Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China.
Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China.
BMC Ophthalmol. 2021 Feb 26;21(1):107. doi: 10.1186/s12886-021-01858-x.
Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen's utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China.
The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately.
Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn't impact cataract surgical resources (β = 0.29, 95% CI: - 0.12, 0.75). In China, residents' average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; β = 0.77, 95% CI: 0.25, 0.90; β = 0.89, 95% CI: 0.82, 0.93).
In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.
未手术白内障是全球视力丧失的主要原因，占视力障碍的 33%，占全球失明的一半。本研究旨在利用安德森利用框架建立一种快速评估方法，并确定撒哈拉以南非洲和中国的白内障手术率的预测因素。
本研究是一项交叉生态流行病学研究，共包括撒哈拉以南非洲的 19 个国家和中国的 31 个省。信息从公开数据和已发表的研究中提取。线性回归和结构方程模型与 Bootstrap 用于分别分析撒哈拉以南非洲和中国的 CSR 预测因素及其对影响的途径。
撒哈拉以南非洲的白内障手术资源与 CSR 呈线性相关（β=0.74，95%CI：0.09，0.91），而 GDP/P 并不影响白内障手术资源（β=0.29，95%CI：-0.12，0.75）。在中国，居民的平均支付能力被确认为 GDP/P 和 CSR 之间的中介（p=0.32，RMSEA=0.07；β=0.77，95%CI：0.25，0.90；β=0.89，95%CI：0.82，0.93）。
在撒哈拉以南非洲，CSR 由医疗保健提供决定。当地经济发展可能不会直接影响 CSR。因此，提供免费白内障手术的国际援助至关重要。在中国，CSR 主要由医疗保健需求（支付能力）决定。为了提高中国服务不足地区的 CSR，必须通过社会保险提高支付能力，并降低手术费用。
