Senlin Lin1,2,3, Yingyan Ma1,2, Zhiyuan Hou3, Nathan Congdon4,5,6, Lina Lu7,8, Haidong Zou9,10. 1. Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China. 2. Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China. 3. Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China. 4. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 S. Xianlie Road, Guangzhou, 510060, China. ncongdon1@gmail.com. 5. Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK. ncongdon1@gmail.com. 6. Orbis International, 520 8th Ave #12, New York, NY, 10018, USA. ncongdon1@gmail.com. 7. Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China. lulina781019@qq.com. 8. Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China. lulina781019@qq.com. 9. Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China. zouhaidong@hotmail.com. 10. Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China. zouhaidong@hotmail.com.
Abstract
BACKGROUND: Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen's utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China. METHODS: The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately. RESULTS: Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn't impact cataract surgical resources (β = 0.29, 95% CI: - 0.12, 0.75). In China, residents' average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93). CONCLUSIONS: In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.
BACKGROUND: Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen's utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China. METHODS: The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately. RESULTS:Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn't impact cataract surgical resources (β = 0.29, 95% CI: - 0.12, 0.75). In China, residents' average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93). CONCLUSIONS: In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.
Entities:
Keywords:
Cataract surgical rate; Developing country; Health service utilization
Authors: Wei Wang; William Yan; Kathy Fotis; Noela M Prasad; Van Charles Lansingh; Hugh R Taylor; Robert P Finger; Damian Facciolo; Mingguang He Journal: Invest Ophthalmol Vis Sci Date: 2016-11-01 Impact factor: 4.799
Authors: Jennifer J Palmer; Farai Chinanayi; Alice Gilbert; Devan Pillay; Samantha Fox; Jyoti Jaggernath; Kovin Naidoo; Ronnie Graham; Daksha Patel; Karl Blanchet Journal: Hum Resour Health Date: 2014-08-15
Authors: Jennifer J Palmer; Farai Chinanayi; Alice Gilbert; Devan Pillay; Samantha Fox; Jyoti Jaggernath; Kovin Naidoo; Ronnie Graham; Daksha Patel; Karl Blanchet Journal: Hum Resour Health Date: 2014-08-15