Age, Gender, and Socio-demographic Disparities in Near Vision Loss: A Global Burden of Disease Study Focusing on Belt and Road Countries

Age, Gender, and Socio-demographic Disparities in Near Vision Loss: A Global Burden of Disease Study Focusing on Belt and Road Countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Age, Gender, and Socio-demographic Disparities in Near Vision Loss: A Global Burden of Disease Study Focusing on Belt and Road Countries Shunmei Ji, Wenchang Jia, Jiashuo Zhang, Chunyan Cai, Xiuyu Mao, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6582843/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Near vision loss (NVL), primarily resulting from presbyopia and other age-related conditions, significantly reduces quality of life and imposes a substantial global economic burden. However, research on NVL’s prevalence and determinants remains limited, particularly in Belt and Road Initiative (BRI) countries. This study aims to analyze the disease burden and temporal trends of NVL in BRI countries. Methods Using data from the Global Burden of Disease 2021 (GBD 2021) study, we examined age-standardized prevalence rates (ASPR) and age-standardized years lived with disability rates (ASYLDR) for NVL across BRI countries from 1990 to 2021. Analyses were stratified by Socio-Demographic Index (SDI) quintiles, and joinpoint regression was employed to estimate the average annual percentage change (AAPC) in disease burden from 1990 to 2021. Results Between 1990 and 2021, South Asia (ASPR: 20,747.02/10 5 ; ASYLDR: 208.01/10 5 ) and East Asia (ASPR: 15,509.26/10 5 ; ASYLDR: 157.57/10 5 ) recorded the highest ASPR and ASYLDR, while Western Europe reported the lowest (ASPR: 5,912.94/10 5 ; ASYLDR: 59.38/10 5 ). Among BRI countries, the Philippines, Nepal, and India exhibited the highest NVL burden, whereas Malaysia reported the lowest. NVL prevalence and YLDs increased with age, peaking at ages 60–64 and 55–59, respectively. Additionally, ASPR and ASYLDR were negatively correlated with SDI (R = -0.467 and R = -0.462, p < 0.01). Conclusions NVL burden varies across BRI countries based on age, gender, and SDI level. Older women in low SDI regions are particularly at risk. International collaboration, public health outreach, and targeted interventions are essential to reduce the global NVL burden. Near vision loss BRI countries Burden of disease YLDs Trend analysis Average annual percent change Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Near vision loss (NVL) is a leading cause of visual impairment worldwide, and carries the highest disease burden among ocular disorders [1, 2] . The primary etiology is presbyopia, an age-related ocular condition marked by reduced lens elasticity, which impairs near-focusing ability.In 2015, an estimated 1.8 billion individuals were affected by presbyopia, with 826 million experiencing clinically significant NVL [2, 3] . Other contributors to near vision impairment include age-related macular degeneration and cataracts, which damage ocular structures and reduce visual acuity. Additional risk factors include refractive errors, glaucoma, diabetic retinopathy, amblyopia, and optic neuritis. With global population aging and increasing life expectancy, the prevalence of NVL is expected to rise substantially[ 4 ]. NVL imposes substantial burdens on both quality of life and economic systems. In 2019, blindness and vision impairment accounted for 21.7% of global disability-adjusted life years (DALYs) [ 5 , 6 ].NVL is linked to lower cognitive function in older adults, reflected in reduced performance on assessments such as the Digit Symbol Substitution Test (DSST)[ 7 ], emphasizing the potential benefits of managing NVL to improve cognitive health.However, many older adults lack regular access to vision care, presenting challenges for effective healthcare delivery. The economic ramifications are particularly severe, with annual direct medical costs reaching $ 11,533 per geographic atrophy-associated NVL patient in the United States and €1,772 in Europe [ 8 ]. The Belt and Road Initiative (BRI), launched by China in 2013,seeks to connect over half of the world’s population across Asia, Europe, and Africa, promoting Eurasian economic integration [ 9 ]. BRI countries vary widely in socio-economic status, healthcare infrastructure, and demographic characteristics, all of which critically shape health outcomes[ 10 ]. Our 2024 study on glaucoma is among the few to examine eye health in these regions, revealing a substantial knowledge gap regarding the influence of local environmental, occupational, and healthcare factors on NVL [ 11 ]Research on the incidence and progression of NVL in BRI countries remains limited. In China, the prevalence of NVL and its associated DALYs significantly increased from 1990 to 2019, particularly among middle-aged and older women. However, comprehensive data for other BRI regions ,especially for 2021, are still lacking [ 4 , 12 ]. Furthermore, the emergence of the COVID-19 pandemic in 2020 may have affected NVL trends [ 13 ]. Utilizing data from GBD 2021, this study evaluates the prevalence and Years Lived with Disability (YLDs) due to NVL from 1990 to 2021 across BRI countries. It explores the impact of regional disparities, the COVID-19 pandemic, gender, age, and the Socio-Demographic Index (SDI) on NVL. By quantitatively assessing NVL rates alongsid e socio-economic and healthcare factors, the study provides critical insights into the determinants of NVL within thes e nations . These findings are essential for developing targeted public health interventions to improve NVL management, enhance eye health outcomes, and promote sustainable health strategies. Ultimately, the study aims to inform health policy, address health disparities, and improve outcomes across diverse regions. Methods Data sources and definitions Adhering to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER, Tab. S1) [ 14 ], this study utilizes data from the GBD 2021 study. The methodologies underpinning our research have been extensively documented in prior publications [ 15 ]. We have employed age-standardised rates (ASRs) for both prevalence and YLDs of NVL, applying a global age structure from the year 2021 for standardization across diverse demographic profiles. YLDs are utilized to estimate the burden of health loss due to diseases and injuries that do not result in death but lead to a reduction in quality of life. We adapted the ASRs using the direct method, aligning them with the world standard population to account for variations in age demographics across different populations. The source of all epidemiological data was the Institute for Health Metrics and Evaluation (IHME). Statistical Approaches To assess NVL in BRI countries, we calculated both prevalence and YLDs, presenting these figures in absolute terms and as ASRs with 95% uncertainty intervals (UIs). To track disease burden changes from 1990 to 2021, we utilized joinpoint regression software to calculate average annual percent changes (AAPCs), also identifying the 95% confidence intervals (CIs) for each trend phase. Trends were categorized as increasing if both the AAPC and the lower limit of the 95% UI were positive, and as decreasing if both the AAPC and the upper limit of the 95% UI were negative. Stability was assumed when neither condition was met. All statistical analyses were conducted using the Joinpoint Regression Program (Version 4.9.0.0, March 2021), with a significance level set at p < 0.05 for all tests. Results 1. Prevalence, Disability Impacts, and Temporal Changes of NVL Between 1990 and 2021, the global incidence of NVL rose significantly, increasing from 0.43 billion to 1.16 billion cases—an overall rise of 169.91%. Similarly, Years YLDs increased from 4.32 million to 11.65 million, reflecting a comparable growth rate of 169.92%. Throughout this period, regions classified as having a middle SDI consistently reported the highest NVL prevalence and YLDs, whereas low and high SDI regions recorded the lowest and second-lowest rates, respectively. (Tab.S2) The age-standardized prevalence rate (ASPR) of NVL ncreased from 9,788.66 per 100,000 people in 1990 to 13,436.18 per 100,000 in 2021, representing a 37.26% rise. Similarly, the global age-standardized YLD rate (ASYLDR) rose from 98.26 to 135.52 per 100,000 during the same period, reflecting a 37.92% increase. High and upper-middle SDI regions consistently exhibited the lowest and second-lowest ASPR and ASYLDR values, respectively. As illustrated in Fig. 1 and Fig. 2 ,considerable geographic disparities in ASPR and ASYLDR were observed among BRI countries. Regionally, South Asia and East Asia reported the highest rates across the study period, while Western Europe reported the lowest.At the national level, the Philippines recorded the highest NVL ASPR in 1990, at 18,646.60 per 100,000. By 2019, India had the highest rate at 23,427.00 per 100,000, followed closely by Nepal with 23,398.54 per 100,000 in 2020. In 2021, India remained the highest at 23,331.06 per 100,000. The highest ASYLDRs were consistently reported in the Philippines, Nepal, and India. Notably, China’s ranking improved over time, reaching fifth place for both ASPR and ASYLDR at the end of the study period. In contrast, Malaysia consistently reported the lowest rates, maintaining approximately 4,000 per 100,000 for ASPR and 40 per 100,000 for ASYLDR. Furthermore, Malaysia showed a steady decline in these rates across all time points.(Tab.S3, Tab.S4) From 1990 to 2021, our analysis reveals a consistent increase in both the ASPR and ASYLDR. The AAPC for ASPR increased from 1.04% over the entire period to 1.53% between 2012 and 2021. Similarly, the AAPC for ASYLDR rose from 1.06–1.50% during the same intervals globally. High SDI regions consistently exhibited the lowest AAPCs for both indicators. During this period, 18 countries reported increases in NVL ASPR, while 41 observed declines, and 8 showed no change. The trend for ASYLDR was comparable, with 21 countries experiencing increases, 41 reporting decreases, and 5 remaining stable. India, China, and Nepal demonstrated the most significant increases in both ASPR and ASYLDR from 1990 to 2021. In the last decade, China, the Russian Federation, and Nepal showed the most substantial growth. This period also marked a notable shift, with more countries reporting increases in both indicators. Countries such as Georgia, Slovakia, and the United Arab Emirates, which had previously shown declining trends, experienced reversals and reported rising NVL rates after 2012. (Tab.S5) 2. Gender-Specific Trends in NVL Figure 3 and Tab.S6 illustrate significant gender disparities in the ASPR and ASYLDR for NVL across various regions in 2021. Globally, women experienced higher ASPR (14,615.50 vs. 12,207.94; p < 0.01) and ASYLDR (146.82 vs. 123.79; p < 0.01) compared to men. The gender gap was most pronounced in South Asia, whereas Central Asia exhibited the smallest disparity. These gender differences were associated with Socio-Demographic Index (SDI) levels, with the most substantial disparities observed in lower-middle SDI countries, smaller gaps in low SDI countries, and minimal differences in high SDI countries. Unlike most countries, only Estonia, the Lao People's Democratic Republic, Slovenia, and Latvia reported higher NVL rates in men than in women. India and Nepal hold the top spots for both genders for ASYLDR. The largest gender gaps in NVL are observed in Bangladesh, Bhutan, the United Arab Emirates, Pakistan, and Iran, making them the top five among 66 countries studied, whereas India is seventh and Nepal sixth From 1990 to 2021, a comprehensive analysis of global NVL data reveals an upward trend in both ASPR and ASYLDR across genders. The AAPC for NVL ASPR registered at 1.52% (1.35, 1.70) for males and 1.44% (1.28, 1.60) for females. In terms of ASYLDR, the AAPC was 1.55% (1.37, 1.73) for males and 1.46% (1.30, 1.62) for females. Notably, the growth rates varied by SDI, with the most substantial increases in lower-middle SDI regions for males and middle SDI regions for females, while high SDI regions consistently report the smallest increases. Among Belt and Road Initiative (BRI) countries, NVL ASPR increased in 25 countries for males and 28 for females; remained stable in 12 and 11 countries, respectively; and decreased in 29 countries for males and 27 for females. For ASYLDR, 29 countries experienced increases in males and 26 in females, while 14 countries remained stable for males and 16 for females, and 23 and 24 countries, respectively, recorded decreases.Notably, gender-specific trends were evident in several countries. In India, the United Arab Emirates, Pakistan, Hungary, and Georgia, marked differences were observed in ASPR and ASYLDR between males and females. In Greece, male rates decreased while female rates increased for both indicators. India, Nepal, and the Russian Federation exhibited the most significant increases in ASPR and ASYLDR for both genders, with China ranking fourth. (Tab.S7, Tab.S8) 3. Age-Specific Trends in NVL Prevalence and YLDs in 2021 Figure 4 illustrates that the prevalence of NVL and associated YLDs generally increase with age worldwide, peaking in the 60–64 and 55–59 age groups, respectively. NVL prevalence reaches its highest value at 38,916.52 cases per 100,000 in the 60–64 age group and remains high, slightly declining to 35,085.76 among individuals aged 85 and older. Similarly, YLDs peak at 394.28 per 100,000 in the 55–59 age group and then decrease to 320.26 in the oldest age group. For children aged 0–14, the AAPC for both NVL prevalence and YLDs is about 0.14%.In the 15–49 age group, a substantial increase is observed, with an AAPC of 2.45% for both indicators. Among individuals aged 50–74, the AAPC is approximately 1.45%, while those aged 75 and older show the lowest AAPC, around 0.12%. In early childhood, NVL prevalence is highest in low SDI regions (368.94 per 100,000), compared to 167.42 in high SDI regions. This disparity widens with age, peaking in the 80–84 age group for low SDI regions and in the 55–59 age group for high SDI regions. Among children aged 0–14, NVL prevalence and YLDs are increasing in low and low-middle SDI regions, but declining in high-middle and high SDI regions. For those aged 15–49, prevalence is rising across all SDI levels, with the steepest increases in low-middle and middle SDI regions. The upward trend continues in the 50–74 age group, particularly in middle and high-middle SDI regions. In contrast, individuals aged 75 and older exhibit lower AAPC values, with some declines observed in high-middle and high SDI regions. In the BRI regions, NVL prevalence and YLDs exhibit substantial variation across age groups and geographic areas. For instance, in East Asia, NVL prevalence peaks at 54,400.02 per 100,000 in individuals aged 60–64 and declines to 35,038.50 among those aged 85 and older, with YLDs following a similar trend. In Central Asia, the peak prevalence occurs in the same age group (60–64), reaching 58,351.66 per 100,000, whereas in South Asia, it rises to 57,444.92 among individuals aged 75–79. Southeast Asia and high-income Asia Pacific regions display more gradual increases, with the highest rates observed in the oldest age groups. Western Europe exhibits the least pronounced increase, with both prevalence and YLDs peaking in the oldest cohort. (Tab.S9, S10) In East Asia, particularly China, YLDs and prevalence decline in the youngest and oldest age groups but rise notably among working-age adults. In Central Asia, NVL prevalence among children generally decreases, although Armenia and Azerbaijan report slight increases in adult YLDs. South Asia, especially India and Nepal, shows substantial increases in both YLDs and prevalence across all age groups; notably, YLDs among India’s working-age adults increased by 4.32%. In Southeast Asia, particularly Indonesia, adult YLDs and prevalence have risen significantly, though rates among children remain low. In high-income Asia Pacific countries such as Singapore, YLDs and prevalence remain consistently low across all age groups. In the Middle East and North Africa, trends are mixed, with Iran exhibiting rising YLDs and prevalence among adults and the elderly. Similarly, Eastern Europe, particularly Russia, reports increases in both indicators among adults.(Tab.S11, S12) 4. Burden of NVL by SDI Figure 5 shows a strong negative correlation between both NVL ASPR and ASYLDR and SDI from 1990 to 2021 (R = -0.467 and R = -0.462, P < 0.001). Regions with lower SDI consistently experienced higher NVL burdens, while those with higher SDI reported lower rates. Globally, ASPR and ASYLDR values remained below expected levels from 1990 to 2012 but surpassed expectations from 2013 to 2021. Central and Southern Sub-Saharan Africa and Andean Latin America persistently reported higher-than-expected NVL burdens, whereas Central Asia, Central Europe, and Southeast Asia maintained lower-than-expected rates throughout the study period. In East Asia, NVL rates increased from lower to higher than expected over time. Eastern Europe and Tropical Latin America exhibited fluctuating trends. Developed regions, including High-income Asia Pacific, Western Europe, and High-income North America, initially recorded lower-than-expected rates but gradually converged with global projections. (see Tab.S13) Discussion The study covering the period from 1990 to 2021 underscores the escalating global health burden of NVL, with cases increasing by 169.9% and generating significant economic costs [ 16 ]. The analysis reveals a consistent increase in both NVL prevalence and YLDs, particularly over the past decade, indicating that NVL is becoming increasingly common and disabling. BRI countries exhibited notable geographic disparities in NVL prevalence and YLDs, reflecting substantial regional health challenges. South Asia and East Asia consistently exhibited the highest ASPR and ASYLDR throughout thi s period. In Western populations, presbyopia symptoms generally emerge around the age of 40, whereas in equatorial regions such as Central and South America, earlier onset is often observed, possibly due to greater ultraviolet radiation exposure[ 17 ]. However, this latitude-based association is not absolute. For instance, while Indonesia and the Philippines report high NVL rates, Malaysia—despite its similar geographic location—consistently shows low rates. Conversely, the Russian Federation, the northernmost BRI country, demonstrates high prevalence and YLDs. These findings suggest that additional factors beyond latitude contribute to NVL patterns[ 18 ]. The increases in both NVL prevalence and YLDs across more countries in the past decade, compared to the overall period from 1990 to 2021, highlights an escalating global challenge in NVL management. The period has provided insights into the impact of the COVID-19 pandemic on NVL management. Countries such as India, China, and Nepal—already burdened with high NVL rates—reported further increases during the pandemic, primarily due to interruptions in routine health services, especially ophthalmologic care. Similarly, countries like Georgia, Slovakia, and the United Arab Emirates, which had previously shown declining NVL trends, experienced reversals during the pandemic, indicating the pandemic’s strain on healthcare systems.COVID-19 infection has been linked to several serious ocular complications associated with NVL. Acute viral retinitis [19] and unilateral optic neuritis [20] can result in monocular blindness, while additional complications include optic disc edema and homonymous visual field loss [21] . Moreover, the pandemic has exacerbated eye-related issues due to increased screen time and prolonged indoor activity.These findings underscore the need for comprehensive health policies and strategic interventions to mitigate the long-term effects of the pandemic on NVL management[ 22 ]. As BRI countries move toward post-pandemic recovery, addressing the backlog of care and strengthening healthcare system capacities to manage NVL is essential [ 23 ]. Furthermore, the data underscore significant gender-based disparities in NVL across global regions. Women are disproportionately affected, particularly in South Asia, North Africa, and the Middle East. These disparities are especially evident in countries with lower-middle SDI scores—such as Bhutan, Indonesia, and Bangladesh—where NVL rates are significantly higher among women. In rural South Asia, for instance, women often have limited autonomy in seeking medical care Socioeconomic barriers and restricted healthcare access substantially affect women’s health outcomes, emphasizing the need for gender-sensitive health policies[ 12 , 24 , 25 ]. Uncorrected refractive errors, which are more prevalent among women in less developed countries, contribute notably to the elevated NVL burden [ 26 ]. Additional factors, including longer life expectancy, shorter tear breakup time [ 27 ], the nature of tasks performed by women, and specific visual demands may further exacerbate these disparities.Conversely, in countries such as Estonia, the Lao People’s Democratic Republic, Slovenia, and Latvia, NVL prevalence is higher among men. This trend may be driven by occupational exposures and lifestyle-related risk factors, including outdoor labor without adequate eye protection, higher rates of smoking, and alcohol consumption—all recognized contributors to eye disease.Longitudinal trends show increases in both NVL prevalence and YLDs across genders, with a slightly higher rate observed among men ,suggests a rising global burden of NVL for both genders. These findings point to a growing global burden of NVL and reflect a complex interplay of socioeconomic conditions, healthcare accessibility, and cultural norms influencing gender-specific outcomes. Simultaneously, age-related variations in NVL are evident. Age-specific data from 1990 to 2021 reveal a significant global increase in both NVL prevalence and YLDs with advancing age, reflecting the cumulative burden of visual impairment over the lifespan[ 28 ]. The later peak in NVL prevalence compared to YLDs can be attributed to the disease’s slow progression. While NVL typically develops slowly, the associated disabilities can affect daily functioning earlier, leading to a premature rise in YLDs before clinical diagnosis.This delay in diagnosis is partly attributed to the disease’s non-specific early symptoms, contributing to the lag in peak prevalence. Additionally, common comorbidities in older adults intensify disability severity, causing an earlier peak in YLDs. These findings highlight the interplay between age and geographic disparities in influencing NVL patterns.For example, in China, while NVL prevalence and YLDs have declined among the youngest and oldest age groups, a notable rise is observed among working-age adults. This trend may indicate gaps in occupational health policies or lifestyle-related risk factors[ 28 ]. In contrast, South Asia—particularly India and Nepal—marked increases across all age groups underscore the need for targeted interventions to improve healthcare access and manage chronic disease . Finally, the SDI plays a critical role in assessing the social and demographic characteristics of regions, encompassing education, health status, and income [ 29 ]. Between 1990 and 2021, our analysis revealed a strong negative correlation between SDI and both the prevalence of NVL and YLDs. This pattern aligns with trends observed in other health conditions, emphasizing the broad influence of socio-economic factors on public health outcomes [ 30 ].This period also marks a notable transition in the global NVL burden. Prior to 2012, NVL rates were generally below expected global levels. However, from 2013 onward, these rates exceeded expectations, likely influenced by global economic and demographic changes that affected healthcare accessibility and quality. Regional comparisons highlight stark disparities: while low-SDI regions report higher-than-expected NVL burdens, high-SDI regions maintain rates below expectations. These differences may be attributed to stronger healthcare systems, greater access to preventive services, and higher education levels, which enhance health literacy and early intervention. Overall, regional disparities, the COVID-19 pandemic, gender, age, and SDI levels all contribute to NVL burden variation. The differing trends across countries reflect inequities in healthcare access, preventive strategies, and policy effectiveness. Analyzing these trends underscores the need for targeted health communication, public education, and policies emphasizing prevention, early detection, accurate diagnosis, and effective management [ 31 ].Collaborative health efforts, especially in regions with limited healthcare infrastructure, are vital for addressing the growing NVL burden. Moreover, investments in healthcare systems in low-SDI areas can substantially reduce NVL rates. Finally, advances in diagnostic technologies may increase reported prevalence, reflecting better detection rather than actual disease worsening. Recent research underscores that presbyopia should be regarded as a manageable condition rather than an unavoidable consequence of aging[ 32 ].Various interventions,including reading glasses, eye drops [ 33 , 34 ], contact lenses, refractive surgery, and intraocular lenses [ 35 , 36 ], are available to manage presbyopia. Among these, reading glasses are the most commonly used. However, inadequate correction of NVL remains a significant global concern[ 2 ]. Despite the high prevalence of presbyopia, spectacle coverage remains low. As of 2015, 1.8 billion people were affected by presbyopia, with 826 million experiencing visual impairment due to insufficient correction. This unmet need results in substantial productivity losses, particularly in low- and middle-income countries, amounting to an estimated global economic loss of USD 315 billion annually [ 37 ]. For instance, in rural Jhajjar, Haryana, the prevalence of presbyopia was 42.9%, but spectacle coverage was only 25.8% [ 38 ]. These figures highlight the urgent need for greater awareness and the expansion of affordable and accessible eye care services to effectively address presbyopia worldwide. This study faces limitations, including the inherent constraints of the GBD methodology and variability in data quality across BRI countries. Diverse political climates and migration trends further influence these findings. The absence of specific risk factors for NVL in the GBD suggests a need for more research into region-specific disease factors. Conclusions This study examined the influence of regional disparities, the COVID-19 pandemic, gender, age, and SDI levels on NVL. Findings indicate that regions with lower SDI scores experience higher rates of NVL and related disabilities, highlighting significant healthcare and socio-economic challenges. The COVID-19 pandemic further exacerbated these issues by disrupting healthcare delivery and exposing vulnerabilities in global health systems. The analysis also reveals that women,particularly in lower-middle SDI regions,are disproportionately affected by NVL due to limited access to healthcare and persistent socio-economic barriers. Additionally, NVL prevalence and associated disability rates increase with age, peaking among the elderly. These findings underscore the urgent need for public health strategies tailored to the unique cultural and economic contexts of each region, advocating for a departure from one-size-fits-all solutions. Declarations Conflicts of Interest: The authors declare no conflicts of interest. The manuscript has been reviewed and approved by all authors, who confirm that the authorship criteria outlined earlier in this document have been met. Each author affirms that the manuscript represents an honest and accurate account of the research conducted. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding The project was supported by the National Natural Science Foundation of China (82401297). Author Contribution Author Contributions: Concept and Design: XL; Data Acquisition and Visualization: WJ, JZ, WL, CC, BC; Data Analysis: WJ, JZ, WL, CC, BC; Supervision and Project Administration: XL; Manuscript Preparation: SJ; Manuscript Editing: SJ, WJ, JZ, CC; Manuscript Review: All authors; Corresponding Author: XL (responsible for the integrity of the work as a whole). SJ, WJ, and JZ contributed equally to this work. The final manuscript was reviewed and approved by all authors. Acknowledgement We would like to express our sincere gratitude to Professor Dai Jinhui (Institutes of Opthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China) for his invaluable guidance in the clinical aspects of the research on near vision loss. Data Availability For accessing the data utilized in these analyses, kindly navigate to the GBD 2021 website of the Global Health Data Exchange. https://vizhub.healthdata.org/gbd-results/ References Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H et al : Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis . Lancet Glob Health 2017, 5 (9):e888-e897. 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Yu Y, Petrovic M, Zhang WH: Older European Adults and Access to Healthcare During the COVID-19 Pandemic . China CDC Wkly 2022, 4 (39):879-884. Gaffey AE, Burg MM, Rosman L, Portnoy GA, Brandt CA, Cavanagh CE, Skanderson M, Dziura J, Mattocks KM, Bastian LA et al : Baseline Characteristics from the Women Veterans Cohort Study: Gender Differences and Similarities in Health and Healthcare Utilization . J Womens Health (Larchmt) 2021, 30 (7):944-955. DiGiacomo M, Green A, Rodrigues E, Mulligan K, Davidson PM: Developing a gender-based approach to chronic conditions and women's health: a qualitative investigation of community-dwelling women and service provider perspectives . BMC Womens Health 2015, 15 :105. Lou L, Liu X, Tang X, Wang L, Ye J: Gender Inequality in Global Burden of Uncorrected Refractive Error . American journal of ophthalmology 2019, 198 :1-7. Ayaki M, Negishi K: Short Tear Breakup Time Could Exacerbate the Progression of Presbyopia in Women . BioMed research international 2022, 2022 :8159669. Zou M, Chen A, Liu Z, Jin L, Zheng D, Congdon N, Jin G: The burden, causes, and determinants of blindness and vision impairment in Asia: An analysis of the Global Burden of Disease Study . J Glob Health 2024, 14 :04100. Nair R, Chen M, Dutt AS, Hagopian L, Singh A, Du M: Significant regional inequalities in the prevalence of intellectual disability and trends from 1990 to 2019: a systematic analysis of GBD 2019 . Epidemiol Psychiatr Sci 2022, 31 :e91. Barakat C, Konstantinidis T: A Review of the Relationship between Socioeconomic Status Change and Health . Int J Environ Res Public Health 2023, 20 (13). Wolffsohn JS, Berkow D, Chan KY, Chaurasiya SK, Fadel D, Haddad M, Imane T, Jones L, Sheppard AL, Vianya-Estopa M et al : BCLA CLEAR Presbyopia: Evaluation and diagnosis . Cont Lens Anterior Eye 2024:102156. Brujic M, Kruger P, Todd J, Barnes E, Wuttke M, Perna F, Alio J: Living with presbyopia: experiences from a virtual roundtable dialogue among impacted individuals and healthcare professionals . BMC ophthalmology 2022, 22 (1):204. Panja S, Gaikwad H, Rankenberg J, Nam MH, Nagaraj RH: Promotion of Protein Solubility and Reduction in Stiffness in Human Lenses by Aggrelyte-1: Implications for Reversing Presbyopia . Int J Mol Sci 2023, 24 (3). Szumny D, Kucharska AZ, Czajor K, Bernacka K, Ziolkowska S, Krzyzanowska-Berkowska P, Magdalan J, Misiuk-Hojlo M, Sozanski T, Szelag A: Extract from Aronia melanocarpa, Lonicera caerulea, and Vaccinium myrtillus Improves near Visual Acuity in People with Presbyopia . Nutrients 2024, 16 (7). Stokes J, Shirneshan E, Graham CA, Paulich M, Johnson N: Exploring the Experience of Living with and Managing Presbyopia . Optom Vis Sci 2022, 99 (8):635-644. Gabric K, Gabric N, Pinero DP, Gabric I: Comparative Analysis of the Clinical Outcomes of Two Toric Presbyopia-Correcting Intraocular Lenses . Ophthalmol Ther 2024, 13 (3):775-790. Ma Q, Chen M, Li D, Zhou R, Du Y, Yin S, Chen B, Wang H, Jiang J, Guan Z et al : Potential productivity loss from uncorrected and under-corrected presbyopia in low- and middle-income countries: A life table modeling study . Front Public Health 2022, 10 :983423. Malhotra S, Vashist P, Kalaivani M, Rath RS, Gupta N, Gupta SK, Prasad M, Sathiyamoorthy R: Prevalence of presbyopia, spectacles coverage and barriers for unmet need among adult population of rural Jhajjar, Haryana . J Family Med Prim Care 2022, 11 (1):287-293. Additional Declarations No competing interests reported. Supplementary Files Tab.S1GATHERchecklistofinformationincludedinreportsofglobalhealthestimates.docx Tab.S2NumberofYLDsandPrevalencein1990201920202021.xlsx Tab.S3ASPRofNVLin199020192020and2021.xlsx Tab.S4ASYLDRsofNVLin199020192020and202.xlsx Tab.S5AAPCofASPRandASYLDsfrom19902021and20122021.xlsx Tab.S6ASPRsandASYLDRsforbothgendersin2021AcrosstheBRIcountries.xlsx Tab.S7AAPCinASPRsbetweenmalesandfemalesfrom1990to2021.xlsx Tab.S8AAPCinASYLDRsBetweenmalesandfemalesfrom1990to2021.xlsx Tab.S9PrevalenceratesforNVLacrossallagesin2021.xlsx Tab.S10YLDsratesforNVLacrossallagesin2021.xlsx Tab.S11AAPCinNVLprevalenceacrossthedifferentagegroupsfrom1990to2021.xlsx Tab.S12AAPCinYLDsacrossthedifferentagegroupsduetonvlfrom1990to2021.xlsx Tab.S13ASRsofprevalenceandYLDsacross21GBDregionsin199020192020and2021.xlsx Supplementarymaterials.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6582843","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":467087261,"identity":"1c3a406f-dea5-4b16-af09-8d7b4eb38c26","order_by":0,"name":"Shunmei Ji","email":"","orcid":"","institution":"Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Shunmei","middleName":"","lastName":"Ji","suffix":""},{"id":467087262,"identity":"c1756477-83df-4758-9337-d08b7ab7046b","order_by":1,"name":"Wenchang Jia","email":"","orcid":"","institution":"Department of Health Management Centre, Zhongshan Hospital, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Wenchang","middleName":"","lastName":"Jia","suffix":""},{"id":467087263,"identity":"a3d6125c-4021-42d6-9b44-a13ab08e54f1","order_by":2,"name":"Jiashuo Zhang","email":"","orcid":"","institution":"School of Basic Medical Sciences, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jiashuo","middleName":"","lastName":"Zhang","suffix":""},{"id":467087264,"identity":"4ccc4dad-c470-4620-8737-b06d2143977f","order_by":3,"name":"Chunyan Cai","email":"","orcid":"","institution":"Hunan Subdistrict Community Health Service Cente","correspondingAuthor":false,"prefix":"","firstName":"Chunyan","middleName":"","lastName":"Cai","suffix":""},{"id":467087265,"identity":"16ee209c-8323-4762-b9fd-9a3fff1c23b1","order_by":4,"name":"Xiuyu Mao","email":"","orcid":"","institution":"Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiuyu","middleName":"","lastName":"Mao","suffix":""},{"id":467087266,"identity":"c4f6d7c8-fb2c-46ea-a8e4-7ddd6bd7a7de","order_by":5,"name":"Xiangwu Chen","email":"","orcid":"","institution":"Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiangwu","middleName":"","lastName":"Chen","suffix":""},{"id":467087267,"identity":"67b714de-128d-45a9-93ab-27461fc12012","order_by":6,"name":"Lei Wu","email":"","orcid":"","institution":"Department of Health Management Centre, Zhongshan Hospital, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Wu","suffix":""},{"id":467087268,"identity":"6267c415-205e-4fb3-88f1-5901410725ca","order_by":7,"name":"Binghong Chen","email":"","orcid":"","institution":"Department of Health Management Centre, Zhongshan Hospital, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Binghong","middleName":"","lastName":"Chen","suffix":""},{"id":467087269,"identity":"03641df0-ac7b-47a4-ab6b-72086acd1711","order_by":8,"name":"Xiaopan Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYDACZgglw8bMfPCBRIWEHD+xWnjY2NuSDSzOWBhLNhBpGQ8Dzxkzicq2isQNhLQYHGd++Lig5g4Pn0SCgcTNeRKMGxiYHz66gUeLZDObsfGMY8942CQSEgxnbpNgNmcAiuTg0cLPzGAmzcN2GKTlQLLkNgk2ywYeNml8WtiY2b9J8/wDaUlsOPx3jgSPwQECWviZecykeduAWngOMzZINkhIENQi2cxTbDyz7zAokJkZJI5JGIB9h0+LwfnjGx8XfDssJ9/M//2HRE1dfT9788PH+LSAADNeLjFaRsEoGAWjYBSgAQC3z0FuRUAHRAAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Health Management Centre, Zhongshan Hospital, Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Xiaopan","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-05-03 08:08:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6582843/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6582843/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84207588,"identity":"5189711f-8e44-42f3-8bca-17be33aff4ab","added_by":"auto","created_at":"2025-06-09 09:28:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13828591,"visible":true,"origin":"","legend":"\u003cp\u003eASPR and AAPC in the BRI countries (1990, 2019, 2020, 2021)\u003c/p\u003e\n\u003cp\u003eA. ASPRs in 1990; B. ASPRs in 2019; C. ASPRs in 2020; D. ASPRs in 2021; E. Trend of ASPR from 1990 to 2021; F. Trend of ASPR from 2012 to 2021.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/2e5af65ec9cfa9a97e5260c9.jpg"},{"id":84207597,"identity":"ccb53621-f357-4a16-96f1-1bcda3e3eefc","added_by":"auto","created_at":"2025-06-09 09:28:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13706029,"visible":true,"origin":"","legend":"\u003cp\u003eASYLDR and AAPC in the BRI countries (1990, 2019, 2020, 2021)\u003c/p\u003e\n\u003cp\u003eA. ASYLDRs in 1990; B. ASYLDRs in 2019; C. ASYLDRs in 2020; D. ASYLDRs in 2021; E. Trend of ASYLDR from 1990 to 2021; F. Trend of ASYLDR from 2012 to 2021.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/620308e8f0c8ca100a9380ac.jpg"},{"id":84209204,"identity":"7b3c136c-3868-485c-8f8f-c226f5d2a2b1","added_by":"auto","created_at":"2025-06-09 09:44:02","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15729241,"visible":true,"origin":"","legend":"\u003cp\u003eGender Differences in Age-standardised Rates of NVL Prevalence and YLDs in 2021, and their AAPCs from 1990 to 2021 Across the BRI countries\u003c/p\u003e\n\u003cp\u003eA. ASPRs in males in 2021; B. ASPRs in females in 2021; C. ASYLDRs in males in 2021; D. ASYLDRs in females in 2021; E. Trend of ASPR in males from 1990 to 2021; F. Trend of ASPR in females from 1990 to 2021; G. Trend of ASYLDR in males from 1990 to 2021; H. Trend of ASYLDR in females from 1990 to 2021.\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/00ac80316f07d3692fd84637.jpg"},{"id":84209202,"identity":"29475e96-d8f4-4891-99cf-819a71f3d1d4","added_by":"auto","created_at":"2025-06-09 09:44:02","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":16694524,"visible":true,"origin":"","legend":"\u003cp\u003eComparative analysis of prevalence and YLDs rates for NVL across all ages in 2021, and Temporal trends in NVL prevalence across different age groups from 1990 to 2021\u003c/p\u003e\n\u003cp\u003eA. The prevalence rates of all ages in 2021; B. The YLDs rates of all ages in 2021; C. Trend in prevalence rate in people aged 0-14 years from 1990 to 2021; D. Trend in prevalence rate in people aged 15-49 years from 1990 to 2021; E. Trend in prevalence rate in people aged 50-74 years from 1990 to 2021; F. Trend in prevalence rate in people aged ≥75 years from 1990 to 2021; G. Trend in YLDs rate in people aged 0-14 years from 1990 to 2021; H. Trend in YLDs rate in people aged 15-49 years from 1990 to 2021; I. Trend in YLDs rate in people aged 50-74 years from 1990 to 2021; J. Trend in YLDs rate in people aged ≥75 years from 1990 to 2021.\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/f8b4916e21662615cf84a816.jpg"},{"id":84207614,"identity":"273222db-0b5e-4c56-afa5-a36508b35574","added_by":"auto","created_at":"2025-06-09 09:28:02","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":7710238,"visible":true,"origin":"","legend":"\u003cp\u003eAge‐standardised prevalence and YLDs rates of NVL for GBD 2021 by SDI, 1990–2021\u003c/p\u003e\n\u003cp\u003eA. ASPRs for GBD 2021; B. ASYLDRs for GBD 2021\u003c/p\u003e\n\u003cp\u003eExpected values based on Socio‐demographic Index and disease rates in all locations are shown as the black line. Thirty points are plotted for each GBD region and show the observed age‐standardised YLDs rates from 1990 to 2021 for that region.\u003c/p\u003e","description":"","filename":"Fig.5regionSDI9021.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/dc420b8ac04eb4f7c451c0c3.jpg"},{"id":96363009,"identity":"628f7618-940f-4ecd-abb4-eb89bbd52f7a","added_by":"auto","created_at":"2025-11-20 10:03:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":70042053,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/6568ea12-441d-4ea2-add9-f519e6e23ffe.pdf"},{"id":84207587,"identity":"9537ae43-ce26-453e-a39f-1da9ce362cd7","added_by":"auto","created_at":"2025-06-09 09:28:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17472,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S1GATHERchecklistofinformationincludedinreportsofglobalhealthestimates.docx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/5e9b37b772f1cc036b57fc36.docx"},{"id":84207595,"identity":"da6c4243-9340-4291-ba73-2f0207744b63","added_by":"auto","created_at":"2025-06-09 09:28:02","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":27969,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S2NumberofYLDsandPrevalencein1990201920202021.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/52abd05f46b5f5530bb6ec0f.xlsx"},{"id":84207592,"identity":"e52fa7e4-8a9d-4e0c-80fc-f1a094939384","added_by":"auto","created_at":"2025-06-09 09:28:02","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":21811,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S3ASPRofNVLin199020192020and2021.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/934ce58a36548f9a3b06aa44.xlsx"},{"id":84207589,"identity":"7dc49698-d1dd-428c-8ba3-1e4136289541","added_by":"auto","created_at":"2025-06-09 09:28:02","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":20649,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S4ASYLDRsofNVLin199020192020and202.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/49ff6d92143b120fca756b8b.xlsx"},{"id":84207599,"identity":"55f5a6bb-f326-48f0-a057-26506fd16e29","added_by":"auto","created_at":"2025-06-09 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09:36:02","extension":"xlsx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":50567,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S9PrevalenceratesforNVLacrossallagesin2021.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/24d7f206ef33cb3c205b73ea.xlsx"},{"id":84207609,"identity":"606e0525-48dc-4c2d-a15a-41ceef4d64f0","added_by":"auto","created_at":"2025-06-09 09:28:02","extension":"xlsx","order_by":10,"title":"","display":"","copyAsset":false,"role":"supplement","size":48128,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S10YLDsratesforNVLacrossallagesin2021.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/b86a9cb8e04940f65648a918.xlsx"},{"id":84207611,"identity":"ba87d1f0-7169-4fd8-8e6e-5f054e8c41a2","added_by":"auto","created_at":"2025-06-09 09:28:02","extension":"xlsx","order_by":11,"title":"","display":"","copyAsset":false,"role":"supplement","size":22858,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S11AAPCinNVLprevalenceacrossthedifferentagegroupsfrom1990to2021.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/e05e5b908467b663ec3ed7fd.xlsx"},{"id":84207633,"identity":"bfb7a4ac-d817-4127-a8a7-8ff9bd8a7769","added_by":"auto","created_at":"2025-06-09 09:28:03","extension":"xlsx","order_by":12,"title":"","display":"","copyAsset":false,"role":"supplement","size":30341,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S12AAPCinYLDsacrossthedifferentagegroupsduetonvlfrom1990to2021.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/2500fa95f2d27bd70d209493.xlsx"},{"id":84207635,"identity":"36706be3-4cb6-4d99-ba1c-e225c2e0af51","added_by":"auto","created_at":"2025-06-09 09:28:03","extension":"xlsx","order_by":13,"title":"","display":"","copyAsset":false,"role":"supplement","size":14939,"visible":true,"origin":"","legend":"","description":"","filename":"Tab.S13ASRsofprevalenceandYLDsacross21GBDregionsin199020192020and2021.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/945e5941cfebcf40f889a41a.xlsx"},{"id":84207616,"identity":"689c3597-30ac-4481-a484-4941c25aa61d","added_by":"auto","created_at":"2025-06-09 09:28:03","extension":"docx","order_by":14,"title":"","display":"","copyAsset":false,"role":"supplement","size":16571,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-6582843/v1/1dcbe0ae0d386dbcfb1b9bcf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Age, Gender, and Socio-demographic Disparities in Near Vision Loss: A Global Burden of Disease Study Focusing on Belt and Road Countries","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNear vision loss (NVL) is a leading cause of visual impairment worldwide, and carries the highest disease burden among ocular disorders\u003csup\u003e[1, 2]\u003c/sup\u003e. The primary etiology is presbyopia, an age-related ocular condition marked by reduced lens elasticity, which impairs near-focusing ability.In 2015, an estimated 1.8\u0026nbsp;billion individuals were affected by presbyopia, with 826\u0026nbsp;million experiencing clinically significant NVL \u003csup\u003e[2, 3]\u003c/sup\u003e. Other contributors to near vision impairment include age-related macular degeneration and cataracts, which damage ocular structures and reduce visual acuity. Additional risk factors include refractive errors, glaucoma, diabetic retinopathy, amblyopia, and optic neuritis. With global population aging and increasing life expectancy, the prevalence of NVL is expected to rise substantially[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNVL imposes substantial burdens on both quality of life and economic systems. In 2019, blindness and vision impairment accounted for 21.7% of global disability-adjusted life years (DALYs) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].NVL is linked to lower cognitive function in older adults, reflected in reduced performance on assessments such as the Digit Symbol Substitution Test (DSST)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], emphasizing the potential benefits of managing NVL to improve cognitive health.However, many older adults lack regular access to vision care, presenting challenges for effective healthcare delivery. The economic ramifications are particularly severe, with annual direct medical costs reaching \u003cspan\u003e$\u003c/span\u003e11,533 per geographic atrophy-associated NVL patient in the United States and \u0026euro;1,772 in Europe [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Belt and Road Initiative (BRI), launched by China in 2013,seeks to connect over half of the world\u0026rsquo;s population across Asia, Europe, and Africa, promoting Eurasian economic integration [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. BRI countries vary widely in socio-economic status, healthcare infrastructure, and demographic characteristics, all of which critically shape health outcomes[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our 2024 study on glaucoma is among the few to examine eye health in these regions, revealing a substantial knowledge gap regarding the influence of local environmental, occupational, and healthcare factors on NVL [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]Research on the incidence and progression of NVL in BRI countries remains limited. In China, the prevalence of NVL and its associated DALYs significantly increased from 1990 to 2019, particularly among middle-aged and older women. However, comprehensive data for other BRI regions ,especially for 2021, are still lacking [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, the emergence of the COVID-19 pandemic in 2020 may have affected NVL trends [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUtilizing data from GBD 2021, this study evaluates the prevalence and Years Lived with Disability (YLDs) due to NVL from 1990 to 2021 across BRI countries. It explores the impact of regional disparities, the COVID-19 pandemic, gender, age, and the Socio-Demographic Index (SDI) on NVL. By quantitatively assessing NVL rates alongsid\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ee\u003c/span\u003e socio-economic and healthcare factors, the study provides critical insights into the determinants of NVL within thes\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ee nations\u003c/span\u003e. These findings are essential for developing targeted public health interventions to improve NVL management, enhance eye health outcomes, and promote sustainable health strategies. Ultimately, the study aims to inform health policy, address health disparities, and improve outcomes across diverse regions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData sources and definitions\u003c/h2\u003e \u003cp\u003eAdhering to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER, Tab. S1) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], this study utilizes data from the GBD 2021 study. The methodologies underpinning our research have been extensively documented in prior publications [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We have employed age-standardised rates (ASRs) for both prevalence and YLDs of NVL, applying a global age structure from the year 2021 for standardization across diverse demographic profiles. YLDs are utilized to estimate the burden of health loss due to diseases and injuries that do not result in death but lead to a reduction in quality of life. We adapted the ASRs using the direct method, aligning them with the world standard population to account for variations in age demographics across different populations. The source of all epidemiological data was the Institute for Health Metrics and Evaluation (IHME).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStatistical Approaches\u003c/h3\u003e\n\u003cp\u003eTo assess NVL in BRI countries, we calculated both prevalence and YLDs, presenting these figures in absolute terms and as ASRs with 95% uncertainty intervals (UIs). To track disease burden changes from 1990 to 2021, we utilized joinpoint regression software to calculate average annual percent changes (AAPCs), also identifying the 95% confidence intervals (CIs) for each trend phase. Trends were categorized as increasing if both the AAPC and the lower limit of the 95% UI were positive, and as decreasing if both the AAPC and the upper limit of the 95% UI were negative. Stability was assumed when neither condition was met. All statistical analyses were conducted using the Joinpoint Regression Program (Version 4.9.0.0, March 2021), with a significance level set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1. Prevalence, Disability Impacts, and Temporal Changes of NVL\u003c/h2\u003e \u003cp\u003eBetween 1990 and 2021, the global incidence of NVL rose significantly, increasing from 0.43\u0026nbsp;billion to 1.16\u0026nbsp;billion cases\u0026mdash;an overall rise of 169.91%. Similarly, Years YLDs increased from 4.32\u0026nbsp;million to 11.65\u0026nbsp;million, reflecting a comparable growth rate of 169.92%. Throughout this period, regions classified as having a middle SDI consistently reported the highest NVL prevalence and YLDs, whereas low and high SDI regions recorded the lowest and second-lowest rates, respectively. (Tab.S2)\u003c/p\u003e \u003cp\u003eThe age-standardized prevalence rate (ASPR) of NVL ncreased from 9,788.66 per 100,000 people in 1990 to 13,436.18 per 100,000 in 2021, representing a 37.26% rise. Similarly, the global age-standardized YLD rate (ASYLDR) rose from 98.26 to 135.52 per 100,000 during the same period, reflecting a 37.92% increase. High and upper-middle SDI regions consistently exhibited the lowest and second-lowest ASPR and ASYLDR values, respectively. As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,considerable geographic disparities in ASPR and ASYLDR were observed among BRI countries. Regionally, South Asia and East Asia reported the highest rates across the study period, while Western Europe reported the lowest.At the national level, the Philippines recorded the highest NVL ASPR in 1990, at 18,646.60 per 100,000. By 2019, India had the highest rate at 23,427.00 per 100,000, followed closely by Nepal with 23,398.54 per 100,000 in 2020. In 2021, India remained the highest at 23,331.06 per 100,000. The highest ASYLDRs were consistently reported in the Philippines, Nepal, and India. Notably, China\u0026rsquo;s ranking improved over time, reaching fifth place for both ASPR and ASYLDR at the end of the study period. In contrast, Malaysia consistently reported the lowest rates, maintaining approximately 4,000 per 100,000 for ASPR and 40 per 100,000 for ASYLDR. Furthermore, Malaysia showed a steady decline in these rates across all time points.(Tab.S3, Tab.S4)\u003c/p\u003e \u003cp\u003eFrom 1990 to 2021, our analysis reveals a consistent increase in both the ASPR and ASYLDR. The AAPC for ASPR increased from 1.04% over the entire period to 1.53% between 2012 and 2021. Similarly, the AAPC for ASYLDR rose from 1.06\u0026ndash;1.50% during the same intervals globally. High SDI regions consistently exhibited the lowest AAPCs for both indicators. During this period, 18 countries reported increases in NVL ASPR, while 41 observed declines, and 8 showed no change. The trend for ASYLDR was comparable, with 21 countries experiencing increases, 41 reporting decreases, and 5 remaining stable. India, China, and Nepal demonstrated the most significant increases in both ASPR and ASYLDR from 1990 to 2021. In the last decade, China, the Russian Federation, and Nepal showed the most substantial growth. This period also marked a notable shift, with more countries reporting increases in both indicators. Countries such as Georgia, Slovakia, and the United Arab Emirates, which had previously shown declining trends, experienced reversals and reported rising NVL rates after 2012. (Tab.S5)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2. Gender-Specific Trends in NVL\u003c/h3\u003e\n\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Tab.S6 illustrate significant gender disparities in the ASPR and ASYLDR for NVL across various regions in 2021. Globally, women experienced higher ASPR (14,615.50 vs. 12,207.94; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and ASYLDR (146.82 vs. 123.79; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) compared to men. The gender gap was most pronounced in South Asia, whereas Central Asia exhibited the smallest disparity. These gender differences were associated with Socio-Demographic Index (SDI) levels, with the most substantial disparities observed in lower-middle SDI countries, smaller gaps in low SDI countries, and minimal differences in high SDI countries.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUnlike most countries, only Estonia, the Lao People's Democratic Republic, Slovenia, and Latvia reported higher NVL rates in men than in women. India and Nepal hold the top spots for both genders for ASYLDR. The largest gender gaps in NVL are observed in Bangladesh, Bhutan, the United Arab Emirates, Pakistan, and Iran, making them the top five among 66 countries studied, whereas India is seventh and Nepal sixth\u003c/p\u003e \u003cp\u003eFrom 1990 to 2021, a comprehensive analysis of global NVL data reveals an upward trend in both ASPR and ASYLDR across genders. The AAPC for NVL ASPR registered at 1.52% (1.35, 1.70) for males and 1.44% (1.28, 1.60) for females. In terms of ASYLDR, the AAPC was 1.55% (1.37, 1.73) for males and 1.46% (1.30, 1.62) for females. Notably, the growth rates varied by SDI, with the most substantial increases in lower-middle SDI regions for males and middle SDI regions for females, while high SDI regions consistently report the smallest increases. Among Belt and Road Initiative (BRI) countries, NVL ASPR increased in 25 countries for males and 28 for females; remained stable in 12 and 11 countries, respectively; and decreased in 29 countries for males and 27 for females. For ASYLDR, 29 countries experienced increases in males and 26 in females, while 14 countries remained stable for males and 16 for females, and 23 and 24 countries, respectively, recorded decreases.Notably, gender-specific trends were evident in several countries. In India, the United Arab Emirates, Pakistan, Hungary, and Georgia, marked differences were observed in ASPR and ASYLDR between males and females. In Greece, male rates decreased while female rates increased for both indicators. India, Nepal, and the Russian Federation exhibited the most significant increases in ASPR and ASYLDR for both genders, with China ranking fourth. (Tab.S7, Tab.S8)\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3. Age-Specific Trends in NVL Prevalence and YLDs in 2021\u003c/h2\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrates that the prevalence of NVL and associated YLDs generally increase with age worldwide, peaking in the 60\u0026ndash;64 and 55\u0026ndash;59 age groups, respectively. NVL prevalence reaches its highest value at 38,916.52 cases per 100,000 in the 60\u0026ndash;64 age group and remains high, slightly declining to 35,085.76 among individuals aged 85 and older. Similarly, YLDs peak at 394.28 per 100,000 in the 55\u0026ndash;59 age group and then decrease to 320.26 in the oldest age group. For children aged 0\u0026ndash;14, the AAPC for both NVL prevalence and YLDs is about 0.14%.In the 15\u0026ndash;49 age group, a substantial increase is observed, with an AAPC of 2.45% for both indicators. Among individuals aged 50\u0026ndash;74, the AAPC is approximately 1.45%, while those aged 75 and older show the lowest AAPC, around 0.12%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn early childhood, NVL prevalence is highest in low SDI regions (368.94 per 100,000), compared to 167.42 in high SDI regions. This disparity widens with age, peaking in the 80\u0026ndash;84 age group for low SDI regions and in the 55\u0026ndash;59 age group for high SDI regions. Among children aged 0\u0026ndash;14, NVL prevalence and YLDs are increasing in low and low-middle SDI regions, but declining in high-middle and high SDI regions. For those aged 15\u0026ndash;49, prevalence is rising across all SDI levels, with the steepest increases in low-middle and middle SDI regions. The upward trend continues in the 50\u0026ndash;74 age group, particularly in middle and high-middle SDI regions. In contrast, individuals aged 75 and older exhibit lower AAPC values, with some declines observed in high-middle and high SDI regions.\u003c/p\u003e \u003cp\u003eIn the BRI regions, NVL prevalence and YLDs exhibit substantial variation across age groups and geographic areas. For instance, in East Asia, NVL prevalence peaks at 54,400.02 per 100,000 in individuals aged 60\u0026ndash;64 and declines to 35,038.50 among those aged 85 and older, with YLDs following a similar trend. In Central Asia, the peak prevalence occurs in the same age group (60\u0026ndash;64), reaching 58,351.66 per 100,000, whereas in South Asia, it rises to 57,444.92 among individuals aged 75\u0026ndash;79. Southeast Asia and high-income Asia Pacific regions display more gradual increases, with the highest rates observed in the oldest age groups. Western Europe exhibits the least pronounced increase, with both prevalence and YLDs peaking in the oldest cohort. (Tab.S9, S10)\u003c/p\u003e \u003cp\u003eIn East Asia, particularly China, YLDs and prevalence decline in the youngest and oldest age groups but rise notably among working-age adults. In Central Asia, NVL prevalence among children generally decreases, although Armenia and Azerbaijan report slight increases in adult YLDs. South Asia, especially India and Nepal, shows substantial increases in both YLDs and prevalence across all age groups; notably, YLDs among India\u0026rsquo;s working-age adults increased by 4.32%. In Southeast Asia, particularly Indonesia, adult YLDs and prevalence have risen significantly, though rates among children remain low. In high-income Asia Pacific countries such as Singapore, YLDs and prevalence remain consistently low across all age groups. In the Middle East and North Africa, trends are mixed, with Iran exhibiting rising YLDs and prevalence among adults and the elderly. Similarly, Eastern Europe, particularly Russia, reports increases in both indicators among adults.(Tab.S11, S12)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e4. Burden of NVL by SDI\u003c/h3\u003e\n\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows a strong negative correlation between both NVL ASPR and ASYLDR and SDI from 1990 to 2021 (R = -0.467 and R = -0.462, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regions with lower SDI consistently experienced higher NVL burdens, while those with higher SDI reported lower rates. Globally, ASPR and ASYLDR values remained below expected levels from 1990 to 2012 but surpassed expectations from 2013 to 2021. Central and Southern Sub-Saharan Africa and Andean Latin America persistently reported higher-than-expected NVL burdens, whereas Central Asia, Central Europe, and Southeast Asia maintained lower-than-expected rates throughout the study period. In East Asia, NVL rates increased from lower to higher than expected over time. Eastern Europe and Tropical Latin America exhibited fluctuating trends. Developed regions, including High-income Asia Pacific, Western Europe, and High-income North America, initially recorded lower-than-expected rates but gradually converged with global projections. (see Tab.S13)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study covering the period from 1990 to 2021 underscores the escalating global health burden of NVL, with cases increasing by 169.9% and generating significant economic costs [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The analysis reveals a consistent increase in both NVL prevalence and YLDs, particularly over the past decade, indicating that NVL is becoming increasingly common and disabling.\u003c/p\u003e \u003cp\u003eBRI countries exhibited notable geographic disparities in NVL prevalence and YLDs, reflecting substantial regional health challenges. South Asia and East Asia consistently exhibited the highest ASPR and ASYLDR throughout thi\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003es\u003c/span\u003e period. In Western populations, presbyopia symptoms generally emerge around the age of 40, whereas in equatorial regions such as Central and South America, earlier onset is often observed, possibly due to greater ultraviolet radiation exposure[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, this latitude-based association is not absolute. For instance, while Indonesia and the Philippines report high NVL rates, Malaysia\u0026mdash;despite its similar geographic location\u0026mdash;consistently shows low rates. Conversely, the Russian Federation, the northernmost BRI country, demonstrates high prevalence and YLDs. These findings suggest that additional factors beyond latitude contribute to NVL patterns[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe increases in both NVL prevalence and YLDs across more countries in the past decade, compared to the overall period from 1990 to 2021, highlights an escalating global challenge in NVL management. The period has provided insights into the impact of the COVID-19 pandemic on NVL management. Countries such as India, China, and Nepal\u0026mdash;already burdened with high NVL rates\u0026mdash;reported further increases during the pandemic, primarily due to interruptions in routine health services, especially ophthalmologic care. Similarly, countries like Georgia, Slovakia, and the United Arab Emirates, which had previously shown declining NVL trends, experienced reversals during the pandemic, indicating the pandemic\u0026rsquo;s strain on healthcare systems.COVID-19 infection has been linked to several serious ocular complications associated with NVL. Acute viral retinitis \u003csup\u003e[19]\u003c/sup\u003e and unilateral optic neuritis \u003csup\u003e[20]\u003c/sup\u003e can result in monocular blindness, while additional complications include optic disc edema and homonymous visual field loss \u003csup\u003e[21]\u003c/sup\u003e. Moreover, the pandemic has exacerbated eye-related issues due to increased screen time and prolonged indoor activity.These findings underscore the need for comprehensive health policies and strategic interventions to mitigate the long-term effects of the pandemic on NVL management[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. As BRI countries move toward post-pandemic recovery, addressing the backlog of care and strengthening healthcare system capacities to manage NVL is essential [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, the data underscore significant gender-based disparities in NVL across global regions. Women are disproportionately affected, particularly in South Asia, North Africa, and the Middle East. These disparities are especially evident in countries with lower-middle SDI scores\u0026mdash;such as Bhutan, Indonesia, and Bangladesh\u0026mdash;where NVL rates are significantly higher among women. In rural South Asia, for instance, women often have limited autonomy in seeking medical care Socioeconomic barriers and restricted healthcare access substantially affect women\u0026rsquo;s health outcomes, emphasizing the need for gender-sensitive health policies[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Uncorrected refractive errors, which are more prevalent among women in less developed countries, contribute notably to the elevated NVL burden [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Additional factors, including longer life expectancy, shorter tear breakup time [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], the nature of tasks performed by women, and specific visual demands may further exacerbate these disparities.Conversely, in countries such as Estonia, the Lao People\u0026rsquo;s Democratic Republic, Slovenia, and Latvia, NVL prevalence is higher among men. This trend may be driven by occupational exposures and lifestyle-related risk factors, including outdoor labor without adequate eye protection, higher rates of smoking, and alcohol consumption\u0026mdash;all recognized contributors to eye disease.Longitudinal trends show increases in both NVL prevalence and YLDs across genders, with a slightly higher rate observed among men ,suggests a rising global burden of NVL for both genders. These findings point to a growing global burden of NVL and reflect a complex interplay of socioeconomic conditions, healthcare accessibility, and cultural norms influencing gender-specific outcomes.\u003c/p\u003e \u003cp\u003eSimultaneously, age-related variations in NVL are evident. Age-specific data from 1990 to 2021 reveal a significant global increase in both NVL prevalence and YLDs with advancing age, reflecting the cumulative burden of visual impairment over the lifespan[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The later peak in NVL prevalence compared to YLDs can be attributed to the disease\u0026rsquo;s slow progression. While NVL typically develops slowly, the associated disabilities can affect daily functioning earlier, leading to a premature rise in YLDs before clinical diagnosis.This delay in diagnosis is partly attributed to the disease\u0026rsquo;s non-specific early symptoms, contributing to the lag in peak prevalence. Additionally, common comorbidities in older adults intensify disability severity, causing an earlier peak in YLDs. These findings highlight the interplay between age and geographic disparities in influencing NVL patterns.For example, in China, while NVL prevalence and YLDs have declined among the youngest and oldest age groups, a notable rise is observed among working-age adults. This trend may indicate gaps in occupational health policies or lifestyle-related risk factors[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In contrast, South Asia\u0026mdash;particularly India and Nepal\u0026mdash;marked increases across all age groups underscore the need for targeted interventions to improve healthcare access and manage chronic disease .\u003c/p\u003e \u003cp\u003eFinally, the SDI plays a critical role in assessing the social and demographic characteristics of regions, encompassing education, health status, and income [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Between 1990 and 2021, our analysis revealed a strong negative correlation between SDI and both the prevalence of NVL and YLDs. This pattern aligns with trends observed in other health conditions, emphasizing the broad influence of socio-economic factors on public health outcomes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].This period also marks a notable transition in the global NVL burden. Prior to 2012, NVL rates were generally below expected global levels. However, from 2013 onward, these rates exceeded expectations, likely influenced by global economic and demographic changes that affected healthcare accessibility and quality. Regional comparisons highlight stark disparities: while low-SDI regions report higher-than-expected NVL burdens, high-SDI regions maintain rates below expectations. These differences may be attributed to stronger healthcare systems, greater access to preventive services, and higher education levels, which enhance health literacy and early intervention.\u003c/p\u003e \u003cp\u003eOverall, regional disparities, the COVID-19 pandemic, gender, age, and SDI levels all contribute to NVL burden variation. The differing trends across countries reflect inequities in healthcare access, preventive strategies, and policy effectiveness. Analyzing these trends underscores the need for targeted health communication, public education, and policies emphasizing prevention, early detection, accurate diagnosis, and effective management [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].Collaborative health efforts, especially in regions with limited healthcare infrastructure, are vital for addressing the growing NVL burden. Moreover, investments in healthcare systems in low-SDI areas can substantially reduce NVL rates. Finally, advances in diagnostic technologies may increase reported prevalence, reflecting better detection rather than actual disease worsening.\u003c/p\u003e \u003cp\u003eRecent research underscores that presbyopia should be regarded as a manageable condition rather than an unavoidable consequence of aging[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].Various interventions,including reading glasses, eye drops [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], contact lenses, refractive surgery, and intraocular lenses [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], are available to manage presbyopia. Among these, reading glasses are the most commonly used. However, inadequate correction of NVL remains a significant global concern[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite the high prevalence of presbyopia, spectacle coverage remains low. As of 2015, 1.8\u0026nbsp;billion people were affected by presbyopia, with 826\u0026nbsp;million experiencing visual impairment due to insufficient correction. This unmet need results in substantial productivity losses, particularly in low- and middle-income countries, amounting to an estimated global economic loss of USD 315\u0026nbsp;billion annually [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. For instance, in rural Jhajjar, Haryana, the prevalence of presbyopia was 42.9%, but spectacle coverage was only 25.8% [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These figures highlight the urgent need for greater awareness and the expansion of affordable and accessible eye care services to effectively address presbyopia worldwide.\u003c/p\u003e \u003cp\u003eThis study faces limitations, including the inherent constraints of the GBD methodology and variability in data quality across BRI countries. Diverse political climates and migration trends further influence these findings. The absence of specific risk factors for NVL in the GBD suggests a need for more research into region-specific disease factors.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study examined the influence of regional disparities, the COVID-19 pandemic, gender, age, and SDI levels on NVL. Findings indicate that regions with lower SDI scores experience higher rates of NVL and related disabilities, highlighting significant healthcare and socio-economic challenges. The COVID-19 pandemic further exacerbated these issues by disrupting healthcare delivery and exposing vulnerabilities in global health systems. The analysis also reveals that women,particularly in lower-middle SDI regions,are disproportionately affected by NVL due to limited access to healthcare and persistent socio-economic barriers. Additionally, NVL prevalence and associated disability rates increase with age, peaking among the elderly. These findings underscore the urgent need for public health strategies tailored to the unique cultural and economic contexts of each region, advocating for a departure from one-size-fits-all solutions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflicts of Interest:\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest. The manuscript has been reviewed and approved by all authors, who confirm that the authorship criteria outlined earlier in this document have been met. Each author affirms that the manuscript represents an honest and accurate account of the research conducted.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe project was supported by the National Natural Science Foundation of China (82401297).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions: Concept and Design: XL; Data Acquisition and Visualization: WJ, JZ, WL, CC, BC; Data Analysis: WJ, JZ, WL, CC, BC; Supervision and Project Administration: XL; Manuscript Preparation: SJ; Manuscript Editing: SJ, WJ, JZ, CC; Manuscript Review: All authors; Corresponding Author: XL (responsible for the integrity of the work as a whole). SJ, WJ, and JZ contributed equally to this work. The final manuscript was reviewed and approved by all authors.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our sincere gratitude to Professor Dai Jinhui (Institutes of Opthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China) for his invaluable guidance in the clinical aspects of the research on near vision loss.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eFor accessing the data utilized in these analyses, kindly navigate to the GBD 2021 website of the Global Health Data Exchange. https://vizhub.healthdata.org/gbd-results/\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eMagnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: 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\u003cstrong\u003ePrevalence of presbyopia, spectacles coverage and barriers for unmet need among adult population of rural Jhajjar, Haryana\u003c/strong\u003e. \u003cem\u003eJ Family Med Prim Care \u003c/em\u003e2022, \u003cstrong\u003e11\u003c/strong\u003e(1):287-293.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Near vision loss, BRI countries, Burden of disease, YLDs, Trend analysis, Average annual percent change","lastPublishedDoi":"10.21203/rs.3.rs-6582843/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6582843/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNear vision loss (NVL), primarily resulting from presbyopia and other age-related conditions, significantly reduces quality of life and imposes a substantial global economic burden. However, research on NVL\u0026rsquo;s prevalence and determinants remains limited, particularly in Belt and Road Initiative (BRI) countries. This study aims to analyze the disease burden and temporal trends of NVL in BRI countries.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing data from the Global Burden of Disease 2021 (GBD 2021) study, we examined age-standardized prevalence rates (ASPR) and age-standardized years lived with disability rates (ASYLDR) for NVL across BRI countries from 1990 to 2021. Analyses were stratified by Socio-Demographic Index (SDI) quintiles, and joinpoint regression was employed to estimate the average annual percentage change (AAPC) in disease burden from 1990 to 2021.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBetween 1990 and 2021, South Asia (ASPR: 20,747.02/10\u003csup\u003e5\u003c/sup\u003e; ASYLDR: 208.01/10\u003csup\u003e5\u003c/sup\u003e) and East Asia (ASPR: 15,509.26/10\u003csup\u003e5\u003c/sup\u003e; ASYLDR: 157.57/10\u003csup\u003e5\u003c/sup\u003e) recorded the highest ASPR and ASYLDR, while Western Europe reported the lowest (ASPR: 5,912.94/10\u003csup\u003e5\u003c/sup\u003e; ASYLDR: 59.38/10\u003csup\u003e5\u003c/sup\u003e). Among BRI countries, the Philippines, Nepal, and India exhibited the highest NVL burden, whereas Malaysia reported the lowest. NVL prevalence and YLDs increased with age, peaking at ages 60\u0026ndash;64 and 55\u0026ndash;59, respectively. Additionally, ASPR and ASYLDR were negatively correlated with SDI (R = -0.467 and R = -0.462, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNVL burden varies across BRI countries based on age, gender, and SDI level. Older women in low SDI regions are particularly at risk. International collaboration, public health outreach, and targeted interventions are essential to reduce the global NVL burden.\u003c/p\u003e","manuscriptTitle":"Age, Gender, and Socio-demographic Disparities in Near Vision Loss: A Global Burden of Disease Study Focusing on Belt and Road Countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 09:27:56","doi":"10.21203/rs.3.rs-6582843/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b08b4be-8ea1-4786-8956-7c2b3d7cfc56","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T04:08:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 09:27:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6582843","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6582843","identity":"rs-6582843","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}