Persistence of severe global inequalities in the burden of blindness and vision loss from 1990 to 2019: findings from the Global Burden of Disease Study 2019

Aims To assess the global burden and economic inequalities in the distribution of blindness and vision loss between 1990 and 2019. Methods A secondary analysis of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019. Data for disability-adjusted life-years (DALYs) due to blindness and vision loss were extracted from the GBD 2019. Data for gross domestic product per capita were extracted from the World Bank database. Slope index of inequality (SII) and concentration index were computed to assess absolute and relative cross-national health inequality, respectively. Results Countries with high, high-middle, middle, low-middle and low Socio-demographic Index (SDI) had decline of age-standardised DALY rate of 4.3%, 5.2%, 16.0%, 21.4% and 11.30% from 1990 to 2019, respectively. The poorest 50% of world citizens bore 59.0% and 66.2% of the burden of blindness and vision loss in 1990 and 2019, respectively. The absolute cross-national inequality (SII) fell from −303.5 (95% CI −370.8 to −236.2) in 1990 to −256.0 (95% CI −288.1 to −223.8) in 2019. The relative inequality (concentration index) for global blindness and vision loss remained essentially constant between 1991 (−0.197, 95% CI −0.234 to −0.160) and 2019 (−0.193, 95% CI −0.216 to −0.169). Conclusion Though countries with middle and low-middle SDI were the most successful in decreasing burden of blindness and vision loss, a high level of cross-national health inequality persisted over the past three decades. More attention must be paid to the elimination of avoidable blindness and vision loss in low-income and middle-income countries.

目的：评估1990年至2019年间失明和视力丧失分布的全球负担以及经济不平等情况。 方法：对2019年全球疾病、伤害和危险因素研究（GBD）进行二次分析。从2019年全球疾病负担研究中提取因失明和视力丧失导致的伤残调整生命年（DALYs）数据。从世界银行数据库中提取人均国内生产总值数据。分别计算不平等斜率指数（SII）和集中指数以评估绝对和相对的跨国健康不平等。 结果：社会人口指数（SDI）为高、高中、中、低中、低的国家从1990年到2019年年龄标准化DALY率分别下降了4.3%、5.2%、16.0%、21.4%和11.30%。1990年和2019年，世界上最贫困的50%人口分别承担了59.0%和66.2%的失明和视力丧失负担。跨国绝对不平等（SII）从1990年的 -303.5（95%置信区间 -370.8至 -236.2）下降到2019年的 -256.0（95%置信区间 -288.1至 -223.8）。1991年（ -0.197，95%置信区间 -0.234至 -0.160）到2019年（ -0.193，95%置信区间 -0.216至 -0.169），全球失明和视力丧失的相对不平等（集中指数）基本保持不变。 结论：尽管社会人口指数为中、低中的国家在降低失明和视力丧失负担方面最为成功，但在过去三十年中，跨国健康不平等程度仍然较高。必须更加关注在低收入和中等收入国家消除可避免的失明和视力丧失。