Cataract Surgical Rate and Socioeconomics: A Global Study.
OBJECTIVE
Cataract is the leading cause of blindness and cataract surgical rate (CSR) is used as a proxy indicator of access to cataract services in a country. The aim of this study was to explore the associations between the CSR and the economic development of countries in terms of gross domestic product per capital (GDP/P) and gross national income per capita (GNI/P).


METHODS
We systematically searched OVID (Medline and Embase), Pubmed, Embase.com, ISI Web of Science, and Cochrane Library databases, and retrieved additional data from unpublished reports. Cataract surgical rates and economic indicators (GDP/P, GNI/P) were collected for each country from 2005 to 2014. Complete data were used for the 50 largest countries according to World Health Organization (WHO) population estimates. Linear correlations between GDP/P and CSR were calculated. Cataract surgical rate data over two periods were used for analysis: 2005 to 2009 and 2010 to 2014 (CSR in 2009 or nearest year, CSR in 2014 or nearest year).


RESULTS
Over the study period, CSR data were available for 152 countries across both time periods. Most of the CSR data were obtained from nongovernment organization (NGO) reports, including WHO reports. A good linear correlation between CSR and GDP/P was found overall, nearest to 2009 (β = 0.162, Linear: y = 0.162x + 282.242; R2 = 0.665, P < 0.001). Regression analysis of CSR nearest to 2014 produced similar findings, with significant correlations between CSR and GDP/P (Linear: y = 0.208x + 94.008; R2 = 0.785, P < 0.001). When using GNI/P as an economic indicator, similarly excellent lines of fit were obtained. After adjusting for time and country, CSR was significantly associated with GDP/P (Coefficient = 0.147, R2 = 0.759, P < 0.001), and GNI/P (Coefficient = 0.152, R2 = 0.757, P < 0.001). Most countries had an increase in CSRs over time, with the greatest increases observed for Iran and Argentina.


CONCLUSIONS
Cataract surgical rate and economic indicators are closely associated, indicating the strong influence of resource availability on healthcare delivery. Considering this relationship, it is important to be innovative in delivery of low-cost services and invest strategically in capacity development to meet cataract surgical need in low-resource settings.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
Wei
W
Wang
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia 3Department of Ophthalmology, University of Melbourne, Parkville, Victoria, Australia.
William
W
Yan
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia 3Department of Ophthalmology, University of Melbourne, Parkville, Victoria, Australia.
Kathy
K
Fotis
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia 4The Fred Hollows Foundation, Carlton, Victoria, Australia.
Noela M
NM
Prasad
Help Me See, New York, New York, United States 6Instituto Mexicano de Oftalmologia, Santiago de Querétaro, Queretaro, Mexico.
Van Charles
VC
Lansingh
Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
Hugh R
HR
Taylor
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia 3Department of Ophthalmology, University of Melbourne, Parkville, Victoria, Australia 8Department of Ophthalmology, University of Bonn, Bonn, Germany.
Robert P
RP
Finger
International Agency for the Prevention of Blindness, Western Pacific Region, Singapore Eye Research Institute, Singapore.
Damian
D
Facciolo
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China 2Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia 3Department of Ophthalmology, University of Melbourne, Parkville, Victoria, Australia.
Mingguang
M
He
D002387:Cataract Extraction / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D014943:Global Health; D059066:Gross Domestic Product; D006801:Humans; D007182:Income; D012044:Regression Analysis; D012959:Socioeconomic Factors