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. 2023 Oct 18;38(5):885–892. doi: 10.1038/s41433-023-02798-0

The burden of vision loss due to cataract in China: findings from the Global Burden of Disease Study 2019

Rui Fang 1,2, Pei-Lin Yue 1,2, Xue-Fei Ding 1,2, Ning-Xin Lv 1,2, Yu-Xuan Jia 1,2, Zhao-Chuan Liu 1,2,3,4, Hong-Gang Zhou 5, Xu-Dong Song 1,2,3,4,✉
PMCID: PMC10965953  PMID: 37853108

Abstract

Objective

To provide a reference for future policy and measure formulation by conducting a detailed analysis of the burden of vision loss due to cataract by year, age, and gender in China from 1990 to 2019.

Methods

Data on the prevalence and disability-adjusted life-years (DALYs) due to cataract in China and neighboring and other G20 countries were extracted from the 2019 Global Burden of Disease (GBD) study to observe the changing trends of vision loss.

Results

The number and rate of all-age prevalence and DALYs for cataract in China increased significantly from 1990 to 2019. The age-standardized DALYs rate witnessed a slowly declining trend by 10.16%. And the age-standardized prevalence increased by 14.35% over the 30-year period. Higher prevalence and DALYs were observed in female population from 1990 through 2019, with little improvement over the decades(all p < 0.001). The disease burden of cataract is higher in middle-aged and elderly people. Blindness accounted for the largest proportion of vision impairment burden caused by cataract in China. The age-standardized prevalence and DALY rate of cataract in China were lower than those in India and Pakistan, but higher than those in Russia, South Korea, North Korea, Singapore, and Japan.

Conclusions

In the past 30 years, although the age-standardized DALYs rate has decreased slightly in China, the all-age prevalence and DALYs have both increased. This study highlights the importance of reducing cataract burden by providing timely and easily accessible quality care, especially in females and the elderly population.

Subject terms: Epidemiology, Health care economics

Introduction

Cataract is a prevalent ocular disorder identified by lens opacification, which is the leading cause of blindness across the world [1–3]. Improved living conditions and accessibility to therapies significantly expanded life expectancy, and the incidence of cataracts is increasing as the global population aging trend gradually aggravates. Cataract blindness accounted for 10.8 million people in 2010 and is projected to increase to 40 million by 2025 [4, 5]. Patients suffer from blurred vision or blindness due to loss of lens transparency, changed refractive properties, and increased light scattering. Patients with cataracts are at increased risk of falls, traffic accidents, and cognitive impairments such as Alzheimer’s disease, which affect the quality of life of older adults and place a heavy burden on public health care and social resources [6–8].

The pathogenesis of cataract has not been fully elucidated, and there is still a lack of effective drug preparations to reverse cataract opacity [1]. Surgical removal of the cloudy lens is the mainstream clinical treatment for cataract patients to restore vision. However, factors such as surgical costs, postoperative complications, and unequal distribution of surgical resources have limited the widespread adoption of cataract surgery worldwide, especially in medically underserved designation [9, 10]. Current effective cataract surgical coverage (ECSC) has fallen short of expectations. High-income countries had the highest median ECSC at 60.5%, while low-income countries had only 14.8% [11]. It was estimated that a total investment of $573.3 million will be required to eliminate blindness from cataracts between 2010 and 2020 [12]. The management of cataracts will become a socio-economic challenge, as the social and economic costs of cataracts are quite staggering and the need for cataract surgery far exceeds the limited public health resources.

China is the largest developing country with a population of 1.41 billion, accounting for 18% of the global population in 2020 [13]. Over the past 30 years, China has made great efforts to improve the prevention and treatment of eye diseases and has achieved positive results. The burden of vision-impairing diseases such as glaucoma, age-related macular degeneration, and diabetic retinopathy has all declined [14–17]. China’s seventh national census has found an aging tsunami looming, which is bound to bring more challenges [13]. The health burden of disease can be quantified in disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) in the Global Burden of Diseases Study (GBD study) [18]. The effect of cataract can be assessed by examining a general measure of health loss using DALYs. Although visual impairment due to cataracts is a preventable cause of disability, it remains a prominent medical agenda in an aging world. To limit visual impairment due to cataract, a comprehensive data analysis of the burden of cataract is necessary. Although many researchers have described the global burden of cataract, the health burden of cataract in China is poorly understood [19–21].

In this study, we investigated the prevalence and DALYs trends of blindness and vision loss due to cataract, as well as their differences by age and gender in the Chinese population and compared them with those in neighboring and Group of 20(G20) countries. We aimed to raise public awareness of the burden of cataract through this study and provide the basis for the development of effective and targeted policies for the treatment and control of cataract.

Methods

Data sources

The statistical estimation protocol for GBD studies has been described in detail previously [22]. Briefly, to ensure consistency between incidence, prevalence, response rate, and cause of death for each disease, the investigators used the Bayesian meta-regression tool DisMod-MR 2.1 as the primary estimation method. DALYs, in short, is the number of years of life and disability lost due to illness and is the sum of YLDs and YLLs. One DALY can be thought of as one lost year of a “healthy” life. Since the estimated value of DALYs for cataract is equal to YLDs [18], DALYs are used uniformly below to avoid confusion. 95% uncertainty intervals (UIs) for every metric were presented based on the 25th and 975th ordered values of 1000 draws of the posterior distribution [22]. Blindness and vision loss are classified into three different stages of visual impairment based on the Snellen chart: moderate vision impairment(MVL, Visual acuity (VA) < 6/18 but ≥6/60), severe vision impairment(SVL, VA < 6/60 but ≥3/60), and blindness(VA < 3/60 or peripheral visual field <10% of the central fixation) [18]. The total of different stages of vision loss is equal to all the vision loss. We extracted data on the prevalence and DALY of vision loss due to cataract from the 2019 GBD study, which systematically analysed the burden of 369 diseases in 204 countries and regions [18].

The 2019 GBD’s Socio-Demographic Index (SDI) is an indicator of social development, including GDP per capita, the average number of years of schooling for adults, and the fertility rate for women under 25. The higher the SDI value, the better the social and economic development. SDI was divided into high (>0.81), medium-high (0.70–0.81), medium (0.61–0.69), medium-low (0.46–0.60), and low (<0.46) according to the SDI value [18].

Data of interest were collected from the Global Health Data Exchange System(GHDx, https://vizhub.healthdata.org/gbd-results/), including the following: (1) all-age prevalence and DALYs number of blindness and vision loss due to cataract in China from 1990 to 2019; (2) all-age/age-standardized prevalence and DALYs rate of blindness and vision loss due to cataract in China, global and different SDI regions from 1990 to 2019; (3) age-, gender-specific prevalence and DALYs number/rate of blindness and vision loss caused by cataract in China from 1990 to 2019; (4) age-standardized prevalence and DALYs rate of different stages vision loss caused by cataract in China, neighboring nations(North Korea, Russia, Japan, South Korea, Singapore, India, and Pakistan) and other G20 member nations in 1990 and 2019.

Statistical analysis

The data were expressed as values within the 95% uncertainty interval (UI). The crude DALY rate is calculated based on the number per 100,000 population adjusted for population size, while the age-standardized DALY rate is calculated based on the adjustment for age structure. The health burden of cataract was analysed descriptively by year, age, and gender. To analyse the distribution of prevalence and DALY for cataracts in different age groups from 1990 to 2019, 5 years were divided into one age group. Wilcoxon signed-rank test was used to compare gender differences among age groups and years. All statistical analysis and graphing were performed using R statistical software (version 4.1.2; R Foundation for Statistical Computing, Vienna, Austria). A p-value less than 0.05 was considered statistically significant.

Results

Trends of Cataract Health Burden in China from 1990 to 2019

From 1990 to 2019, the health burden of cataract in China showed an overall upward trend(Fig. 1). The all-age DALY number and crude rate peaked in 2017 and began to decline, while the age-standardized DALYs rate began to decline in 2001 for both genders. The all-age number of DALYs about blindness and vision loss due to cataract in China increased by 142.14% from 449,322.84 (95% UI: 317,651.79 to 618,751.82) in 1990 to 1,087,987.61 (95% UI: 761,917.08 to 1487,672.38) in 2019 for both genders(Fig. 1A). Similarly, the crude DALYs rate increased from 1990 (37.96, 95% UI: 26.84–52.27) to 2019 (76.49, 95% UI: 53.57–104.59), with an increase of 101.51%(Fig. 1B). After adjustment for age structure, however, the age-standardized DALYs rate slightly declined by 10.16% from 65.85 (95% UI: 46.39–89.41) in 1990 to 59.16(95% UI: 41.70–80.15) in 2019 (Fig. 1C). It is worth pointing out that gender differences have always been present in the burden of cataract. From 1990 to 2019, Chinese women have been more susceptible than men to visual impairment caused by cataract. The three indicators of DALYs showed similar trends in male and female populations over the 30 years, while those among women far exceeded those among men with statistically significant differences (all p < 0.001)(Fig. S1).

Fig. 1. DALYs of cataract from 1990 to 2019 in China.

Fig. 1

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DALYs numbers (A), crude DALYs rates (B), and age-standardized DALYs rates (C). Shaded areas represent 95% uncertainty intervals. DALY disability-adjusted life year.

Similar to DALYs trends, the number of prevalence has substantially increased by 223.54% over the past 30 years, from 5,607,600.94 (95% UI 4,895,979.54 to 6,402,853.51) in 1990 to 18,142,568.96(95% UI 15,617,088.67 to 20,841,571.94) in 2019 (Fig. 2A). The crude prevalence rate rose from 1990 to 2019 by a relatively low margin with 169.25% (1990: 473.74, 95% UI 413.62 to 540.92; 2019: 1275.53, 95% UI 1097.98 to 1465.29 per 100,000 population) (Fig. 2B). In contrast to the decrease in age-standardized DALY rate, age-standardized prevalence increased by 14.35% over the 30-year period from 867.09 (95% UI: 761.36–975.42) in 1990 to 991.56(95% UI: 861.52–1131.04) in 2019 (Fig. 2C). Prevalence number, crude rate, and age-standardized rate of cataract were higher among women than for men with statistical significance as well as DALYs(all p < 0.001).

Fig. 2. Prevalence of cataract from 1990 to 2019 and DALYs of cataract in 1990 and 2019 in China.

Fig. 2

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Burden of cataract in China in terms of prevalence numbers (A), crude prevalence rates (B), and age-standardized prevalence rates (C) by gender. Burden of cataract in China in terms of DALYs numbers (D), crude DALYs rates and (E) by age and gender in 1990 and 2019. The distribution of visual impairment severity burden due to cataract by age in terms of DALYs numbers (F) and crude DALYs rates (G) by age in 2019. DALY disability-adjusted life year.

Age-specific and gender disparity of cataract health burden in China

The age-specific number and crude rate of DALYs due to cataract by gender in 1990 and 2019 were illustrated in Fig. 2. Based on the distribution of DALY numbers in 1990 and 2019, the 30-year period witnessed similar distribution patterns for different age groups. For both males and females in 1990 and 2019, the burden of cataracts began to increase significantly at age 40 and peaked in the 70–74 age group(Female vs. Male in 2019: 115,842.16 (95%UI:79929.03–164024.06) vs. 75281.09(95% UI: 51,669.90-107,623.61))(Fig. 2D). After accounting for population growth, the DALYs per 100,000 population attributable to cataract increased gradually with age (Fig. 2E). Among the population younger than 40 years in 2019, the DALY number of cataract is higher in men than in women. With the increase in age, the DALY number of cataract for females is beyond that for males in different age groups (p = 0.001). The gender gap peaked in the group aged 80–84 years(Female vs. Male:99,045.96 (95% UI: 68,377.03–135,964.34) vs. 54,702.46(95% UI: 37,649.62–75,918.38)) (Fig. 2D).

Figure 2 also depicted the distribution of different visual impairment stages burden due to cataract at different age groups in China in 2019, calculated by DALY number and crude DALY rate. In general, blindness predominated across age groups in terms of DALY number and crude DALY rate. With the increase of age, the burden of cataract at different stages of vision impairment showed a “reversed U” trend of first increasing and then decreasing (Fig. 2F). The burden of cataracts for both blindness and MVL peaked in the 70–74 age group(blindness:92,745.26(95% UI: 57,405.38-144,214.48), MVL: 74,959.60(95% UI: 41,168.49–125,860.71)), while the burden of SVL was highest in the 75–79 age group(42,162.1,95% UI:23,586.07–71,140.11). The older the age, the higher the crude DALYs rate of cataract in different visual impairment stages (Fig. 2G).

Comparison of cataract burden between China and neighboring countries and other G20 nations

Age-standardized DALYs rate and age-standardized prevalence rate in 1990 and 2019 were used to make a basic assessment of the burden of cataract in the Chinese population and seven neighboring countries (Fig. 3 and Fig. S2). China ranked third in both the age-standardized prevalence rate and age-standardized DALYs rate, while Pakistan and India ranked top two in these two study years. Japan has the lowest disease burden due to cataracts and, unlike the other seven countries where the burden is heavier for women, Japanese women have a lower cataract burden than men (Fig. 3) (female vs male of age-standardized DALYs rate in 2019:19.47(95% UI: 13.31–27.53) vs 23.07(95% UI: 15.66–32.53)). A decline in age-standardized rates of cataract was observed globally, in China and elsewhere over the three decades. When it comes to the percentage change in DALYs number between 1990 and 2019, China has a higher percentage increase compared with most regions worldwide, except Singapore and South Korea (Table 1).

Fig. 3. Age-standardized DALYs rate of cataract in China and neighboring countries.

Fig. 3

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Distribution of age-standardized DALYs rate of cataract by gender in 1990 (A) and 2019 (B). DALY disability-adjusted life year.

Table 1.

Number and Age-standardized rates of DALYs for vision loss due to cataract in 1990 and 2019.

name number of DALYs (1990) number of DALYs (2019) Percentage change from 1990 to 2019 (%) age-adjusted DALYs (1990) age-adjusted DALYs (2019) Percentage change from 1990 to 2019 (%)
(thousands) (95%UI) (thousands) (95%UI) rates(95%UI) rates(95%UI)
Global 3492.60 (2481.85–4719.63) 6676.28 (4761.21–9006.19) 91.15 93.17 (66.14–125.32) 82.94 (59.06–111.75) −10.98
China 449.32 (317.65–618.75) 1087.99 (761.92–1487.67) 142.14 65.85 (46.39–89.41) 59.16 (41.70–80.15) −10.16
North Korea 2.69 (1.81–3.78) 5.36 (3.51–7.65) 99.42 23.46 (15.91–32.63) 18.63 (12.25–26.49) −20.61
Russia 50.52 (35.38–68.10) 61.78 (43.12–84.74) 22.29 30.85 (21.68–41.42) 26.35 (18.44–36.29) −14.57
Japan 32.50 (22.88–44.38) 76.03 (53.44–103.33) 134.01 20.25 (14.31–27.55) 19.25 (13.53–26.41) −4.90
South Korea 6.73 (4.67–9.36) 17.41 (12.07–24.18) 158.54 26.10 (17.94–35.64) 20.34 (14.11–28.27) −22.06
Singapore 0.5 (0.35–0.69) 1.75 (1.21–2.44) 250.19 25.28 (17.84–35.13) 23.50 (16.20–32.63) −7.07
India 1023.32 (727.567–1389.62) 2037.41 (1459.77–2721.86) 99.10 270.75 (193.15–363.64) 195.06 (140.25–259.06) −27.96
Pakistan 166.61 (118.09–225.00) 262.01 (186.39–356.09) 57.26 315.38 (223.63–424.91) 273.31 (195.03–368.63) −13.34
High-middle SDI 527.85 (374.26–709.15) 1079.89 (770.49–1455.31) 104.58 54.05 (38.26–71.81) 53.72 (38.45–72.57) −0.62
High SDI 226.71 (161.08–309.55) 407.17 (289.68–556.59) 79.61 21.86 (15.50–29.71) 20.57 (14.49–28.10) −5.93
Low-middle SDI 1126.63 (800.06–1538.17) 2009.36 (1432.49–2712.78) 78.35 216.76 (153.53–292.32) 160.43 (114.24–215.23) −25.99
Low SDI 370.75 (264.02–506.46) 706.52 (502.22–953.37) 90.57 180.68 (128.63–244.99) 153.38 (108.77–206.59) −15.11
Middle SDI 1238.75 (878.93–1687.53) 2469.95 (1747.30–3330.11) 99.39 139.91 (99.06–188.58) 107.61 (75.96–144.28) −23.09
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Except for the European Union, we analysed and compared 19 countries in the G20. The proportion of age-standardized DALYs for different visual impairment stages by gender in China and other G20 member countries in 2019 is shown in Fig. 4. India, Indonesia, and Saudi Arabia were among the top three countries for the burden of cataracts at different stages of visual impairment. Blindness accounted for the majority of the burden for cataract in Turkey, South Africa, India, Indonesia, Saudi Arabia, China, and Brazil. While the proportion of blindness in countries such as the USA, UK, South Korea, Russia, Germany, Japan, Italy, and France is relatively low, and MVL and SVL are major contributors to the burden of cataracts.

Fig. 4. Age-standardized DALYs rates of cataract in G20 nations.

Fig. 4

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Age-standardized DALYs rates of blindness, moderate, severe and all vision impairment associated with cataract by gender in 2019. DALY disability-adjusted life year.

Discussion

Previous studies have estimated the global health burden of cataract, but little is known about that in China, the world’s most populous country [19–21]. Using data from the GBD study, we reveal the burden of cataract by age and sex in China from 1990 to 2019, which may provide a reference for policymakers to evaluate and improve existing eye care policies. The results showed that, although the age-standardized DALY rate slightly decreased (10.16%), the all-age DALY number and crude DALY rate of cataract in China increased significantly and doubled from 1990 to 2019. At present, the health burden of cataract is still heavy in China, especially among female, middle-aged, and elderly populations. The percentage increase of the burden of cataracts in China is higher than that in the world and at a relatively high level compared with neighboring countries and other G20 countries. These results suggest that although there have been improvements in eye care in China over the past few decades, we still face enormous challenges due to population growth and aging, and more efforts are needed to reduce the burden of cataracts and make improvements in well-being and quality of life [23].

To motivate people to systematically eliminate avoidable blindness, WHO and international agencies launched the global initiative “Vision 2020: The Right to See” [24]. Refractive errors and cataract are the key subjects of conquering to eliminate avoidable blindness disease. Cataract patients can improve their vision by cataract phacoemulsification combined with intraocular lens implantation. With a cost of less than $100 per DALY avoided, cataract surgery is a highly cost-effective measure to prevent disability [12]. Although cataract surgery is of great social and economic benefit, it is not a panacea.

In the past 30 years, the burden of cataract has increased significantly in all countries. In 2019, the number of cataract DALY in China was nearly 1.4 times that in 1990. There has been a substantial increase in the number of prevalence for cataract nearly 2.3-fold over the past 30 years. He and his colleagues found that the global DALY numbers of cataract vision loss increased by 89.42% in 2015 from 1990, which is significantly lower than our study [20]. We found that although the age-standardized DALY rate has decreased in China, neighboring countries, and the whole world, it is of no practical significance to consider population growth and aging. The age-standardized rate of cataract DALYs and prevalence peaked in 2001 and then began to decline. The exact reasons for this trend remain to be investigated, and we suspect that the effects of China’s healthcare reforms in the 1990s may be contributed in a way. Although the prevalence and DALY are not directly comparable, both types of information are important for understanding cataract vision loss. The number of cataract prevalence in China in 2019 was nearly 2.3 times that of 1990. Even after adjusting for population growth and age structure, the age-standardized incidence of cataract increased by 14.35% over the three decades. In recent years, China has made some progress in reducing the burden of cataract, such as the “Bright Project, Cataract revision”. However, as the country with the largest population, China is also facing serious challenges and there is still much work to be done.

When we studied the burden of cataract vision loss by age group, it was found to be concentrated in people aged 50–90, with the 70–74 age group being most affected, for both genders. Compared with 30 years ago, the burden of cataracts in 2019 was lower for those aged 20–40, but more than doubled for those aged 40 and older, especially the elderly. The one-child policy since the 1970s has contributed to the control of reasonable population growth, but it has also partly led to the plight of an aging population in China. The proportion of people aged 60 or above in China rose from 8.57% in 1990 to 18.7% in 2020, outpacing the growth of the total population [13]. Based on the realistic pressure brought by the growing proportion of the elderly population, the delay of retirement has begun to cause a heated debate [25]. To maximize the role of the older generation in social production, it is particularly important to relieve the burden of cataract. In addition to improving the quality of life of the population, it will also increase productivity and social benefits. Considering that previous studies mostly evaluated the burden of cataract from the overall level of visual impairment, we evaluated the burden of cataract from different stages of visual impairment to refine. Unlike other eye diseases, the burden of MVL accounted for the most, in the different age groups, blindness burden caused by cataract occupied the main position [15, 26]. Previous studies have found that the burden of cataracts is higher in the female population, and we also found this phenomenon in people over 40 years old in China. In addition to women’s higher life expectancy, gender inequality also contributes in part [27]. The elderly and female population play an important role in the increasing burden of cataract vision loss, and national policies should give priority to these vulnerable groups and make appropriate adjustments.

Ono et al. found that the burden of cataracts is most unevenly distributed globally among non-communicable eye diseases [28]. There is a significant difference in the burden of cataract in different SDI countries. The burden of cataract in countries with high SDI is significantly less than that in countries with moderate and low SDI, and the burden of cataract in China is close to that in countries with high-middle SDI. The burden of cataract vision loss in China is lower than in India, Indonesia, and Pakistan, but worse than other neighboring and G20 member nations, ranking suboptimal level. This is understandable given China’s huge population. Socioeconomic levels also contribute significantly to the disparity. Countries with high SDI have better eye care and greater access to cataract surgery. Higher national income is associated with a higher density of eye doctors, with high-income countries having 18 times more eye doctors per million population than low-income countries [29]. At present, there are about 32 ophthalmologists per million population in China [30], which exceeds the requirement of WHO for well-off countries. However, the distribution of ophthalmologists varies in different provinces. In 2017, the annual rate of cataract surgery was 2205 per million people, an encouraging improvement over previous years [31], however, it is still considerably less than that of the USA, European countries, even India. And it is worth noting that the age-standardized DALY rate of cataract blindness burden is still high in China compared with other developed countries. DALY reflects the gap between the actual health status and the standard status, indicating that cataract blindness seriously damages the healthy life span and quality of life of patients. The actual burden of cataract vision loss in China may be underestimated, because the GBD cataract study only investigated the cataract burden in people over 20 years of age, and congenital cataracts were not included in our study. But given the rarity of congenital cataracts, the impact on the actual burden is very slight. The increasing burden of cataract poses a great challenge to the Chinese medical system. Despite progress, there is still much room for improvement. We cannot yet be satisfied and need to further raise public awareness of the burden of cataract and improve medical services.

This study has several limitations. Firstly, due to the availability of data and limitations of statistical assumptions, the accuracy of the estimated burden in the 2019 GBD study may be affected [18]. Second, as noted above, the estimated burden of vision loss in GBD may be incomplete because congenital cataracts are not included. Third, only the national burden of cataracts has been analysed, and the burden in different provinces of China cannot be described specifically lacking data. As with other large federal countries such as India and Brazil, there may also be inter-provincial differences.

In summary, the latest GBD database was used in this study to demonstrate the disease burden of cataract in China over the last 30 years. The burden of cataract is on the rise in terms of prevalence and DALY, with females and the elderly population bearing a higher burden. In the future, China will expect to encounter a more severe cataract burden due to the aging and growth of the population. The results of this study may provide a reference for policymakers to develop policies and measures to effectively address this growing burden.

Summary

What was known before

  1. Previous studies have estimated the global health burden of cataract and found that the burden of cataracts is most unevenly distributed globally among non-communicable eye diseases.

  2. There are significant differences in the burden of cataracts in different countries, as well as between men and women.

What this study adds

  1. Using data from the GBD study, we reveal the burden of cataract by age and sex in China from 1990 to 2019.

  2. The number and rate of all-age prevalence and DALYs for cataract in China increased significantly from 1990 to 2019. The age-standardized DALYs rate witnessed a slowly declining trend and the age-standardized prevalence increased.

  3. Higher prevalence and DALYs were observed in female population from 1990 through 2019, with little improvement over the decades.

  4. The disease burden of cataract is higher in middle-aged and elderly people. Blindness accounted for the largest proportion of vision impairment burden caused by cataract in China.

  5. The age-standardized prevalence and DALY rate of cataract in China were lower than those in India and Pakistan, but higher than those in Russia, South Korea, South Korea, Singapore, and Japan.

Supplementary information

supplemental figures (715.6KB, pdf)

Author contributions

RF developed the concept for the manuscript, enrollment of participants, data gathering and drafting the manuscript, and conducted data analysis. XFD, PLY, NXL, ZL and YXJ critically verified the data obtained from the GBD database. HGZ and XDS drafted and revised the manuscript. XDS and HGZ contributed equally to this work. All authors read and approved the final manuscript.

Funding

National Natural Science Foundation of China (82271067). The funding organizations had no role in the design or conduct of this research.

Competing interests

The authors declare no competing interests.

Consent for publication

Not applicable.

Footnotes

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

The online version contains supplementary material available at 10.1038/s41433-023-02798-0.

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