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Evaluation and model to achieve sex parity in cataract surgical coverage in Theni district, India
  1. Sachin Gupta1,
  2. Ravilla D Ravindran2,
  3. Ashok Vardhan3,
  4. Thulasiraj D Ravilla4
  1. 1 Cornell S C Johnson College of Business, Ithaca, New York, USA
  2. 2 Aravind Eye Care System, Madurai, Tamil Nadu, India
  3. 3 Cataract Services, Aravind Eye Hospital, Tirupati, India
  4. 4 LAICO, Madurai, Tamil Nadu, India
  1. Correspondence to Mr Thulasiraj D Ravilla; thulsi{at}aravind.org

Abstract

Background/aims To propose an approach to determine the target ratio of cataract surgical rates (CSRs) of female to male subpopulations to increase sex parity in cataract surgical coverage (CSC), based on the sex gap in cataract burden and incidence, and demonstrate its application to Theni district, India.

Methods A population-based longitudinal study between January 2016 and April 2018. We recruited 24 327 participants using random cluster sampling. We conducted detailed eye examinations of 7087 participants aged ≥40 years (4098 females, 2989 males). We fit exponential models to the age-specific and sex-specific cataract burden and estimated annual incidence rates. We developed a spreadsheet-based planning tool to compute the target CSR ratio of female to male subpopulations.

Results Among those aged ≥40 years, cataract burden was 21.4% for females and 17.5% for males (p<0.05). CSC was 73.9% for females versus 78.6% for males (p<0.05), with an effective CSC of 52.6% for females versus 57.6% for males (p<0.05). Treating only incident cataracts each year requires a target CSR ratio of female to male subpopulations of 1.30, while addressing in addition 10% of the coverage backlog for females and 5% for males requires a target CSR ratio of 1.48.

Conclusions The female population in Theni district, as in many low-income and middle-income countries, bears a higher cataract burden and lower CSC. To enhance sex parity in coverage, both the higher number of annual incident cataracts and the larger backlog in females will need to be addressed.

  • vision
  • epidemiology
  • ophthalmologic surgical procedures
  • public health
  • treatment surgery

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors All authors have given final approval of this version to be published. AV, SG, TDR and RDR designed this study. AV, TDR and SG collected and managed the data. SG analysed the data. SG, AV, TDR and RDR prepared the manuscript and conducted critical revisions for important intellectual content. AV and TDR did the overall coordination of the study. TDR

    is the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.