Global and Regional Burden of Refraction Disorders In Children, Adolescents and Young Adults from 1990 to 2021: Trends, Inequalities and Future Predictions with Machine Learning.

PURPOSE: This study aims to forecast future trends and quantify the contributions of key determinants, extending current evidence for tailored interventions

METHODS

The study used data from the Global Burden of Disease Study 2021 for children, adolescents and young adults aged 0-24 years. Temporal trends were analysed with joinpoint regression, while health inequalities were assessed using the slope index of inequality (SII) and concentration index (CIx). Bayesian age-period-cohort (BAPC) modelling and XGBoost were employed to project prevalence and years lived with disability (YLDs) and SHAP values were used to quantify the contributions of key predictors.

RESULTS

A slight but significant global decrease was observed in both prevalence (average annual percent change, AAPC: -0.05%) and YLD rates (AAPC: -0.08%) from 1990 to 2021. Females consistently exhibited higher burden than males, though both groups showed significant reductions. In 2021, the prevalence rate was highest in the 15-19 year age group and YLDs were highest in the 20-24 year age group. A positive correlation was observed between the socio-demographic index (SDI) and both prevalence (r = 0.44) and YLDs rates (r = 0.43). Socioeconomic disparities widened over time, as indicated by an increase in the SII for prevalence (from 497.98 to 525.10) and YLDs (from 15.46 to 16.53), alongside a decline in the CIx for prevalence (from -0.075 to -0.091) and YLDs (from -0.065 to -0.083). In predictive modelling, age emerged as the strongest predictor of disease burden, followed by year, SDI, GDP and sex.

CONCLUSION

The global burden of refraction disorders is declining yet marked by significant inequalities. Mitigating this burden requires tailored strategies, shifting from primary prevention in high-SDI regions to ensuring access to affordable corrections in low-SDI settings.