title: Prevalence of visual impairment in El Salvador: inequalities in educational level and occupational status.
abstract: OBJECTIVE
  To examine the prevalence of blindness, visual impairment, and related eye diseases and conditions among adults in El Salvador, and to explore socioeconomic inequalities in their prevalence by education level and occupational status, stratified by sex.
  
  
  METHODS
  Based upon the Rapid Assessment of Avoidable Blindness (RAAB) methodology, this nationwide sample comprised 3 800 participants (3 399 examined) ≥ 50 years old from 76 randomly selected clusters of 50 persons each. The prevalence of blindness, visual impairment and related eye diseases and conditions, including uncorrected refractive error (URE), was calculated for categories of education level and occupational status. Multiple logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and stratified by sex.
  
  
  RESULTS
  Age-adjusted prevalence was 2.4% (95% CI: 2.2-2.6) for blindness (men: 2.8% (95% CI: 2.5-3.1); women: 2.2% (95% CI: 1.9-2.5)) and 11.8% (95% CI: 11.6-12.0) for moderate visual impairment (men: 10.8% (95% CI: 10.5-11.1); women: 12.6% (95% CI: 12.4-12.8)). The proportion of visual impairment due to cataract was 43.8% in men and 33.5% in women. Inverse gradients of socioeconomic inequalities were observed in the prevalence of visual impairment. For example, the age-adjusted OR (AOR) was 3.4 (95% CI: 2.0-6.4) for visual impairment and 4.3 (95% CI: 2.1-10.4) for related URE in illiterate women compared to those with secondary education, and 1.9 (95% CI: 1.1-3.1) in cataract in unemployed men.
  
  
  CONCLUSIONS
  Blindness and visual impairment prevalence is high in the El Salvador adult population. The main associated conditions are cataract and URE, two treatable conditions. As socioeconomic and gender inequalities in ocular health may herald discrimination and important barriers to accessing affordable, good-quality, and timely health care services, prioritization of public eye health care and disability policies should be put in place, particularly among women, the unemployed, and uneducated people.
authors.affiliation: UNESCO Chair in Visual Health and Development, Universitat Politècnica de Catalunya, Terrassa, Spain, a.rius@upc.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Rius
authors.affiliation: UNESCO Chair in Visual Health and Development, Universitat Politècnica de Catalunya, Terrassa, Spain, a.rius@upc.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Guisasola
authors.affiliation: TransLab Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Sabidó
authors.affiliation: College of Optometry, Nova Southeastern University, Florida, United States of America.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Leasher
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Moriña
authors.affiliation: School of Medicine, Universidad de El Salvador, San Salvador, El Salvador.
authors.forename: Astrid
authors.initials: A
authors.lastname: Villalobos
authors.affiliation: International Agency for the Prevention of Blindness, Querétaro, Mexico.
authors.forename: Van C
authors.initials: VC
authors.lastname: Lansingh
authors.affiliation: Pan American Health Organization, District of Columbia, United States of America.
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Mujica
authors.affiliation: Department of Ophthalmology, Hospital Zacami, San Salvador, El Salvador.
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Rivera-Handal
authors.affiliation: Pan American Health Organization, Bogotá, Colombia.
authors.forename: Juan Casrlos
authors.initials: JC
authors.lastname: Silva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology; D004522:Educational Status; D004544:El Salvador / Q000453:epidemiology; D005128:Eye Diseases / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D015995:Prevalence; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000453:epidemiology*; D014792:Visual Acuity