Original article
Socioeconomic Disparity in Global Burden of Cataract: An Analysis for 2013 With Time Trends Since 1990

https://doi.org/10.1016/j.ajo.2017.04.008Get rights and content

Purpose

To assess socioeconomic disparity in global burden of cataract, by using disability-adjusted life years (DALYs).

Design

International, comparative burden-of-disease study.

Methods

Published data on national age-standardized DALY rates caused by cataract and human development index (HDI) between 1990 and 2013 were obtained. The association between age-standardized DALY rates and HDI in 2013 was analyzed. The health-related Gini coefficients and the concentration indexes were calculated to explore the trends in between-country inequality in cataract burden from 1990 to 2013.

Results

Multiple comparison revealed that lower-HDI countries had higher age-standardized DALY rates caused by cataract. Age-standardized DALY rates were inversely associated with HDI (β = −0.522, P < .01). From 1990 to 2013, global age-standardized DALY rates showed a trend of decline, whereas the Gini coefficients increased from 0.409 to 0.439. The concentration indexes indicated that socioeconomic-associated inequality declined in the 1990s and subsequently increased since 2000, with values of −0.259 in 1990, −0.244 in 2000, and −0.273 in 2013.

Conclusions

Global health progress in cataract was accompanied by widening inequality, with cataract burden being more concentrated in countries with lower socioeconomic status. The findings highlight the need to provide more cataract services for developing countries, to combat global vision loss caused by cataract.

Section snippets

Study Design

This is an international, comparative burden-of-disease study.

Global Burden of Cataract

Global burden of cataract (ICD-10 codes H25-H26 and H28-H28.210) had been estimated in terms of age-standardized DALYs per 100 000 population in the GBD 2013 study including 188 countries.7 Methods to compute age-standardized DALY rates have been described previously in the GBD 2013 study.7 The following GBD 2013 data concerning cataract were collected from the Global Health Data Exchange11: (1) national age-standardized DALY rates

Socioeconomic Disparity in Cataract Burden

HDI data in 2013 were available for 183 countries, including 47 very high-HDI, 51 high-HDI, 42 medium-HDI, and 43 low-HDI countries. Kruskal-Wallis tests indicated significant difference in age-standardized DALY rates across countries with different levels of socioeconomic development (P < .01). Multiple comparisons by Mann-Whitney U tests suggested higher age-standardized DALY rates in lower-HDI countries (Figure 1). The medians (interquartile ranges) of age-standardized DALY rates were 101.0

Discussion

This study revealed that global health progress in cataract has been accompanied by widening inequality since 1990. Countries with lower levels of socioeconomic development are found to have higher cataract burden. The socioeconomic-associated inequality in global cataract burden has been increasing since 2000, with burden being more concentrated in less developed countries.

According to the GBD 2010 study, the global age-standardized prevalence of blindness and MSVI owing to cataract reduced by

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