Article Text

Download PDFPDF
Persistence of severe global inequalities in the burden of blindness and vision loss from 1990 to 2019: findings from the Global Burden of Disease Study 2019
  1. Yuancun Li1,
  2. Hongxi Wang1,
  3. Zhiqiang Guan1,
  4. Chengyao Guo1,2,
  5. Pi Guo3,
  6. Yali Du1,
  7. Shengjie Yin1,
  8. Binyao Chen1,
  9. Jiao Jiang1,
  10. Yueting Ma1,
  11. Liu Jing1,2,
  12. Yingzi Huang1,
  13. Ke Zheng1,2,
  14. Qian Ma1,2,
  15. Ruiqing Zhou1,2,
  16. Min Chen1,2,
  17. Nathan Congdon4,5,6,
  18. Kunliang Qiu1,
  19. Mingzhi Zhang1
  1. 1Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University, Shantou, People's Republic of China
  2. 2Medical College, Shantou University, Shantou, China
  3. 3Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
  4. 4Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangdong, China
  5. 5Orbis International, New York City, New York, USA
  6. 6School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK
  1. Correspondence to Dr Mingzhi Zhang, The Chinese University of Hong Kong, Hong Kong, Guangdong, Hong Kong; zmz{at}; Dr Kunliang Qiu; qkl{at}


Aims To assess the global burden and economic inequalities in the distribution of blindness and vision loss between 1990 and 2019.

Methods A secondary analysis of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019. Data for disability-adjusted life-years (DALYs) due to blindness and vision loss were extracted from the GBD 2019. Data for gross domestic product per capita were extracted from the World Bank database. Slope index of inequality (SII) and concentration index were computed to assess absolute and relative cross-national health inequality, respectively.

Results Countries with high, high-middle, middle, low-middle and low Socio-demographic Index (SDI) had decline of age-standardised DALY rate of 4.3%, 5.2%, 16.0%, 21.4% and 11.30% from 1990 to 2019, respectively. The poorest 50% of world citizens bore 59.0% and 66.2% of the burden of blindness and vision loss in 1990 and 2019, respectively. The absolute cross-national inequality (SII) fell from −303.5 (95% CI −370.8 to −236.2) in 1990 to −256.0 (95% CI −288.1 to −223.8) in 2019. The relative inequality (concentration index) for global blindness and vision loss remained essentially constant between 1991 (−0.197, 95% CI −0.234 to −0.160) and 2019 (−0.193, 95% CI −0.216 to −0.169).

Conclusion Though countries with middle and low-middle SDI were the most successful in decreasing burden of blindness and vision loss, a high level of cross-national health inequality persisted over the past three decades. More attention must be paid to the elimination of avoidable blindness and vision loss in low-income and middle-income countries.

  • Epidemiology
  • Vision
  • Public health

Data availability statement

Data are available in a public, open access repository.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available in a public, open access repository.

View Full Text


  • YL, HW and ZG are joint first authors.

  • YL, HW and ZG contributed equally.

  • KQ and MZ contributed equally.

  • Contributors KQ and MZ: design the study, results interpretation, finalise the manuscript; YL, HW and ZG: data analysis, drafting the manuscript; CG, PG, YD, SY, BC, JJ, YM, LJ, YH, KZ, QM, RZ and MC: data collection, data analysis. NC: draft and revise the manuscript. KQ: responsible for the overall content as the guarantor

  • Funding This study was partly supported by Special Fund for Science and Technology of Guangdong Province, grant number: 2019ST024 and the Science and Technology Plan Project of Shantou, grant number:汕府科[2019]106.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • 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.