Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position

Ramke, Jacqueline; Zwi, Anthony B.; Lee, Arier; Blignault, Ilse; Gilbert, Clare

doi:10.1136/bjophthalmol-2016-309691

Cited by 25 publications

(25 citation statements)

References 19 publications

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“…This result is in agreement with a previous report showing that the cataract surgical rate (CSR) was significantly associated with the gross domestic product per capital (GDP/P), with South Korea being one of the countries where CSR was below the economy‐projected rates . The relationship of socioeconomic factors and the residential area with cataract surgery has been reported . This was also observed in the present study, where most cataract surgeries were performed in cities (85.72% in metropolitan, large and small cities vs 14.28% in rural areas) and individuals with a higher household income (90%‐100% relative to the median).…”

Section: Discussionsupporting

confidence: 93%

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Ryu

Kim

Hong

et al. 2020

Clinical Exper Ophthalmology

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Importance: Detailed incidence data for cataract surgery in the general population are limited, yet important for determining the surgical needs of the community and formulation of healthcare policies.Background: To report incidence rates of cataract surgery in South Korea.Design: Nationwide, retrospective population-based study. Participants: This study involved the entire population of South Korea (n = 47 990 761); 2 236 107 eyes of 1 591 176 patients confirmed as having cataract surgery from 1 January 2011 to 31 December 2015 were included.Methods: Data for all patients who underwent primary cataract surgery in South Korea were retrieved using Korean Electronic Data Interchange and Korean Standard Classification of Diseases-7 codes. Annual incidence rates were calculated and adjusted to the national population data for the corresponding year.Main Outcome Measures: The average incidence of cataract surgery during the 5-year study period was estimated using population data from the 2010 Korean census.Results: The incidence of cataract surgery increased from 8.54/1000 personyears in 2011 to 9.67/1000 person-years in 2015. The probability of second-eye surgery within 12 months after the first-eye surgery increased from 42.98% in 2011 to 48.01% in 2015. In total, 85.72% of surgeries were performed in nonrural areas: 43.18% in individuals with a higher household income and 76.65% in primary healthcare centres. The rate of vitrectomy for posterior capsular rupture was 0.72%. Conclusions and Relevance: The incidence of cataract surgery in South Korea is increasing over time. Our findings are expected to aid in the formulation of future healthcare policies concerning cataract surgery in South Korea. K E Y W O R D S cataract surgery, epidemiology, incidence Sun Young Ryu and Jiwon Kim contributed equally to this study.

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Section: Discussionsupporting

confidence: 93%

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Ryu

Kim

Hong

et al. 2020

Clinical Exper Ophthalmology

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“…To our knowledge, no study has measured HI in use of cataract surgery. In studies that examined economic inequality in the 3 mentioned outcomes, cataract surgical rate and economic indicators were closely associated 7 (10,25,30,35,36). The results of the present study showed that having a better economic status leads to receiving more cataract surgery service.…”

Section: Discussionmentioning

confidence: 99%

“…This finding indicated that diabetics had the same need for cataract surgery; however, the group with a high economic status was more likely to use cataract surgery because of their better economic status. Studies have shown that diabetes is one of the determinants of choosing cataract surgery and is a risk factor for cataract (10,24,25). However, no study was found on the role of diabetes in economic inequality in using cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been demonstrated that cataract blindness and its relevant services are unequally distributed among countries and regions. Moreover, the blindness from cataract was focused unequally: impoverished and less developed countries had a higher rate of cataract and worse cataract service indicators (2,10,11). A review of the available literature identified inequalities in cataract service indicators, such as cataract surgical rate (CSR) and cataract surgical coverage (CSC) in different countries, including Iran (10,12,13).…”

Section: Introductionmentioning

confidence: 99%

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Horizontal inequity in the utilization of cataract surgery in Iran: Shahroud Eye Cohort Study, 2009-2014

Raznahan

Emamian

Alipour

et al. 2019

Med. J. Islam. Republ. Iran

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Background: Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middleaged population in 2009 and 2014. Methods: Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05. Results: The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821-0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods. Conclusion: The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.

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“…For example, in 2015 among adults 50 years and above, the age-standardised prevalence of cataract blindness ranged from 0.08% (80% uncertainty interval (UI) 0.03%–0.19%) in high-income countries of the Asia Pacific region to 2.35% (80% UI 0.72%–5.04%) in West Sub-Saharan Africa—almost a 30-fold difference 1. Inequality (ie, measurable differences between population subgroups) is also evident within countries, with a higher prevalence of cataract blindness among socially disadvantaged groups such as women, rural dwellers and people who are not literate 3. These inequalities are avoidable and unjust and are referred to as inequities 4…”

Section: Inequity In Access To Cataract Servicesmentioning

confidence: 99%

Reducing inequity of cataract blindness and vision impairment is a global priority, but where is the evidence?

2018

Self Cite

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Throughout the world, people who are socially or economically disadvantaged disproportionately experience blindness and vision impairment caused by cataract. Reducing vision loss from cataract and its unequal distribution must be a priority if the WHO's aim of 'universal eye health' is to be realised. To help achieve this, decision-makers and service planners need evidence on which strategies improve access to cataract services among disadvantaged populations, and under what circumstances. Unfortunately, despite many strategies to improve cataract services being implemented in recent decades, evidence of what works, for who and in what circumstances is not readily available. This paper summarises the extent of the evidence on interventions to reduce inequity of vision loss from cataract and makes suggestions for how the evidence base can be strengthened.

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Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position

Cited by 25 publications

References 19 publications

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Horizontal inequity in the utilization of cataract surgery in Iran: Shahroud Eye Cohort Study, 2009-2014

Reducing inequity of cataract blindness and vision impairment is a global priority, but where is the evidence?

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