Age, sex, and regional disparities in vision impairment burden among the population with diabetes: a 10-year trend analysis in Taiwan

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Abstract
Diabetes prevalence is increasing in Taiwan, raising concern over vision impairment among affected individuals. This study aimed to assess the burden of cause-specific vision impairment among individuals with diabetes, overall and stratified by age, sex, geographic region, and time, with a particular focus on diabetic retinopathy (DR). A cross-sectional, annual analysis was conducted from 2010 to 2020. Population prevalence of major eye diseases among adults aged ≥20 years with diabetes was obtained from the National Health Insurance Research Database. Ophthalmological data from a multicentre electronic medical record system across various hospital levels were used to characterise cause-specific vision impairment. Hierarchical Bayesian models integrated these datasets to estimate the prevalence of vision impairment and corresponding years lived with disability. In 2019, DR accounted for 1283.9 years lived with disability (95% credible interval: 992.9-1, 644.6), comprising 50.8% of the total vision impairment burden among individuals with diabetes, followed by glaucoma (11.7%) and cataract (9.9%). The age-standardised prevalence per 1000 individuals for DR-related vision impairment was 0.58 (0.43-0.76), 0.50 (0.36-0.67), 0.12 (0.06-0.20), and 0.09 (0.05-0.17) for mild, moderate, severe, and blindness, respectively. Higher burdens were observed in females, individuals aged 20-39, and residents of eastern Taiwan. Between 2010 and 2020, the prevalence of DR-related vision impairment decreased in the 55-69 age group and increased in the 20-39 age group. This study highlights high-risk subgroups for vision impairment among individuals with diabetes, providing evidence to inform targeted public health and diabetes eye-care strategies.

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