PURPOSE Visual impairment (VI) in working-age individuals significantly impacts public health and the economy. However, the avoidable causes, defined as cataract and refraction disorders, have not been extensively investigated. This study aims to quantify global trends, inequalities, and projections for avoidable VI among this demographic. DESIGN Retrospective, observational, population-based trend study. METHODS We derived data on avoidable VI prevalence and population size data in working age from the Global Burden of Disease (GBD) 2021 study. We employed the joinpoint regression analysis to assess trends from 1990 to 2021 by age, sex, sociodemographic index (SDI), type, and severity at the global, regional, and national levels. Cross-country inequalities were evaluated using the slope index of inequality and the health inequality concentration index. Subsequently, we performed Bayesian age-period-cohort modeling to estimate the avoidable BVL burden in working age by 2040. RESULTS The prevalence of avoidable VI in working age decreased overall from 1990 to 2021, driven primarily by reductions in refraction disorders, with an average annual percentage change (AAPC) of -0.15 (95% confidence interval [CI], -0.18 to -0.12; P<0.001). We observed significant declines in severe vision loss and blindness, while moderate vision loss remained stable. Females exhibited a heavier burden of avoidable VI, but showed slower improvement compared to males. Socioeconomic disparities persisted, with lower socioeconomic index (SDI) regions bearing a disproportionate burden, whereas the high SDI region showed an unfavorable increasing trend. From 1990 to 2021, the inequality slope index increased from 574.45 (95% CI, 914.95 to 233.95) to 652.27 (95% CI, 932.95 to 371.58), while the health inequality concentration index improved from -0.21 (95% CI, -0.26 to -0.17) to -0.17 (95% CI, -0.2 to -0.14). We project a continued decline in the global prevalence of avoidable working-age VI, but a 23.4% increase in avoidable VI cases by 2040, reaching approximately 146 million. CONCLUSIONS Despite overall declines in avoidable VI among working-age individuals, significant improvement opportunities and disparities persist. The anticipated increase in avoidable VI cases necessitates integrated eye health strategies, substantial investment in eye care services to enhance accessibility and affordability, and fair employment policies for the visually impaired.

中文翻译：

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工作年龄个体可避免的视力障碍的全球趋势和预测：一项基于人群的研究：工作年龄可避免的视力障碍。


目的 工作年龄个体的视力障碍 （VI） 对公共卫生和经济产生重大影响。然而，可避免的原因，定义为白内障和屈光障碍，尚未得到广泛调查。本研究旨在量化这一人群中可避免的 VI 的全球趋势、不平等和预测。设计 回顾性、观察性、基于人群的趋势研究。方法 我们从 2021 年全球疾病负担 （GBD） 研究中获得了工作年龄可避免的 VI 患病率和人口规模数据的数据。我们采用连接点回归分析来评估 1990 年至 2021 年在全球、区域和国家层面按年龄、性别、社会人口指数 （SDI）、类型和严重程度划分的趋势。使用不平等的斜率指数和健康不平等集中指数评估跨国不平等。随后，我们进行了贝叶斯年龄-时期-队列建模，以估计到 2040 年工作年龄可避免的 BVL 负担。结果 从 1990 年到 2021 年，工作年龄可避免的 VI 患病率总体下降，主要是由于屈光障碍的减少，平均年百分比变化 （AAPC） 为 -0.15（95% 置信区间 [CI]，-0.18 至 -0.12;P<0.001）。我们观察到严重视力丧失和失明的显着下降，而中度视力丧失保持稳定。女性表现出更重的可避免 VI 负担，但与男性相比，改善较慢。社会经济差距持续存在，社会经济指数 （SDI） 较低的地区承担了不成比例的负担，而 SDI 高地区则表现出不利的增长趋势。从 1990 年到 2021 年，不等式斜率指数从 574.45（95% CI，914.95 至 233.95）增加到 652.27（95% CI，932.95 至 371。58），而健康不平等集中指数从 -0.21（95% CI，-0.26 至 -0.17）提高到 -0.17（95% CI，-0.2 至 -0.14）。我们预计全球可避免的工作年龄 VI 患病率将继续下降，但到 2040 年，可避免的 VI 病例将增加 23.4%，达到约 1.46 亿例。结论 尽管工作年龄个体的可避免 VI 总体下降，但显着的改善机会和差异仍然存在。预计可避免的 VI 病例会增加，因此需要综合眼健康策略，对眼保健服务进行大量投资以提高可及性和可负担性，并为视障人士制定公平就业政策。