Visual Impairment and Blindness in Spanish Adults

Geographic Inequalities Are Not Explained by Age or Education
  • Anna Rius
    Correspondence
    Correspondence: Anna Rius, MPH, UNESCO Chair Visual Health and Development (UPC), Violinista Vellsolà 37, 08222 Terrassa, Barcelona, Spain.
    Affiliations
    UNESCO Chair for Visual Health and Development, Department of Optometry and Optics, Universitat Politècnica de Catalunya, Barcelona, Spain
    Search for articles by this author
  • Lucía Artazcoz
    Affiliations
    Agència de Salut Pública de Barcelona, Barcelona, Spain

    CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Centro de Investigación en Salud Laboral, Universitat Pompeu Fabra, Barcelona, Spain

    Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain
    Search for articles by this author
  • Laura Guisasola
    Affiliations
    UNESCO Chair for Visual Health and Development, Department of Optometry and Optics, Universitat Politècnica de Catalunya, Barcelona, Spain
    Search for articles by this author
  • Joan Benach
    Affiliations
    Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
    Search for articles by this author
Published:September 18, 2013DOI:https://doi.org/10.1016/j.ophtha.2013.07.017

      Objectives

      The objectives of this study were to examine for the first time the prevalence of visual impairment and blindness among adults in Spain, to explore regional differences, and to assess whether they may vary as a function of sex or be explained by age and individual or regional socioeconomic position.

      Design

      Data were obtained from the 2008 Spanish Survey on Disability, Personal Autonomy, and Dependency Situations, a cross-sectional survey based on a representative sample of the noninstitutionalized population of Spain.

      Participants

      The sample was composed of 213 626 participants aged ≥15 years (103 093 men and 110 533 women); 360 were blind (160 men and 200 women), 4048 had near visual impairment (1397 men and 2651 women), and 4034 had distance visual impairment (1445 men and 2589 women).

      Methods

      The prevalence of near and distance visual impairment was calculated for each region. Multiple logistic regression models were fitted to calculate odds ratios and 95% confidence intervals. All analyses were stratified by sex.

      Main Outcome Measures

      Visual impairment was based on 3 questions aimed at identifying blindness and near and distance visual impairment.

      Results

      The prevalence (percentage) of blindness was 0.17 (men, 0.16; women, 0.18): 1.89 for near visual impairment (men, 1.36; women, 2.40), 1.89 for distance visual impairment (men, 1.40; women, 2.34), and 2.43 for any visual impairment (men, 1.81; women, 3.02). Regional inequalities in the prevalence of visual impairment were observed, correlated with regional income, and the prevalence was consistently higher among women than men. The magnitude of the inequalities remained after adjusting for age and educational level, and a north-to-south pattern of increasing prevalence was observed.

      Conclusions

      Regional and sex inequalities in the prevalence of visual impairment and blindness were observed in Spain, with a north-to-south gradient of increasing prevalence that was not explained by age or individual educational level but was correlated with regional level of economic development. Factors that could be prioritized for future policies and research include differential regional economic development, rural environment, quality of eye care services, diabetes, ultraviolet light exposure, or gender inequalities in diagnostic and therapeutic health care.

      References

        • Pascolini D.
        • Mariotti S.P.
        Global estimates of visual impairment: 2010.
        Br J Ophthalmol. 2012; 96: 614-618
        • Chiang P.P.
        • Keeffe J.E.
        • Le Mesurier R.T.
        • Taylor H.R.
        Global burden of disease and visual impairment.
        Lancet. 2006; 368 ([letter]): 365
        • Frick K.D.
        • Foster A.
        The magnitude and cost of global blindness: an increasing problem that can be alleviated.
        Am J Ophthalmol. 2003; 135: 471-476
      1. Ricard P, ed. International Agency for the Prevention of Blindness: 2010 Report. Available at: http://www.iapb.org/sites/iapb.org/files/State%20of%20the%20World%20Sight_2010.pdf. Accessed June 14, 2013.

        • Resnikoff S.
        • Pascolini D.
        • Etya'ale D.
        • et al.
        Global data on visual impairment in the year 2002.
        Bull World Health Organ. 2004; 82: 844-851
        • Zhao J.
        • Ellwein L.B.
        • Cui H.
        • et al.
        Prevalence of vision impairment in older adults in rural China: the China Nine-Province Survey.
        Ophthalmology. 2010; 117: 409-416
        • Jadoon M.Z.
        • Dineen B.
        • Bourne R.R.
        • et al.
        Prevalence of blindness and visual impairment in Pakistan: the Pakistan National Blindness and Visual Impairment Survey.
        Invest Ophthalmol Vis Sci. 2006; 47: 4749-4755
        • Rabiu M.M.
        • Gudlavalleti M.V.
        • Gilbert C.E.
        • et al.
        Nigeria National Blindness and Visual Impairment Study Group. Ecological determinants of blindness in Nigeria: the Nigeria National Blindness and Visual Impairment Survey.
        S Afr Med J. 2011; 101: 53-58
        • Dandona L.
        • Dandona R.
        • Srinivas M.
        • et al.
        Blindness in the Indian state of Andhra Pradesh.
        Invest Ophthalmol Vis Sci. 2001; 42: 908-916
      2. Visual impairment and eye care among older adults–five states, 2005.
        MMWR Morb Mortal Wkly Rep. 2006; 55: 1321-1325
        • Sit A.J.
        • Chipman M.
        • Trope G.E.
        Blindness registrations and socioeconomic factors in Canada: an ecologic study.
        Ophthalmic Epidemiol. 2004; 11: 199-211
        • Brezin A.P.
        • Lafuma A.
        • Fagnani F.
        • et al.
        Prevalence and burden of self-reported blindness, low vision, and visual impairment in the French community: a nationwide survey.
        Arch Ophthalmol. 2005; 123: 1117-1124
        • Dandona R.
        • Dandona L.
        Socioeconomic status and blindness.
        Br J Ophthalmol. 2001; 85: 1484-1488
        • Ho V.H.
        • Schwab I.R.
        Social economic development in the prevention of global blindness.
        Br J Ophthalmol. 2001; 85: 653-657
        • Solar O.
        • Irwin A.
        A conceptual framework for action on the social determinants of health: Social Determinants of Health Discussion Paper 2.
        World Health Organization, Geneva, Switzerland2010 (Available at:) (Accessed June 14, 2013)
        • Lafuma A.J.
        • Brézin A.P.
        • Fagnani F.L.
        • et al.
        Prevalence of visual impairment in relation to the number of ophthalmologists in a given area: a nationwide approach.
        Health Qual Life Outcomes [serial online]. 2006; 4 (Available at:) (Accessed June 14, 2013): 34
        • Gunnlaugsdottir E.
        • Arnarsson A.
        • Jonasson F.
        Prevalence and causes of visual impairment and blindness in Icelanders aged 50 years and older: the Reykjavik Eye Study.
        Acta Ophthalmol. 2008; 86: 778-785
        • Laitinen A.
        • Koskinen S.
        • Härkänen T.
        • et al.
        A nationwide population-based survey on visual acuity, near vision, and self-reported visual function in the adult population in Finland.
        Ophthalmology. 2005; 112: 2227-2237
        • Esteban J.J.
        • Martínez M.S.
        • Navalón P.G.
        • et al.
        Visual impairment and quality of life: gender differences in the elderly in Cuenca, Spain.
        Qual Life Res. 2008; 17: 37-45
        • Abou-Gareeb I.
        • Lewallen S.
        • Bassett K.
        • Courtright P.
        Gender and blindness: a meta-analysis of population-based prevalence surveys.
        Ophthalmic Epidemiol. 2001; 8: 39-56
      3. Instituto Nacional de Estadística. Survey on Disability, personal autonomy and dependency situations (AGE) 2007-2008. Methodology. Available at: http://www.ine.es/en/metodologia/t15/t1530418_en.pdf. Accessed June 26, 2013.

        • Klein B.E.
        • Klein R.
        • Lee K.E.
        • Cruickshanks K.J.
        Associations of performance-based and self-reported measures of visual function: the Beaver Dam Eye Study.
        Ophthalmic Epidemiol. 1999; 6: 49-60
        • Hiller R.
        • Krueger D.E.
        Validity of a survey question as a measure of visual acuity impairment.
        Am J Public Health. 1983; 73: 93-96
      4. Instituto Nacional de Estadística. PIB per cápita 2007 [in Spanish]. Available at: www.ine.es/daco/daco42/cre00/c11_cre.xls. Accessed June 28, 2013.

      5. Ministerio de Sanidad, Servicios Sociales e Igualdad. Minimum Data Set-Outpatient (MBDS EPA) [in Spanish]. Available at: http://pestadistico.msc.es/PEMSC25/Cubo.aspx?IdNodo=6431&InitCat=CMBD_AAE&CubeName=Cap%C3%ADtulo%20-%20Categor%C3%ADa%20CIE9MC&CubeDescription=Cap%C3%ADtulo%20-%20Categor%C3%ADa%20CIE9MC. Accessed July 2, 2013.

      6. System information on waiting lists in the National Health System [in Spanish]. Ministerio de Sanidad, Servicios Sociales e Igualdad; June 30, 2010. Available at: http://www.msps.es/estadEstudios/estadisticas/inforRecopilaciones/docs/ListaEsperaJunio10_CISNS.pdf. Accessed March 30, 2012.

        • Hodge W.
        • Horsley T.
        • Albiani D.
        • et al.
        The consequences of waiting for cataract surgery: a systematic review.
        CMAJ. 2007; 176: 1285-1290
        • Visión y Vida
        White Paper: Vision, Spain, 2009.
        ([in Catalan]) Vision y Vida, Madrid, Spain2009: 117-138
        • Kyari F.
        • Gudlavalleti M.V.
        • Sivsubramaniam S.
        • Nigeria National Blindness and Visual Impairment Study Group
        • et al.
        Prevalence of blindness and visual impairment in Nigeria: the National Blindness and Visual Impairment Study.
        Invest Ophthalmol Vis Sci. 2009; 50: 2033-2039
        • Espelt A.
        • Kunst A.E.
        • Palència L.
        • et al.
        Twenty years of socio-economic inequalities in type 2 diabetes mellitus prevalence in Spain, 1987-2006.
        Eur J Public Health. 2012; 22: 765-771
        • Ruiz-Ramos M.
        • Escolar-Pujolar A.
        • Mayoral-Sánchez E.
        • et al.
        Diabetes mellitus in Spain: death rates, prevalence, impact, costs and inequalities.
        Gac Sanit. 2006; 20 ([in Spanish]): 15-24
        • Cundiff D.K.
        • Nigg C.R.
        Diet and diabetic retinopathy: insights from the Diabetes Control and Complications Trial (DCCT).
        MedGenMed [serial online]. 2005; 7 (Available at:) (Accessed June 14, 2013): 3
        • Chang J.R.
        • Koo E.
        • Agrón E.
        • et al.
        Age-Related Eye Disease Study Group. Risk factors associated with incident cataracts and cataract surgery in the Age-related Eye Disease Study (AREDS): AREDS report number 32.
        Ophthalmology. 2011; 118: 2113-2119
        • Worley A.
        • Grimmer-Somers K.
        Risk factors for glaucoma: what do they really mean?.
        Aust J Prim Health. 2011; 17: 233-239
      7. Agencia Estatal de Meteorología, Ministerio de Agricultura, Alimentación y Medioambiente de España. Monthly Solar Radiation in July 2012 [in Spanish]. Available at: http://www.aemet.es/documentos/es/serviciosclimaticos/vigilancia_clima/radiacion_ozono/radiacion_solar/2012/InformeRad_Solar_2012_07.pdf. Accessed June 14, 2013.

        • Dolin P.J.
        Ultraviolet radiation and cataract: a review of the epidemiological evidence.
        Br J Ophthalmol. 1994; 78: 478-482
        • Hollows F.
        • Moran D.
        Cataract–the ultraviolet risk factor.
        Lancet. 1981; 2: 1249-1250
        • Arber S.
        • McKinlay J.
        • Adams A.
        • et al.
        Patient characteristics and inequalities in doctors' diagnostic and management strategies relating to CHD: a video-simulation experiment.
        Soc Sci Med. 2006; 62: 103-115
        • Schaubel D.E.
        • Stewart D.E.
        • Morrison H.I.
        • et al.
        Sex inequality in kidney transplantation rates.
        Arch Intern Med. 2000; 160: 2349-2354
        • Ulldemolins A.R.
        • Lansingh V.C.
        • Valencia L.G.
        • et al.
        Social inequalities in blindness and visual impairment: a review of social determinants.
        Indian J Ophthalmol. 2012; 60: 368-375
      8. OECD. Social Policies and data. OECD family database [database online]. Available at: http://www.oecd.org/social/soc/LMF1.5%20Gender%20pay%20gaps%20for%20full%20time%20workers%20-%20updated%20081212.pdf. Accessed July 2, 2013.

      9. Instituto Nacional de Estadística. Residential variations statistics 2007: domestic migration of Spaniards classified by autonomous community of origin and autonomous community of destination. [in Spanish]. Available at: http://www.ine.es/jaxi/tabla.do?path=/t20/p307/a2007/l1/&file=0101321.px&type=pcaxis&L=1. Accessed July 4, 2013.