Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019

Abstract

Background Vision loss is an important public health issue in China, but a detailed understanding of national and regional trends in its prevalence and causes, which could inform health policy, has not been available. This study aimed to assess the prevalence, causes, and regional distribution of vision impairment and blindness in China in 1990 and 2019.Methods Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used to estimate the prevalence of moderate and severe vision impairment and blindness in China and compare with other Group of 20 (G20) countries. We used GBD methodology to systematically analyse all available demographic and epidemiological data at the provincial level in China. We compared the age-standardised prevalences across provinces, and the changes in proportion of vision loss attributable to various eye diseases in 1990 and 2019. We used two different counterfactual scenarios with respect to population structure and age-specific prevalence to assess the contribution of population growth and ageing to trends in vision loss. FindingsIn 2019, the age-standardised prevalence was 2•57% (uncertainty interval [UI] 2•28-2•86) for moderate vision impairment, 0•25% (0•22-0•29) for severe vision impairment, and 0•48% (0•43-0•54) for blindness in China, which were all below the global average, but the prevalence of moderate and severe vision impairment had increased more rapidly than in other G20 countries from 1990 to 2019. The prevalence of vision loss increased with age, and the main causes of vision loss varied across age groups. The leading causes of vision impairment in China were uncorrected refractive error, cataract, and macular degeneration in both 1990 and 2019 in the overall population. From 1990 to 2019, the number of people with moderate vision impairment increased by 133•67% (from 19•65 to 45•92 million), those with severe vision impairment increased by 147•14% (from 1•89 to 4•67 million), and those with blindness increased by 64•35% (from 5•29 to 8•69 million); in each case, 20•16% of the increase could be explained by population growth. The contributions to these changes by population ageing were 87•22% for moderate vision impairment, 116•06% for severe vision impairment, and 99•22% for blindness, and the contributions by age-specific prevalence were 26•29% for moderate vision impairment, 10•91% for severe vision impairment, and -55•04% for blindness. The prevalence and specific causes of vision loss differed across provinces.Interpretation Although a comprehensive national policy to prevent blindness is in place, public awareness of visual health needs improving, and reducing the prevalence of moderate and severe vision impairment should be prioritised in future work.

Global burden of upper respiratory infections in 204 countries and territories, from 1990 to 2019

“…The GBD 2019 study provided a comprehensive and up-to-date estimation of the epidemiology of diseases and injuries in different sexes and age groups, for 204 countries and territories, 21 regions, from 1990 to 2019 [12] . Details about the study design and methods of GBD studies have been extensively described in existing GBD literature [12] , [13] , [14] , [15] , [16] , [17] , [18] . Data of GBD studies are publicly available online, and can be extracted by Global Health Data Exchange query tool ( http://ghdx.healthdata.org/gbd-results-tool ).…”

Global, regional, and national prevalence, disability adjusted life years, and time trends for refraction disorders, 1990–2019: findings from the global burden of disease study 2019

“…Xu’s study has revealed that China’s vision loss burden had increased more rapidly than other G20 countries from 1990 to 2019 [ 18 ]. The main cause of moderate and severe visual impairment are uncorrected refraction disorders, cataract, and macular degeneration in 2019, which were the same in 1990.…”

“…The main cause of moderate and severe visual impairment are uncorrected refraction disorders, cataract, and macular degeneration in 2019, which were the same in 1990. Refraction disorders is the main cause of moderate visual impairment in people younger than 70 years [ 18 ]. Consist with these findings, refraction disorders are less affected by population aging than other eye diseases and the population affected are becoming younger.…”

Improving Access to Refractive Services in Adults: A Health Examination Center-Based Model

“…A most recent survey on the causes of vision loss in China revealed that URE remains the major leading cause of moderate/severe vision impairment and blindness in China in the overall population (19,20). India and China account for approximately 50% of global vision impairment and blindness due to UREs (4,21,22).…”

“…The prevalence of present URE may not be comparable with that derived from the population-based studies, especially when the different diagnostic criteria were used (29-36) (Table 5). Meanwhile, the impacts of URE in the Chinese adults were usually addressed when analyzing the cause of visual impairment (19,20,(37)(38)(39). Studies directly reporting the prevalence, distribution, and service coverage for URE among the adults in China are very limited.…”