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Glaucoma in rural China (the Rural Epidemiology for Glaucoma in China (REG-China)): a national cross-sectional study
  1. Yuanyuan Liu1,
  2. Baoqun Yao1,
  3. Xi Chen2,
  4. Xueli Yang2,
  5. Yong Liu3,
  6. Zhenggao Xie4,
  7. Xiaofeng Chen5,
  8. Zhigang Yuan6,
  9. Xingrong Wang7,
  10. Dan Hu8,
  11. Xiang Ma9,
  12. Weiqi Gao10,
  13. Ruifeng Wang11,
  14. Yuzhong Yang12,
  15. Song Chen1,
  16. Jingkai Zhang1,
  17. Zuoqing Song13,
  18. Junsu Wang1,
  19. Jing Wang14,
  20. Jinyun Pei15,
  21. Weijuan Wang16,
  22. Meiyan Wang17,
  23. Jun Gao18,
  24. Hongwen Zhang19,
  25. Lian Tan3,
  26. Wei Du4,
  27. Xuehui Pan5,
  28. Gang Liu6,
  29. Xiujuan Du7,
  30. Xu Hou8,
  31. Xin Gao9,
  32. Zhen Zhang10,
  33. Zhansheng Shen11,
  34. Changfu Wu12,
  35. Xiaochang Yan20,
  36. Shaoye Bo21,
  37. Xinghuai Sun22,
  38. Nai-jun Tang2,
  39. Chun Zhang23,
  40. Hua Yan1
  1. 1Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
  2. 2Department of Occupational and Environmental Health, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
  3. 3Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Army Medical University, Chongqing, China
  4. 4Department of Ophthalmology, Subei People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
  5. 5Department of Ophthalmology, Ineye Hospital of Chengdu University of TCM, Chengdu, Sichuan, China
  6. 6Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
  7. 7Department of Ophthalmology, Eye Institute of Shandong University of Traditional Chinese Medicine, Affiliated Eye Hospital of Shandong University of TCM, Jinan, Shandong, China
  8. 8Department of Ophthalmology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
  9. 9Department of Ophthalmology, Guyuan Municipal People's Hospital, Guyuan, Gansu, China
  10. 10Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
  11. 11Department of Ophthalmology, Zhengzhou Second People's Hospital, Zhengzhou, Henan, China
  12. 12Department of Ophthalmology, Beizhen People's Hospital, Jinzhou, Liaoning, China
  13. 13Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
  14. 14Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
  15. 15Department of Ophthalmology, Santan Hospital, Tianjin, China
  16. 16Department of Ophthalmology, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
  17. 17Department of Ophthalmology, Tianjin Haibin People’s Hospital, Tianjin, China
  18. 18Department of Ophthalmology, Tianjin Third Central Hospital, Tianjin, China
  19. 19Department of Ophthalmology, Tianjin Jizhou District People's Hospital, Tianjin, China
  20. 20National School of Development, Peking University, Beijing, China
  21. 21Department of Supervisory Board, China Foundation for Disabled Persons, Beijing, China
  22. 22Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
  23. 23Department of Ophthalmology, Peking University Eye Center, Third Hospital of Peking University, Beijing, China
  1. Correspondence to Professor Hua Yan, Tianjin Medical University General Hospital, Tianjin 300070, Tianjin, China; zyyyanhua{at}; Professor Chun Zhang; zhangc1{at}


Objective This study aimed to investigate the prevalence of glaucoma with associated factors in the rural populations of 10 provinces in China.

Design A population-based cross-sectional study.

Methods All participants aged 6 years or older from 10 provinces completed visual acuity testing, slit-lamp examination, ophthalmoscopy and non-contact tonometry. Glaucoma suspects underwent fundus photography, Goldmann applanation tonometry, visual field testing and gonioscopy. Glaucoma was determined according to the International Society of Geographical and Epidemiological Ophthalmology classification scheme. Associations of demographics and medical factors with glaucoma were assessed using multiple logistic regression models.

Results From June 2017 to October 2018, 48 398 of 52 041 participants were included in the final analyses. The age-standardised prevalence of glaucoma was 1.7% (95% CI 1.55% to 1.78%) among the participants older than 6 years, which was 2.1% (95% CI 1.93% to 2.23%) in participants aged over 40 years. The constituent ratios of glaucoma were: 44.4% primary angle-closure glaucoma (PACG), 34.7% primary open-angle glaucoma, 2.6% congenital glaucoma and 18.3% other types of glaucoma. Increasing age, smoking, cerebral stroke, type 2 diabetes, higher education (college or more) and higher personal income were significant risk factors for PACG. The unilateral and bilateral blindness rates in the entire study population were 4.692% and 1.068%, respectively. A family history of glaucoma was a significant risk factor for the prevalence of glaucoma and blindness in at least one eye.

Conclusions Rural populations have a high prevalence of glaucoma, which should be included in chronic disease management programmes in China for long-term care.

  • Glaucoma
  • Epidemiology
  • Public health

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • YL, BY and XC contributed equally.

  • Contributors HY conceived the China Rural Glaucoma Cohort Study (China-RG Study) and take responsibility for its all aspects. HY, YuL and BY designed the study. YoL, ZX, XiaC, ZY, XW, DH, XM, WG, RW, YY, SC, JZ, ZS, JW, JP, WW, MW, JG, HZ, LT, WD, XP, GL, XD, XH, XG, ZZ, ZS and CFW organise the implementation of the project. XiC, XY, XY and JiW were involved in data management and statistical analysis. YuL, BY and XiC wrote the first and subsequent drafts of the report. HY, CZ, NJT, BY and XiC were the co-principal investigators of the project, reviewed and commented on drafts of the report. HY, CZ and NJT supervised its conduct and data analysis, and provided comments on all drafts. SB, CZ and XS were the counselors. All authors interpreted data, contributed to critical revisions, and approved the final version of the Article.

  • Funding This research was supported by the National Natural Science Foundation of China (Grant numbers 81900883, 82020108007, 81830026), Tianjin Natural Science Foundation (Grant Number 19JCQNJC11300), Beijing-Tianjin-Hebei Special Project (Grant number, 19JCZDJC64300(Z)).

  • Disclaimer The sponsor or funding organisations had no role in the design or conduct of this research. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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  • Competing interests None declared.

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

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