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Q. Yin, A. Hu, Y. Liang, M. He, D. S. C. Lam, J. Ge, N. Wang, D. Friedman, J. Zhao, N. Congdon; A Two-Site, Population-Based Study of Barriers to Cataract Surgery in Rural China. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1925.
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© ARVO (1962-2015); The Authors (2016-present)
With 23,000 ophthalmologists, China has a cataract surgical rate of only 24 cases per year per ophthalmologist. We used a multi-site, population-based approach to better understand barriers to cataract surgery in rural China.
Separate population-based studies were carried out in two rural areas, Handan in the north and Yangjiang in the south. Persons blind (presenting VA <= 6/60) due to cataract in >= 1 eye, and those having undergone cataract surgery in >= 1 eye, were administered a survey consisting of questions in four areas suggested by Yorston (Eye. 2005;19:1083-9) to determine uptake of cataract surgery: Knowledge, Perception of Quality, Transportation and Cost. Normalized scores ranging from 0-10 were computed in each area, and logistic regression models used to determine the impact of these potential barriers and demographic factors on uptake of cataract surgery.
In Handan, 88 un-operated and 48 operated persons were recruited, while the figures for Yangjiang were 122 and 95 respectively. Among a total of 363 subjects (un-operated: mean age 73.8 years, 58.6% female; operated: mean age 70.5 years, 60.1% female), scores for Knowledge, Perception of Quality, and Cost were significantly worse for un-operated compared to operated persons at both sites, while Transportation scores did not differ significantly. In models adjusting for age and gender, neither of which was significant, and location, higher Knowledge (OR 1.29 per point increase in score, 95% CI 1.14 - 1.46, p = 0.0005) and Perception of Quality (OR 1.26, 1.13 - 1.41, p = 0.0006) scores were significantly associated with having had cataract surgery, while Transportation (OR 1.05, 0.96 - 1.15) and Cost (OR 1.14, 0.93 - 1.40) scores were not associated.
Our results suggest that lack of knowledge and concerns over poor quality are important barriers to cataract surgical uptake in rural China. Transportation may not be a major problem in these densely-settled areas. Though the lack of significance of cost may appear surprising, the finding is consistent with previous reports that a many in rural China are willing to pay modest amounts for cataract surgery (He M et al, Ophthalmology. 2007;114:411-6.). Strengths of the current study include consistency of findings across geographic regions and a population-based design.
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