Effective cataract surgical coverage in China: results from the China National Eye Health Study (CNEHS)

Abstract

PurposeThe 74th World Health Assembly endorsed a global target for 30% increase in effective cataract surgery coverage (eCSC) from 2020 to 2030. The current study was conducted to help monitoring the progress in the next decade in China.DesignA cross-sectional multi-center study, the China National Eye Health Survey (CNEHS), was conducted from 2021 to 2022 and covered 562 communities/villages from 12 representative provinces in China.MethodsThis study is based on participants who were at least 50 years of years in the CNEHS. eCSC estimates the proportion of individuals with operated cataract achieving postoperative visual acuity ≥6/18 out of the total population including both operated and operable cataract cases. Both the CSC and eCSC were adjusted for age and sex.ResultsA total of 45,051 participants were included in the analysis. The standardized incidence of vision impairment and blindness (best-corrected visual acuity in the better eye <6/18) was 4.4% (95% CI, 4.2%-4.6%). Cataracts accounted for 52.7% of these cases. The weighted rates of CSC and eCSC were 57.2% (95% CI, 47.6%-66.8%) and 38.7% (95% CI, 31.7%-45.6%), respectively. Contributing factors to the quality gap(difference between CSC and eCSC) included concurrent ocular diseases (62.2%) and complications relevant to surgery. CSC increased by 38.9% and eCSC by 26.1% over the decade. Both CSC and eCSC varied substantially across the 12 provinces (range: 41.2%-87.3% for CSC; 16.7%-71.0% for eCSC). Pearson correlation analysis indicated that regional disparities were primarily explained by the level of medical resource allocation, particularly the number of physicians or ophthalmologists per unit population (r=0.6, p=0.03).ConclusionDuring the 2021-2022 period, CSC and eCSC rates in China were 57.2% and 38.7%, respectively. Regional disparity in cataract coverage were observed and correlated with the level of medical resources allocation.WHAT IS ALREADY KNOWN ON THIS TOPICThe latest national epidemiological data on cataract surgical coverage in China dates back to 2014 and contains limited information.WHAT THIS STUDY ADDSBetween 2021 and 2022, the rates of CSC and eCSC in China were 57.2% and 38.7% at the 6/18 threshold, respectively. Comparing this with historical data reveals a significant improvement, with eCSC increasing by 26.1% over the past decade. However, there remains a notable quality gap, largely due to concurrent ocular diseases (62.2%), which should not be included in the eCSC measure. Additionally, substantial regional disparities were identified, with eCSC rates varying from 16.7% to 71.0% across the 12 surveyed provinces/municipalities. These disparities are primarily linked to the distribution of medical resources per capita rather than economic status.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE, OR POLICYDespite significant improvements over the past decade, CSC and eCSC rates in China remain lower than those reported in most other countries. To address this, the government is urged to allocate more medical resources to less developed regions. Furthermore, the definition of eCSC should be revisited to exclude biases from concurrent ocular diseases.