Global patterns in vision loss burden due to vitamin A deficiency from 1990 to 2017

Abstract

Objective: To investigate the vision loss burden due to vitamin A deficiency (VAD) at the global, regional and national levels by year, age, sex and socio-economic status using prevalence and years lived with disability (YLD).

Design: International, retrospective, comparative burden-of-disease study.

Setting: Prevalence and YLD data were extracted from the Global Burden of Disease (GBD) Study 2017. The association of age-standardised YLD rates and human development index (HDI) was tested by Pearson correlation and linear regression analyses. The Gini coefficient and concentration index (CI) were calculated to demonstrate the trends in between-country inequality in vision loss burden due to VAD.

Participants: All participants met the GBD inclusion criteria.

Results: The age-standardised prevalence rate increased by 9·2 %, while the age-standardised YLD rates rose by 10·8 % from 1990 to 2017. Notably, the vision loss burden caused by VAD showed a declining trend since 2014. The vision loss burden was more concentrated in the post-neonatal age group and decreased with increasing age. The age-standardised YLD rates were inversely correlated with HDI (r = -0·2417, P = 0·0084). The CI and Gini coefficients indicated that socio-economic-related and between-country inequality declined from 2000 to 2017. VAD was the eighth leading cause of the age-standardised prevalence rate and ninth leading cause of age-standardised YLD rate among fifteen causes of vision loss in 2017.

Conclusion: VAD has become one of the significant leading causes of vision loss globally. Efforts to control vision impairment related to VAD are needed, especially for children in countries with lower socio-economic status.

Keywords: Global burden of disease; Prevalence; Vision loss; Vitamin A deficiency; Years lived with disability.

Fig. 1

Global burden of vision loss due to VAD by year and age. (a) Age-standardised prevalence rate from 1990 to 2017; (b) age-standardised YLD rate from 1990 to 2017. , Female; , Total; , Male. (c) age-specific prevalence rate by vision loss severity categories (MVL, SVL and blindness) in 2017; (d) age-specific YLD rate by vision loss severity categories in 2017. , Total Male; , Total Female; , MVL-Male; , MVL-Female; , SVL-Male; , SVL-Female; , Blindness-Male; , Blindness-Female. VAD = vitamin A deficiency; YLD = years lived with disability; MVL = moderate vision loss; SVL = severe vision loss. The post neonatal period is 28–364 d

Fig. 2

Age-standardised prevalence (a) and YLD rates (b) of vision loss due to VAD in GBD super regions by sex and severity categories in 2017. The area of each block in the dual-pie chart represents the proportion, and the figure inside represents the absolute number. VAD = vitamin A deficiency; YLD = years lived with disability; MVL = moderate vision loss; SVL = severe vision loss; GBD = Global Burden of Disease. , Male; , Female; , Blindness; , SVL; , MVL

Fig. 3

Age-standardised prevalence (a) and YLD rates (b) of total vision loss due to VAD by GBD regions and sex in 2017. VAD = vitamin A deficiency; YLD = years lived with disability; GBD = Global Burden of Disease. , Global; , Southeast Asia, East Asia, and Oceania; , Sub-Saharan Africa; , North Africa and Middle East; , South Asia; , Latin America and Caribbean; , Central Europe, Eastern Europe and Central Asia

Fig. 4

Geographical distribution and socioeconomic disparities in VAD Vision Loss Burden. (a) Age-standardised prevalence rate maps. , 240-280; , 200-240; , 160-200; , 120-160; , 80-120; , 40-80; , 0-40; , No data; (b) age-standardised YLD rate maps. , 14-17; , 10-14; , 8-10; , 6-8; , 4-6; , 2-4; , 0-2; , No data; (c) association between age-standardised YLD rate and HDI in 2017; (d) concentration index; (e) Gini coefficient. VAD = vitamin A deficiency; YLD = years lived with disability; HDI = human development index. *P < 0·05, **P < 0·01, ***P < 0·001

Fig. 5

Rank of leading fifteen causes of global vision loss due to VAD in 1990 and 2017 and the percentage change of age-standardised prevalence (a) and YLD (b) rates between 1990 and 2017. VAD = vitamin A deficiency; YLD = years lived with disability. The solid lines indicate increases, and the dashed lines indicate decreases in rank between 1990 and 2017. The darker part in each column represents the proportion of age-standardised rates of corresponding causes. , eye diseases; , ascending order in rank; , non-ocular diseases; , descending order in rank