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Burden of visual impairment in mainland China: the Handan Eye Study and Beijing Eye Study

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Abstract

Purpose

To determine the impact of visual impairment (VI) on health-related quality of life (HRQoL) and to compare the health burden of VI in different areas in mainland China.

Methods

A cohort of 6830 people from rural villages and a cohort of 3251 people from an urban city were included to receive comprehensive ophthalmologic examinations and complete the European Quality of Life-5 Dimensions 3 Levels (EQ-5D-3L) questionnaire. For urban and rural populations, a unified VI grouping standard was adopted: the eyes were classified into normal group, mild–moderate group, and severe group according to WHO standards, and then divided into 6 groups considering both eyes. We estimated the effects of VI on the EQ-5D index score using linear regression models and the association between VI and self-reported EQ-5D health problems using logistic regression models. Associations were assessed by the Spearman correlation coefficient.

Results

The prevalence of VI and the index scores of EQ-5D-3L for each subgroup of VI were higher for the rural cohort. In these two cohorts, the severity of VI in rural population (Spearman r = 0.205; p < 0.0001) and urban population (Spearman r = 0.164; p < 0.0001) is correlated with the EQ-5D index score. In the rural cohort, the difference in index scores with bilateral severe VI compared to those without VI, after adjusting for covariates, was − 0.053 for the rural cohort and − 0.084 for the urban cohort, respectively. In the rural cohort, the odds ratio for bilateral severe VI was 4.39 for mobility, 6.33 for self-care, and 5.88 for usual activities. The incidence of anxiety or depression and pain or discomfort in the urban cohort was greater; the OR for bilateral severe VI in the urban cohort was 4.75.

Conclusions

VI has a negative impact on HRQoL in the rural and urban areas of China, especially in urban population. It is also more likely to cause anxiety or depression among the urban cohort, which deserves special attention.

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Data availability

The data of the current study are available from the corresponding author on reasonable request.

Abbreviations

QoL:

Quality of life

EQ-5D-3L:

European Quality of Life-5 Dimensions 3 Levels questionnaire

VI:

Visual impairment

HRQoL:

Health-related quality of life

VRQoL:

Vision-related quality of life

HES:

The Handan Eye Study

BES:

The Beijing Eye Study

VA:

Visual acuity

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Acknowledgements

The authors wish to thank the Beijing Tongren Hospital and all local hospitals in Hebei Yongnian county that are involved in this study for their assistance. All survey participants are greatly appreciated for their valuable contributions.

Funding

This work was supported by the “Yangfan Plan” and clinical innovation projects of the Beijing Municipal Administration of Hospitals, funded by the Chinese government (No. ZYLX2015). The funding body should be WNL; he took responsibility of the research, and also contributed to design, acquisition of funding, interpretation of data, general supervision of the research group, and revision of the manuscript for important intellectual content.

Author information

Authors and Affiliations

  1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China

    Jian Wu, Qian Qian Ji, Cai Xia Lin, Yi Fan Du, Jia Ying Li, Kai Cao & Ning Li Wang

  2. Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, 94304, USA

    Jian Wu

  3. Huaihe Hospital of Henan University, Kaifeng, 475000, Henan, China

    Qian Qian Ji

  4. Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Jia Ying Li

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  1. Jian Wu
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Consortia

the Handan Eye Study Group and the Beijing Eye Study Group

Contributions

WJ conceived of the study, collected the data, and drafted the manuscript. WJ and CK performed the statistical analysis and interpretation of data. LCX and DYF collected the data and did a critical revision of the manuscript. LJY conducted a critical revision of the manuscript. JQQ revised the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Ning Li Wang.

Ethics declarations

Ethical approval and consent to participate.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study obtained the ethical clearance from the Beijing Tongren Hospital Ethical Committee, according to the Helsinki Declaration. Written informed consent was obtained from all participants. For those who were illiterate or blind, we read the consent form to them and asked them to mark the consent form with an inked forefinger, and the consent form with an inked forefinger that was obtained from illiterate participants was also approved by the Ethics committee.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Wu, J., Ji, Q.Q., Lin, C.X. et al. Burden of visual impairment in mainland China: the Handan Eye Study and Beijing Eye Study. Graefes Arch Clin Exp Ophthalmol 259, 3501–3509 (2021). https://doi.org/10.1007/s00417-021-05234-9

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  • DOI: https://doi.org/10.1007/s00417-021-05234-9

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