| Background and objectives:Cataract refers to an ophthalmic disease that causes a decrease in visual quality due to changes in lens properties,and it is currently the leading cause of adult blindness worldwide,with senile cataracts being the most common.With the accelerating aging process in China,the prevalence of cataract increases correspondingly.Vision can be restored from cataract patients through surgery and it is cost-effective,which has been widely recognized by the international community.Remote and poor rural areas in developing countries are still suffering from a lack of medical resources and poor access to cataract surgery.It is of great practical significance to grasp the prevalence of cataracts and the needs and utilization of ophthalmic health services in Chinese rural residents.It includes rational allocation of rural ophthalmic health resources,practically solving the growing eye health problems of rural residents,meeting their needs for ophthalmic health services,achieving theirs longing for a better life,and building a healthy China strategy.It is also an important embodiment of Ophthalmologists expanding from hospital services to out-of-hospital services and undertaking the mission of human blindness prevention.Cataract is similar to other chronic diseases,which is affected by many factors with obvious interaction,complicated causal relationships,and unknown pathogenesis,resulting ina series of difficulties in the prevention and treatment of cataract.Many studies have reported that aging,smoking,women,UV exposure,diabetes,hypertension,and heredity are important risk factors of cataract;Meanwhile,the sub-environment,sub-culture,unique behaviors and customs in different regions play a significant role in the development of cataract.It is of great significance to study the risk factors of cataract in the context of subenvironment and subculture.The combination of prevention and treatment,and the implementation of the strategic thought of prevention as the priority,are also the characteristics of the era in which ophthalmologists have expanded from individual service to group service,from treatment service to prevention service,and innovating ophthalmic medical ability.Part I Research on the prevalence of cataract,and the current situation of service demand and utilization in the central and western regions in ChinaObjective:To master the epidemic situation of cataract disease among rural residents in Jiangxi province and Xinjiang province,as well as the health service demand and utilization of cataract disease among rural residentsMethods:We used stratified cluster random sampling method.A total of 10,964 rural residents aged 50 and above from Jiangxi and Xinjiang provinces in central and western China were randomly examined,with an effective sample of 10,523,and an effective rate of 96.0%.Residents were examined by professional ophthalmologists for daily and corrective visual acuity examination,eye disease physical examination and health service demand and utilization.?2 test and t test were used for goup comparison.Results:Among the 10,523 rural residents aged 50 and over studied in this section,the male/female ratio was 44.5%vs 55.5%.The distribution of 50?,60?,70?,80?years old was 39.0%,35.5%,19.4%,6.2%.The educational composition was 33.7%for illiteracy,43.1%for elementary school,14.6%for junior high school,7.9%for high school,and 0.7%for university and above.(1)Characteristics of cataract prevalence:the prevalence of cataract in rural residents with vision less than 0.5 was 10.9%,and that in Jiangxi(12.4%)higher than that in Xinjiang(8.5%)(P<0.001).The prevalence of females(11.7%)was higher than that of males(10.0%)(?2=8.321,P<0.05).The prevalence rates of "50?,60?,70?and 80?" age groups were 2.0%,6.5%,24.2%and 51.1%,respectively,showing a significant upward trend of age(P<0.001).The prevalence rates of cataract among rural residents with different education levels were:illiteracy 16.7%,primary school 9.3%,middle school 5.1%,high school 6.7%,university 2.7%and above,showing an obvious trend of decreasing with higher academic qualifications(P<0.001).(2)Distribution of residents' daily visual impairment:The distribution of left and right eyesight damage was "?0.5e distribution?""5e?0.5e distributio?""5e-0.3e distributio?""3e?0.le distributi?""le?0.05 distributi?""05 distributi?""05 distribution of left and rn of visual impairment in the right and left eyes of the residents was relatively consistent..(3)Lens examination:"normal crystal/slight crystal opacification,crystal opacification affecting vision,intraocular lens/no posterior capsule opacification,no lens opacification,intraocular lens with posterior capsule opacification,no crystals"accounted for 89.0%vs89.1%,8.5%0 vs8.5%,1.3%vs1.15,0.6%vs0.7%,0.5%vs0.5%,0.1%vs0.2%,respectively in the left and right eyes.The distribution of left and right crystal states is basically the same.(4)Distribution of the causes of residents' visual impairment:refractive error 10.1%,untreated cataract 5.4%,other fundus disease 2.6%,corneal opacity or scarring 0.5%,high myopic fundus degeneration 0.5%,uncorrected no crystal 0.1%,surgical complications 0.1%,the whole eye/abnormal optic nerve/cortical blindness 0.10%.(5)The service demand of vision impairment caused by cataract:the rate of operable/unoperated cataracts in the left and right eyes of residents in both places was 6.6%vs 6.5%among which 7.6%vs7.7%in Jiangxi province and 5.1%vs4.6%in Xinjiang province.Rural residents in central and western China had a higher service demand for visual impairment caused by cataract,and Jiangxi was higher than Xinjiang(P<0.05).Cataract surgery for rural residents in the two places should be done 3.6%(376 person)in one eye,4.3%(455 person)in both eyes,and 1.0%(100 person)in only one eye.The rate of inoperable non-surgical operations for visual impairment caused by cataract in rural residents in both places was 8.8%(931 persons),among which Jiangxi was higher than Xinjiang(11.0%vs 7.5%,P<0.001).(6)The current status of cataract surgery in rural residents of the two places:among the patients who should undergo cataract surgery,the rate of cataract surgery is 27.8%,among which the rate of cataract surgery in one eye is 20.0%,and the rate of cataract surgery in both eyes is 7.8%.The average age of cataract surgery in patients with left and right eye was 66.49±10.46 years old vs 68.58±9.33 years old.The largest proportion of rural residents in the two regions underwent surgery in"government hospitals"(left and right eyes:90.0%vs89.6%),followed by "private hospitals"(left and right eyes:8.1%vs8.0%).In the cataract surgery on the left and right eyes,94.7%vs 93.0%of the patients underwent "implantation of lens",and none underwent "needle extraction".The surgical expenses of rural residents in both places were "partially free"(62.2%vs 54.7%for left and right eyes),and the "fully paid"patients in Xinjiang(45.6%vs 41.3%for right and left eyes)were significantly higher than those in Jiangxi province(6.4%vs 3.2%).The proportion of rural residents in both places with good postoperative results was 65.5%vs 69.1%.The main factors affecting postoperative vision were "other eye diseases"(23.4%vs 21.9%),"surgical complications"(7.7%vs 6.5%),and "late complications"(3.3%vs 2.5%).Conclusion:The prevalence of cataract among rural residents in central and western regions of Jiangxi and Xinjiang is higher than the national level of 6.54%in Singapore and 4.3%in Australia.The rate of vision loss and blindness caused by cataracts is at a high level in China.The burden of cataract is relatively high,which is at a relatively high level throughout the country during the same period.The utilization rate of cataract surgery in the two places is low,but the demand for cataract surgery service is relatively high.Resident cataract surgery is currently mainly carried out in public hospitals,county-level and below primary health institutions have insufficient number of ophthalmologists and limited capacity to effectively carry out cataract surgery.It is very important to strengthen the construction of primary ophthalmology and improve their ophthalmology service capabilities.Part II Study on the influencing factors of cataract disease in residents of central and western ChinaObjective:To grasp the factors affecting cataract disease in rural residents in central and western China,providing the basis for health education and intervention for rural residents.Methods:We used a stratified cluster random sampling method to randomly check 6518 rural residents aged 50 and over in Jiangxi and Xinjiang.The personal health status,family history,vision problems and lifestyle of rural residents were investigated by questionnaire.The risk factors of cataract in rural residents were discussed by unconditional Logistic regression analysisResults:Among the 6,546 rural residents aged 50 and over in the study,the male/female ratio was 43.9%vs56.1%.The distribution of 50?,60?,70?and 80?years old was 37.8%,35.5%,19.4%and 6.2%.Illiteracy,primary school,middle school,high school and college accounted for 27.9 percent,42.5 percent,21.9 percent,7.1 percent and 0.4 percent,respectivelyFactors affecting the incidence of cataract in rural residents:the incidence of female was higher than that of male(OR=1.734,95%CI=1.434-2.097).The risk was higher with age(OR=4.459,95%CI=3.993?4.980).The higher the education level,the lower the risk of disease(OR=0.761,95%Cl=0.677?0.855).Those engaged in "agriculture/forestry/fishing/water conservancy" had a greater risk of disease than those engaged in "enterprises and institutions"(OR=1.604,95%Cl=1.113?2.313).Patients having coronary heart disease have higher risk than that without coronary heart disease(OR=1.480,95%CI=1.046?2.092).HPatients with diabetes have higher risk(OR=1.775,95%CI=1.235?2.552).Patients with hypertension have higher risk among relatives of grade ?/?(OR=1.348,95%CI=1.090?1.666).There was a greater risk of developing cataract in relatives with a history of cataract in grade ?/?(OR=1.643,95%CI=1.172?2.304).Patients with amblyopia had a greater risk of disease(OR=3.633,95%CI=1.356-9.733).Current smokers have a higher risk of disease than non-smokers(OR=2.317,95%CI=1.872?2.867).The lower the frequency of drinking,the lower the risk of disease(OR=0.940,95%CI=0.888?0.994).The worse the regularity of meals,the higher the risk of disease(OR=1.205,95%CI=1.057?1.373).The higher the frequency of eating vegetables,the lower the risk of disease(OR=0.788,95%CI=0.661?0.941)The higher the duration of sunlight,the higher the risk of disease(OR=4.519,95%CI=3.138?6.508).The lower the frequency of physical exercise,the higher the risk of disease(OR=1.188,95%CI=1.094?1.290)Conclusion:This study found that factors affecting cataract include unchangeable risk factors,such as age,gender,family genetic history,etc.The risk factors that are difficult to change,such as low level of education,"agriculture/forestry/fishing/water conservancy",history of coronary heart disease,history of diabetes,impaired vision.The individual behavior factors that are easy to change include current smokers,frequency of drinking alcohol,irregular meals,low frequency of eating vegetables,long hours of sunshine,and low frequency of physical exercise.It can be seen that increasing health education on knowledge of cataract for residents,not smoking,drinking less alcohol,maintaining regular meals,appropriately reducing sunshine time or strengthening sunshine protection,eating more vegetables and taking regular physical exercise can help reduce the risk of cataract. |
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