摘要：Objectives. We assessed global inequality in eye health by using data on the global burden of disease measured in disability-adjusted life years (DALYs). Methods. We estimated the burden of eye disease by calculating the sum of DALYs (from the Global Burden of Disease study, 2004 update) due to trachoma, vitamin A deficiency, glaucoma, cataract, refractive errors, and macular degeneration. We assessed the geographic distribution of eye disease in relation to economic status and etiology by calculating the Gini coefficient, the Theil index, and the Atkinson index. Results. The global burden of eye disease was estimated at 61.4 million DALYs worldwide (4.0% of total DALYs). Vitamin A deficiency and trachoma were distributed more unevenly than were noncommunicable eye diseases, regardless of economic status. For noncommunicable eye diseases, the major contributor was refractive errors, regardless of economic status. The most uneven distribution was observed for cataract (high-income countries) and refractive errors (middle- and low-income countries). Conclusions. Creating new eye health service for refractive errors and reducing the unacceptable eye health disparity in refractive errors should be the highest priorities for international public health services in eye care and eye health. The World Health Organization (WHO) estimates that 314 million people have visual impairment worldwide, of whom 269 million have low vision and 45 million are blind. 1 Ninety percent of all blind and visually disabled people live in middle- and low-income countries. 2 , 3 However, blindness is not always prioritized by health and public health practices, especially when mortality indicators are used. It is true that some population-based studies have suggested an indirect relationship between visual impairment and mortality, 4 – 8 but this is difficult to prove. The first Global Burden of Disease (GBD) study quantified health effects by employing a new metric known as the disability-adjusted life year (DALY). 9 This is a summary measure of population health, integrating mortality with morbidity and disability information in a single unit. One DALY can be thought of as 1 lost year of “healthy” life, and the burden of disease measures the gap between the current health status and an ideal situation in which everyone would live to old age while remaining free of disease and disability. 10 Therefore, the GBD study lifts the curtain on the true magnitude of underestimated diseases and conditions, most of which are not direct causes of mortality. Our goals in this study were as follows: (1) to calculate DALYs due to visual impairment at the global and regional levels, (2) to compare DALYs due to specific causes of visual impairment in relation to economic status, and (3) to measure the global imbalance of eye disease in relation to economic status and specific causes by using recent data from the GBD study.
