Persistence of severe global sex-based inequalities in the burden of visual impairment.

Abstract

Sex-based disparities in vision impairment are a major global health concern. This study quantifies these disparities across major blinding diseases and assesses their association with national-level gender inequality. In this repeated ecological analysis of Global Burden of Disease (GBD) 2023 data, we analysed sex-disaggregated age-standardised years lived with disability (YLD) rates and prevalence for major blinding diseases. Temporal trends were assessed using average annual per cent change (AAPC). Linear regression examined associations between sex differences and the Gender Development Index (GDI) and Gender Inequality Index (GII). Projections were performed using a Bayesian age-period-cohort model. From 1990 to 2023, sex disparities persisted, with a higher AAPC in females than males (0.08% vs -0.06%). In 2023, females had higher YLD rates than males for blindness and vision loss (BVI) (300.9 vs 262.8 per 100 000; +14.5%), cataract (95.1 vs 75.0; +26.7%) and age-related macular degeneration (6.9 vs 5.8; +18.0%), while glaucoma was higher in males. The largest female excess for BVI was in South Asia (difference 69.9 per 100 000). Higher GII and lower GDI were significantly associated with larger sex disparities (β=34.3 per unit GII increase; β=-197.0 per unit GDI increase, all p<0.001). Without targeted intervention, disparities are projected to persist or widen by 2040. Global sex disparities in vision impairment remained substantial from 1990 to 2023 and are projected to continue. The strong association with GDI and GII indicates these disparities are modifiable and linked to structural factors. Gender-sensitive policies are needed to achieve equity in eye health.