Low Cataract Surgical Coverage for Women in El Salvador
Women in middle and low-income nations are reportedly less likely than men to undergo cataract surgery. Relevant literature from Latin America is scarce, and we studied whether women at an international clinic in El Salvador received cataract surgery at a rate appropriate to cataract prevalence and severity.
In this retrospective study, medical records of 2698 patients presenting to an annual eye campaign in El Salvador between 2012-2014 were reviewed for physician documentation of cataract and completion of cataract surgery. Gender, age, reading ability, eye involvement, and visual acuity were recorded for all cataract patients. Cataract patients were stratified by gender and visual acuity, and the relative risk of each subgroup was calculated. Logistic regression was used to model whether combinations of age, gender, reading ability, and visual acuity could accurately predict cataract surgery in this population.
Women with cataract were 19% less likely (RR=0.81, p=0.11) to receive cataract surgery relative to men. Surgical likelihood was equivalent only for profoundly visually impaired women. Women represented 61.0% of all cataract patients, and 56.1-64.8% at any given level of visual impairment. Women comprised 55.9% of cataract surgical cases. The mean age for all cataract patients was 66.53±0.82 (95% CI), and did not differ significantly by gender. However, when stratified by WHO visual impairment, moderately impaired women were significantly younger than similarly impaired men. On logistic regression, visual acuity was the only statistically significant predictor of cataract surgery.
Women carry a higher cataract burden, yet are less likely to undergo surgery in this setting. Confirmation of previously reported trends is unexpected at this clinic given female leadership, associated female-heath and empowerment programs, and US physician participation. Methods to objectively allocate limited resources are needed.