Department of Endocrinology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Eur J Ophthalmol. 2021 May;31(3):1161-1170. doi: 10.1177/1120672120927256. Epub 2020 Jun 4.
To explore the trend patterns and gender disparity in global burden of age-related macular degeneration (AMD) by year, age, and socioeconomic status using disability-adjusted life-years (DALYs) from Global Burden of Disease (GBD) study 2017.
DALYs and impairment data caused by AMD were extracted from GBD Study 2017. World Bank income level (WBIL) and human development index (HDI) in 2017 were cited as indicators of socioeconomic status. The Gini coefficients and the concentration indexes were calculated to unveil trends in between-country inequality. The association between gender inequality and socioeconomic levels was analyzed by Pearson correlation.
Total age-standardized DALYs of AMD showed a slightly descending pattern in recent years. However, gender disparity has existed since 1990 for almost three decades, with female being more heavily impacted. This pattern became more obvious with aging and varied among different WHO and WBIL regions. Meanwhile, female subjects tended to have higher vision impairments. Gini coefficients of AMD burden increased from 0.423 to 0.448, while the ones of female-to-male ratio fluctuated around 0.11 between 1990 and 2017, with concentration indexes changing from 0.024 to -0.057 and 0.046 to 0.029 respectively. Female-minus-male difference ( = 0.1721, = 0.0195) and female-to-male ratio ( = 0.2072, = 0.0048) of age-standardized DALYs rates were positively related to HDI.
Though global AMD health care is progressing, gender imbalance in disease burden of AMD distribution barely improved. Gender sensitive health policy should be emphasized for the increasing elder population and relieving the higher AMD burden of females.
利用 2017 年全球疾病负担研究（GBD）的数据，以残疾调整生命年（DALY）为指标，探讨年龄相关性黄斑变性（AMD）的全球负担在年份、年龄和社会经济地位方面的趋势模式和性别差异。
从 GBD 研究 2017 年中提取 AMD 导致的 DALY 和损伤数据。2017 年世界银行收入水平（WBIL）和人类发展指数（HDI）被引用为社会经济地位的指标。计算基尼系数和集中指数，以揭示国家间不平等的趋势。通过 Pearson 相关分析来分析性别不平等与社会经济水平之间的关系。
AMD 的总年龄标准化 DALY 近年来呈略下降趋势。然而，自 1990 年以来，性别差异已经存在了将近三十年，女性受到的影响更为严重。这种模式随着年龄的增长而变得更加明显，并且在不同的世界卫生组织和世界银行收入水平地区之间存在差异。同时，女性患者的视力损伤程度往往更高。AMD 负担的基尼系数从 0.423 增加到 0.448，而女性与男性比例的基尼系数在 1990 年至 2017 年期间在 0.11 左右波动，集中指数分别从 0.024 变为-0.057 和 0.046 变为 0.029。年龄标准化 DALY 率的女性减男性差异（ = 0.1721， = 0.0195）和女性与男性比例（ = 0.2072， = 0.0048）与 HDI 呈正相关。
尽管全球 AMD 医疗保健正在取得进展，但 AMD 疾病负担分布的性别失衡几乎没有改善。随着老年人口的增加和女性 AMD 负担的增加，应强调性别敏感的卫生政策。
