Ye Xin, She Xiangjun, Shen Lijun
School of Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, China.
Acta Ophthalmol. 2020 Aug;98(5):e593-e598. doi: 10.1111/aos.14330. Epub 2020 Jan 7.
To investigate the association of sex with the global burden of glaucoma by year, age and socio-economic status using disability-adjusted life years (DALYs).
The global, regional and national sex-specific DALY numbers, crude DALY rates and age-standardized DALY rates caused by glaucoma, by year and age, were obtained from the Global Burden of Disease Study 2017. Human development index (HDI) in 2017 as a national socio-economic indicator was obtained from the Human Development Report. t-Test and linear regression were performed to explore the association between sex difference in age-standardized DALY rates and HDI.
Globally, changes in glaucoma DALY number and crude rates were similar of both sexes between 1990 and 2017. After controlling for population size and age structure, age-standardized DALY rates decreased consistently from 10.7 in 1990 to 9.4 in 2017 among men and from 8.8 in 1990 to 8.0 in 2017 among women. In 2017, the global average age-standardized DALY rates were 11.6 ± 8.6 (mean ± standard deviation) in women and 14.9 ± 12.1 in men. The sex difference in age-standardized DALY of 195 countries was significant (t = 3.109; p < .01) in 2017. Men had higher rates than women of the same age, and sexual differences increased with age. t-Test revealed that age-standardized DALY rates among men were higher than those among women for low-HDI countries (t = 3.102; p < .01) and high-HDI countries (t = 2.110; p < .05). The difference (male minus female) in age-standardized DALY rates (standardized β = -0.434, p < .001) and the female-to-male age-standardized DALY rate ratios (standardized β = -0.315, p < .001) were inversely correlated with HDI.
Although global glaucoma health care is progressing, sexual differences in glaucoma burden showed little improvement in the past few decades. Worldwide, men have higher glaucoma burden than women. Older age and lower socio-economic status are associated with greater sex differences in glaucoma burden. Our findings may enhance public awareness of sexual differences in global glaucoma burden and emphasize the importance of making sex-sensitive health policy to manage global vision loss caused by glaucoma.
使用伤残调整生命年（DALYs），按年份、年龄和社会经济地位调查性别与全球青光眼负担之间的关联。
从《2017年全球疾病负担研究》中获取按年份和年龄划分的全球、区域和国家特定性别的青光眼所致DALY数量、粗DALY率和年龄标准化DALY率。从《人类发展报告》中获取2017年作为国家社会经济指标的人类发展指数（HDI）。进行t检验和线性回归，以探讨年龄标准化DALY率的性别差异与HDI之间的关联。
在全球范围内，1990年至2017年期间，青光眼DALY数量和粗率的变化在两性中相似。在控制人口规模和年龄结构后，年龄标准化DALY率在男性中从1990年的10.7持续下降至2017年的9.4，在女性中从1990年的8.8下降至2017年的8.0。2017年，全球平均年龄标准化DALY率在女性中为11.6±8.6（均值±标准差），在男性中为14.9±12.1。2017年，195个国家年龄标准化DALY的性别差异显著（t = 3.109；p <.01）。同一年龄段男性的发病率高于女性，且性别差异随年龄增加。t检验显示，在低HDI国家（t = 3.102；p <.01）和高HDI国家（t = 2.110；p <.05）中，男性的年龄标准化DALY率高于女性。年龄标准化DALY率的差异（男性减去女性）（标准化β = -0.434，p <.001）以及女性与男性年龄标准化DALY率之比（标准化β = -0.315，p <.001）与HDI呈负相关。
尽管全球青光眼医疗正在取得进展，但在过去几十年中，青光眼负担的性别差异几乎没有改善。在全球范围内，男性的青光眼负担高于女性。年龄较大和社会经济地位较低与青光眼负担的更大性别差异相关。我们的研究结果可能会提高公众对全球青光眼负担性别差异的认识，并强调制定对性别敏感的卫生政策以管理全球青光眼所致视力丧失的重要性。
