Department of Ophthalmology, National Taiwan University, Taipei, Taiwan.
Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
BMJ Open. 2023 Oct 13;13(10):e073411. doi: 10.1136/bmjopen-2023-073411.
The study objectives were to investigate trends in the prevalence of common ocular conditions among children with and without disabilities; to compare the prevalence of these conditions in children with various disabilities; and to compare ophthalmic outpatient utilisation related to these ocular conditions in children with and without disabilities.
Repeated cross-sectional nationwide population-based study.
Nationwide analysis in Taiwan based on National Health Insurance (NHI) claims data and the National Disability Registry, from 2014 to 2019.
All children (aged under 18 years) with a disability in any given year between 2014 and 2019 were included in our analysis. All children with a disability (experimental group) were matched 1:1 with a child of the same age without a disability (control group). Data regarding the children's disability type and status and ocular conditions were obtained from the National Disability Registry and NHI database of Taiwan.
(1) The prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia over time; (2) the prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia in children with various disabilities; and (3) the association between disability and the use of outpatient vision care. All outcome measures were assessed using data from 2014 to 2019.
Among children with disability, the prevalence of myopia increased from 15.97% in 2014 to 18.07% in 2019. The prevalence of strabismus (2.06-3.90%), astigmatism (8.25-9.24%), amblyopia (4.13-4.95%) and hyperopia (3.36-4.58%) also increased over the study period in children with disabilities. The prevalence of strabismus, astigmatism, amblyopia and hyperopia was significantly higher in children with disabilities than in those without disabilities in all years. For example, in 2019, the prevalence values for strabismus, astigmatism, amblyopia and hyperopia were 3.90%, 9.24%, 4.95% and 4.58%, respectively, among children with disabilities, and 0.67%, 5.84%, 1.33% and 1.70%, respectively, for those without disabilities. The prevalence of these conditions varied considerably across disability types. For example, in 2019, the prevalence of strabismus was highest in children with visual disabilities (10.66%; p<0.001); these children also exhibited a high prevalence of amblyopia (24.34%; p<0.001). The prevalence of myopia was high in children with autism (24.77%), but the prevalence of other ocular conditions was not elevated in this group. Regression results indicated that for myopia, children with disability had 0.48 fewer outpatient clinic visits than those without disability (p<0.001).
The prevalence of common ocular conditions and the corresponding vision care required vary across types of disabilities among children. Healthcare policies must account for children at high risk of various ocular conditions, including those with less common disabilities.
本研究旨在探讨儿童中伴有和不伴有残疾的常见眼部疾病的患病率趋势；比较各种残疾儿童中这些疾病的患病率；以及比较伴有和不伴有残疾的儿童中与这些眼部疾病相关的眼科门诊就诊情况。
全国性基于全国健康保险（NHI）理赔数据和全国残疾登记的回顾性队列研究。
2014 年至 2019 年，在中国台湾进行的全国性分析。
2014 年至 2019 年期间任何一年患有残疾的所有儿童（年龄在 18 岁以下）均纳入本分析。所有患有残疾的儿童（实验组）均与同年龄无残疾的儿童（对照组）按 1:1 匹配。有关儿童残疾类型和状况以及眼部疾病的数据均从全国残疾登记和中国台湾 NHI 数据库中获得。
（1）近视、斜视、散光、弱视和远视的患病率随时间的变化情况；（2）各种残疾儿童中近视、斜视、散光、弱视和远视的患病率；（3）残疾与门诊视力保健使用之间的关系。所有结局指标均采用 2014 年至 2019 年的数据进行评估。
在残疾儿童中，近视的患病率从 2014 年的 15.97%上升至 2019 年的 18.07%。2014 年至 2019 年期间，斜视（2.06%-3.90%）、散光（8.25%-9.24%）、弱视（4.13%-4.95%）和远视（3.36%-4.58%）的患病率也有所增加。所有年份，残疾儿童的斜视、散光、弱视和远视患病率均显著高于无残疾儿童。例如，2019 年，斜视、散光、弱视和远视的患病率分别为残疾儿童 3.90%、9.24%、4.95%和 4.58%，无残疾儿童分别为 0.67%、5.84%、1.33%和 1.70%。各种残疾类型的患病率差异很大。例如，2019 年，视力残疾儿童斜视的患病率最高（10.66%；p<0.001）；这些儿童的弱视患病率也很高（24.34%；p<0.001）。自闭症儿童的近视患病率较高（24.77%），但该组其他眼部疾病的患病率并未升高。回归结果表明，与无残疾儿童相比，残疾儿童的门诊就诊次数平均减少 0.48 次（p<0.001）。
儿童中常见眼部疾病的患病率和相应的视力保健需求因残疾类型而异。医疗保健政策必须考虑到各种眼部疾病风险较高的儿童，包括患有较不常见残疾的儿童。
