Association of sex with the global burden of vision impairment caused by neonatal preterm birth: An analysis from the global burden of disease study 2019

Abstract

Aims: To investigate the sex-specific global burden of neonatal preterm birth (NPB) vision impairment by year, age, and socioeconomic status using years lived with disability (YLDs).

Methods: The global, regional, and national sex-specific YLD numbers, crude YLD rates, and age-standardized YLD rates of NPB-related moderate and severe vision loss and blindness were obtained from the Global Burden of Disease Study 2019. The Wilcoxon test and linear regression were used to investigate the relationship between sex difference in age-standardized YLD rates and the Human Development Index (HDI).

Results: Between 1990 and 2019, the gender disparity in age-standardized YLD rates for NPB-related vision impairment remained stable, increasing from 10.2 [95% uncertainty interval (UI) 6.7-14.6] to 10.4 (95% UI 6.9-15.0) for men and 10.3 (95% UI 6.8-14.7) to 10.7 (95% UI 7.2-15.1) for women, with women consistently having higher age-standardized YLD rates. Between the ages of 25 and 75, women had higher YLD rates than males, with the biggest disparity in the 60-64 age group. In 2019, sex difference in age-standardized YLD rates across 195 nations was statistically significant. Women had higher age-standardized YLD rates than men in both low (Z = -3.53, p < 0.001) and very high HDI countries (Z = -4.75, p < 0.001). Additionally, age-standardized YLD rates were found to be adversely associated with HDI (male: Standardized β = -0.435, female: Standardized β = -0.440; p < 0.001).

Conclusion: Despite advancements in worldwide NPB health care, sexual differences in NPB-related vision impairment burden showed little change. Female had higher burden than male, particularly in low and very high socioeconomic status countries.

Keywords: Global Burden of Disease; Human Development Index (HDI); neonatal preterm birth (NPB); sex difference; years lived with disability (YLDs).

Figure 1

Global sex-specific burden of vision impairment associated with NPB from 1990 to 2019. (A) Global burden of NPB-related blindness and vision loss, (B) NPB-related blindness, (C) NPB-related moderate vision loss, and (D) NPB-related severe vision loss in terms of YLD numbers, crude YLD rates, and age-standardized YLD rates. NPB, Neonatal preterm birth; YLDs, years lived with disability; blue line, male; orange line, female.

Figure 2

Global map of NPB-related vision impairment burden by sex in 2019. Geographic distribution of age-standardized YLDs per 100,000 population in nations with NPB-related vision impairment in 2019; female (A), male (B), and female minus male (C). NPB, Neonatal preterm birth; YLDs, years lived with disability.

Figure 3

Global sex-specific NPB-related vision impairment burden by age in 2019. Sex disparities in the global burden of (A) NPB-related blindness and vision loss, (B) NPB-related blindness, (C) NPB-related moderate vision loss, and (D) NPB-related severe vision loss by age group in 2019, as measured by YLD numbers and crude YLD rates. NPB, Neonatal preterm birth; YLDs, years lived with disability; blue line, male; orange line, female.

Figure 4

Sex difference of NPB-related vision impairment burden in four socioeconomic development levels. Sex disparities in the burden of (A) NPB-related blindness and vision loss, (B) NPB-related blindness, (C) NPB-related moderate vision loss, and (D) NPB-related severe vision loss by each HDI-based country group in 2019, as measured by age-standardized YLD rates. Lines inside the boxes indicate the medians; boxes represent the 25 and 75% percentiles; and lines outside the boxes show the minimum and the maximum values. For difference between sexes, *P < 0.05, **P < 0.01, ***P < 0.001. Wilcoxon signed ranks test. NPB, Neonatal preterm birth; YLDs, years lived with disability; HDI, Human Development Index.

Figure 5

Association between gender difference of age-standardized YLD rates with HDI. The linear relationships between national age-standardized YLD rates in females and HDI, national age-standardized YLD rates in males and HDI, and national female-to-male age-standardized YLD rate ratios and HDI are presented in the following groups: (A) NPB-related blindness and vision loss, (B) NPB-related blindness, (C) NPB-related moderate vision loss, and (D) NPB-related severe vision loss. NPB, Neonatal preterm birth; YLDs, years lived with disability; HDI, Human Development Index.