefficient and concentration index, with respect to the human development index (HDI).
Overall, correlations between HDI and gross domestic product (GDP) per capita vs CSRs were observed with R values of 49.2% (β = 5.01, P < 0.001) and 38.9% (β = 0.56, P < 0.001), respectively. Analysis of longitudinal CSR data using generalized estimation equation models revealed strong associations between CSR and HDI (P < 0.001), GDP (P < 0.001) and the proportion of people aged ≥50 (P = 0.001). Overall, the trend of inequality in worldwide CSR remained relatively stable.
Inequalities in cataract service provision were found between countries grouped by income and associated with socioeconomic indicators.
白内障是失明的主要原因，也是视力损害的第二大主要原因。大多数视力受损的人生活在资源有限的环境中，获得白内障手术和服务的机会有限。
白内障手术率（CSR）是衡量眼科服务提供情况和评估白内障疾病负担的一个替代指标。本研究旨在评估全球范围内及按收入分组的 CSR 不平等的纵向变化。
系统评价。
本综述纳入了 2000 年 1 月至 2015 年 12 月期间发表的研究。
从已发表文献的系统评价（OVID Medline、Embase、PubMed、ISI、Web of Science）、未发表的报告和数据存储库中检索 CSR 数据。
全球范围内以及按收入水平分组的国家之间的 CSR 不平等情况采用基尼系数和集中指数进行衡量，同时考虑人类发展指数（HDI）。
总体而言，HDI 与国内生产总值（GDP）人均值与 CSR 之间呈正相关，相关系数 R 值分别为 49.2%（β=5.01，P<0.001）和 38.9%（β=0.56，P<0.001）。使用广义估计方程模型对 CSR 的纵向数据进行分析显示，CSR 与 HDI（P<0.001）、GDP（P<0.001）和≥50 岁人群比例（P=0.001）之间存在很强的关联。总体而言，全球 CSR 不平等的趋势相对稳定。
发现按收入分组的国家之间在白内障服务提供方面存在不平等现象，且与社会经济指标相关。
