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Abstract
<p class="first" id="d4179137e292">This comparative burden-of-disease study investigates
the association of sex with
the global burden of cataract by year, age, and socioeconomic status in the Global
Burden of Disease Study 2015.
</p><div class="section">
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<h5 class="section-title" id="d4179137e298">Question</h5>
<p id="d4179137e300">What is the association of sex with the global burden of cataract
by year, age, and
socioeconomic status?
</p>
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<h5 class="section-title" id="d4179137e303">Findings</h5>
<p id="d4179137e305">In this international, comparative burden-of-disease study, differences
in the global
burden of cataract by sex persisted from 1990 through 2015, with women having higher
rates of cataract than men. Older age and lower socioeconomic status were associated
with greater differences in cataract rates by sex.
</p>
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<h5 class="section-title" id="d4179137e308">Meaning</h5>
<p id="d4179137e310">These findings suggest that health policy should be sensitive
to sex when addressing
global vision loss caused by cataract.
</p>
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<h5 class="section-title" id="d4179137e314">Importance</h5>
<p id="d4179137e316">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.
</p>
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<h5 class="section-title" id="d4179137e319">Objective</h5>
<p id="d4179137e321">To investigate the association of sex with the global burden
of cataract by year,
age, and socioeconomic status using disability-adjusted life-years (DALYs).
</p>
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<h5 class="section-title" id="d4179137e324">Design, Setting, and Participants</h5>
<p id="d4179137e326">This 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.
</p>
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<h5 class="section-title" id="d4179137e329">Main Outcomes and Measures</h5>
<p id="d4179137e331">Comparisons 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.
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<h5 class="section-title" id="d4179137e334">Results</h5>
<p id="d4179137e336">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 (
<i>z</i> range, −4.236 to −6.093;
<i>P</i> < .001). The difference (female minus male) in age-standardized DALY rates
(
<i>r</i> = −0.610 [
<i>P</i> < .001]; standardized β = −0.610 [
<i>P</i> < .001]) and the female to male age-standardized DALY rate ratios (
<i>r</i> = −0.180 [
<i>P</i> = .02]; standardized β = −0.180 [
<i>P</i> = .02]) were inversely correlated with HDI.
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<h5 class="section-title" id="d4179137e364">Conclusions and Relevance</h5>
<p id="d4179137e366">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.
</p>
</div>