Zhang Shiyan, Ren Jianping, Chai Ruiting, Yuan Shuang, Hao Yinzhu
School of Public Health, Hangzhou Normal University, Hangzhou, 311121, China.
School of Traditional Chinese Medical, Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.
BMC Public Health. 2024 Dec 18;24(1):3510. doi: 10.1186/s12889-024-21047-x.
Age-related macular degeneration (AMD) is a leading cause of blindness and low vision worldwide. This study examines the global burden and trends in AMD-related low vision and blindness from 1990 to 2021, with projections through 2050.
Data were obtained from the 2021 Global Burden of Disease (GBD 2021) study, covering 204 countries and regions. Key metrics, including the prevalent case numbers, annual disability-adjusted life years (DALYs), age-standardized prevalence rates (ASPR), and age-standardized DALY rates (ASDALYR), specific to low vision and blindness due to AMD, were calculated per 100,000 population. Trend analysis used the estimated annual percentage change (EAPC) method, and K-means clustering identified regions with similar burdens and trends. Autoregressive Integrated Moving Average(ARIMA) and Exponential Smoothing(ES) models provided future projections.
Globally, the total number of prevalent cases and DALYs has substantially increased. The number of prevalent cases of low vision and blindness due to AMD increased from 3,640,180 (95% UI: 3,037,098 - 4,353,902) in 1990 to 8,057,521 (95% UI: 6,705,284-9,823,238) in 2021. DALYs increased from 302,902 (95% UI: 206,475 - 421,952) in 1990 to 578,020 (95% UI: 401,241-797,570) in 2021. From 1990 to 2021, both the ASPR and ASDALYR for AMD-related low vision and blindness showed a downward trend. The ASPR was 94 (95% UI: 78.32-114.42) per 100,000 population, with an EAPC of -0.26 (95% CI: -0.31 to -0.22), and the ASDALYR was 6.78 (95% UI: 4.7-9.32) per 100,000 population, with an EAPC of -0.94 (95% CI: -1.01 to -0.88). The disease burden of AMD-related low vision and blindness increases with age, and the burden for female patients is slightly higher than for males. Regional stratification by the Socio-Demographic Index (SDI) shows that the burden of AMD-related low vision and blindness in areas with low SDI is higher than in areas with high SDI. From 1990 to 2021, notable increases in ASPR and ASDALYR were observed mainly in the southern and central regions of sub-Saharan Africa. Moreover, the increases in prevalence and DALYs vary by region, country, and level of socioeconomic development. The ARIMA model predicts that by 2050, the number of prevalent cases of low vision and blindness due to AMD will reach 13,880,610(95% CI: 9,805,575-17,955,645), and the DALYs will be 764,731(95% CI: 683,535-845,926). The ES model predicts that by 2050, the number of prevalent cases of AMD-related low vision and blindness will reach 9,323,124(95% CI: 5,222,474-13,423,774), and the DALYs will be 641,451 (95% CI: 383,588-899,318).
This study indicates that between 1990 and 2021, the global prevalent cases and DALYs caused by AMD-related low vision and blindness have increased over the past three decades, correlating with factors such as age, gender, socioeconomic status, and geographical location. Predictive models indicate that as the population ages, the number of patients with low vision and blindness due to AMD, along with associated DALYs, will continue to rise. By 2050, it is expected that over 9 million people worldwide will be affected by AMD-related vision loss, with women being particularly impacted. These findings can provide data support for public health planning, resource allocation, and the formulation of medical policies, ensuring an effective response to the challenges posed by the future increase in AMD-related low vision and blindness.
年龄相关性黄斑变性（AMD）是全球失明和视力低下的主要原因。本研究调查了1990年至2021年全球与AMD相关的视力低下和失明的负担及趋势，并预测了到2050年的情况。
数据来自2021年全球疾病负担（GBD 2021）研究，涵盖204个国家和地区。计算了每10万人中与AMD导致的视力低下和失明相关的关键指标，包括现患病例数、年度残疾调整生命年（DALY）、年龄标准化患病率（ASPR）和年龄标准化DALY率（ASDALYR）。趋势分析采用估计年度百分比变化（EAPC）方法，K均值聚类确定了负担和趋势相似的地区。自回归积分移动平均（ARIMA）模型和指数平滑（ES）模型提供了未来预测。
全球范围内，现患病例总数和DALY显著增加。AMD导致的视力低下和失明现患病例数从1990年的3640180例（95%不确定区间：3037098 - 4353902例）增加到2021年的8057521例（95%不确定区间：6705284 - 9823238例）。DALY从1990年的302902例（9�%不确定区间：206475 - 421952例）增加到2021年的578020例（95%不确定区间：401241 - 797570例）。1990年至2021年，与AMD相关的视力低下和失明的ASPR和ASDALYR均呈下降趋势。ASPR为每10万人94例（95%不确定区间：78.32 - 114.42例），EAPC为-0.26（95%置信区间：-0.31至-0.22），ASDALYR为每10万人6.78例（95%不确定区间：4.7 - 9.32例），EAPC为-0.94（95%置信区间：-1.01至-0.88）。与AMD相关的视力低下和失明的疾病负担随年龄增加，女性患者的负担略高于男性。按社会人口指数（SDI）进行区域分层显示，SDI低的地区与AMD相关的视力低下和失明负担高于SDI高的地区。1990年至2年，主要在撒哈拉以南非洲的南部和中部地区观察到ASPR和ASDALYR显著增加。此外，患病率和DALY的增加因地区、国家和社会经济发展水平而异。ARIMA模型预测，到2050年，AMD导致的视力低下和失明现患病例数将达到13880610例（95%置信区间：9805575 - 17955645例）DALY将为764731例（95%置信区间：683535 - 845926例）。ES模型预测，到2050年，与AMD相关的视力低下和失明现患病例数将达到9323124例（95%置信区间：5222474 - 13423774例），DALY将为641451例（95%置信区间：383588 - 899318例）。
本研究表明，在1990年至2021年期间，过去三十年全球与AMD相关的视力低下和失明导致的现患病例和DALY有所增加，这与年龄、性别、社会经济地位和地理位置等因素相关。预测模型表明，随着人口老龄化，AMD导致的视力低下和失明患者数量以及相关的DALY将继续上升。到2050年，预计全球超过900万人将受到与AMD相关的视力丧失影响，女性受影响尤为严重。这些发现可为公共卫生规划、资源分配和医疗政策制定提供数据支持，确保有效应对未来与AMD相关的视力低下和失明增加带来的挑战。
