A two-site, population-based study of barriers to cataract surgery in rural China

¹ Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
² Ophthalmology, Beijing Tongren Hospital, Beijing, China
³ Zhongshan Ophthalmic Center, Guangzhou, China
⁴ DOVS, CUHK, Kowloon, Hong Kong
⁵ Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing, China
⁶ Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
⁷ Ophthalmology, Beijing Union Medical College, Beijing, China
⁸ DOVS, Chinese University of Hong Kong, 30-32 Ngan Shing St, Block B, 7th Floor, Shatin, 00000, Hong Kong

^* To whom correspondence should be addressed. E-mail: ncongdon{at}cuhk.edu.hk.

	Abstract

Aims: China has among the lowest cataract surgical rates in Asia. We sought to identify barriers to cataract surgery in rural China. Methods: All subjects having undergone cataract surgery, and persons with presenting acuity <= 6/60 (in Yangjiang) or <= 6/18 (in Handan) in >= 1 eye due to un-operated cataract were identified in two population-based studies in southern (Yangjiang) and northern (Handan) China. Subjects were administered a questionnaire assessing attitudes in four areas constituting potential barriers to surgery: knowledge about cataract, perceptions of local surgical quality, transportation, and cost and available resources. Results: Interviews were completed on 71-86% of eligible subjects in both sites. Interviewed subjects did not differ significantly from non-respondents with regard to age, gender and presenting acuity in the better-seeing eye. A total of 214 (80.4%) un-operated and 131 (76.6%) operated participants were interviewed, with a mean age of 71.8 +/- 8.0 and 73.7 +/- 7.4 years, respectively (P > 0.1). Among un-operated subjects, 67.8% were blind (presenting vision <= 6/60) in >= 1 eye due to cataract, while among operated participants, 25.2% remained blind in the operated eye. In a multivariate analysis adjusted for age, gender and site, increased knowledge and higher estimates of the quality of surgery were associated with having had surgery, while cost and transportation scores were not. Conclusion: Lack of knowledge about cataract and concerns over the quality of local services appear to be the principal barriers to cataract surgery in rural China.

Key Words: cataract, barriers to care, rural, China, knowledge, quality

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