Association of Sex With the Global Burden of Cataract

Abstract

IMPORTANCE Eye disease burden could help guide health policy making. Differences in cataract burden by sex is a major concern of reducing avoidable blindness caused by cataract.OBJECTIVE To investigate the association of sex with the global burden of cataract by year, age, and socioeconomic status using disability-adjusted life-years (DALYs). DESIGN, SETTING, AND PARTICIPANTSThis international, comparative burden-of-disease study extracted the global, regional, and national sex-specific DALY numbers, crude DALY rates, and age-standardized DALY rates caused by cataract by year and age from the Global Burden of Disease Study 2015. The DALY data were collected from January 1, 1990, through December 31, 2015, for ever 5 years. The human development index (HDI) in 2015 was extracted as an indicator of national socioeconomic status from the Human Development Report. MAIN OUTCOMES AND MEASURESComparisons of sex-specific DALY estimates due to cataract by year, age, and socioeconomic status at the global level. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the socioeconomic-associated sex differences in cataract burden. RESULTS Differences in rates of cataract by sex were similar between 1990 and 2015, with age-standardized DALY rates of 54.5 among men vs 65.0 among women in 1990 and 52.3 among men vs 67.0 among women in 2015. Women had higher rates than men of the same age, and sexual differences increased with age. Paired Wilcoxon signed rank test revealed that age-standardized DALY rates among women were higher than those among men for each HDI-based country group (z range, −4.236 to −6.093; P < .001). The difference (female minus male) in age-standardized DALY rates (r = −0.610 [P < .001]; standardized β = −0.610 [P < .001]) and the female to male age-standardized DALY rate ratios (r = −0.180 [P = .02]; standardized β = −0.180 [P = .02]) were inversely correlated with HDI.CONCLUSIONS AND RELEVANCE Although global cataract health care is progressing, sexual differences in cataract burden showed little improvement in the past few decades. Worldwide, women have a higher cataract burden than men. Older age and lower socioeconomic status are associated with greater differences in rates of cataract by sex. Our findings may enhance public awareness of sexual differences in global cataract burden and emphasize the importance of making sex-sensitive health policy to manage global vision loss caused by cataract.

Association between Exposure to Ambient Air Pollution and Age-Related Cataract: A Nationwide Population-Based Retrospective Cohort Study

“…Differences in rates of cataract by sex were shown in previous studies [ 14 , 19 ]. In the Global Burden of Disease Study 2015, age-standardized, disability-adjusted life year (DALY) rates were 54.5 among men vs. 65.0 among females in 1990, and 52.3 among men vs. 67.0 females in 2015.…”

“…In the Global Burden of Disease Study 2015, age-standardized, disability-adjusted life year (DALY) rates were 54.5 among men vs. 65.0 among females in 1990, and 52.3 among men vs. 67.0 females in 2015. Females had higher rates of cataract than males of the same age [ 19 ]. The mixed effect of exposure to indoor cooking fuels, outdoor activity, and hormone replacement therapy on cataract should be considered in higher-risk females [ 10 , 26 , 27 ].…”

“…The associations between a per-interquartile increase of air pollutants PM 2.5 , PM 10 , NO 2 , SO 2 , CO, and O 3 from 2002 to 2015 and the incidence of cataract were evaluated using the Cox-proportional hazard regression model after adjusting for age, sex, smoking status, insurance level, urbanization, and comorbidity. We conducted stratified analyses by sex because several previous studies have suggested sex difference in cataract development [ 4 , 19 ]…”

Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey

“…Most respondents were female individuals, which might be expected given that several studies have reported the cataract burden, possibly because of older age and reduced socioeconomic status, is increased in women. 23 How this gender disparity might have influenced our results is undetermined, but male respondents were less likely to fear ISBCS. Increased fear of CS in women compared with men has been reported, with the experience of a good operative outcome in the first eye reducing fear of surgery on the second.…”

Risk Factors Associated with Cataracts in Middle-Aged People, an Incidence-Based Case-Control Study in Shiraz, Iran

“…The most important risk factor is age and it seems that age-related cataracts is an inevitable outcome of aging (5)(6)(7). Also, there is evidence from several epidemiologic and population-based studies that both cataracts prevalence and the rate of cataracts ex-traction is higher in females than in males (8)(9)(10). Other suggested risk factors include excessive exposure to the sun, smoking, diabetes mellitus, myopia, obesity, and steroid use (11)(12)(13)(14)(15)(16)(17)(18)(19).…”