Cataract surgical rate in Fars Province: Distribution and trend from 2006 to 2010

Abstract

Purpose

To determine changes in cataract surgical rate (CSR) in Fars Province from 2006 to 2010 and identify the contributions of public and private sectors.

Methods

This descriptive report is part of the Iranian Cataract Surgery Survey. To determine the provincial CSR, weights of major (>3000 annual surgeries) and minor (≤3000) centers were calculated based on the number of centers chosen for each year and multiplied by their numbers of surgeries. To determine public and private sectors' contributions, the numbers of surgeries in each sector were estimated based on the number of sampled centers.

Results

Overall, CSR improved by 25%; the number of CS decreased by 16% in the public sector and increased by 157% in the private sector. In 2006, the public sector contributed to 69% of the CSR, and by 2010, this rate had decreased to 43%.

Conclusion

The decreasing contribution of the public sector calls for studies to identify causes and remove potential barriers.

Introduction

The number of cataract surgeries (CS) per million population per year or the cataract surgical rate (CSR) is an index suggested by the World Health Organization (WHO) as a measure of the provision and uptake of eye care services.1, 2, 3 In Iran, according to the Iranian Cataract Surgery Survey (ICSS), CSR was 1331 in 2005⁴ and increased to 6328 in 2010. While the national growth was promising, it did not occur uniformly throughout the country.⁵

Knowledge of CSR is critical for policymaking and health planning on a local level. Since provinces are the first level of country subdivisions, here we describe the annual CSR from 2006 to 2010 in Fars Province, examine changes, and compare the contributions of the private and public sectors.

Methods

As part of the ICSS, for which nationwide data was collected,6, 7 this report concerns CSR in the Fars Province. After identifying cataract surgical centers, for every year from 2006 to 2010, one week per season was randomly selected for each center after excluding the first 2 weeks of spring which are national holidays, and all cataract surgical records conducted during these weeks were reviewed for data extraction by a skilled and certified team. The total number of CS in these 4 weeks was multiplied by 50/4 (12.5) to calculate the annual number at each center for any given year. Weights were assigned to major (>3000 annual surgeries), minor centers (≤3000 annual surgeries), and the CSR was calculated based on the provincial population as:

$$\text{CSR}=\frac{\begin{array}{l}\left[\text{Annual}\text{number}\text{of}\text{cataract}\text{surgeries}\text{at}\text{major}\text{centers}\times \text{weight}\text{of}\text{major}\text{centers}\text{of}\text{the}\text{province}\right]+\\ \left[\text{Annual}\text{number}\text{of}\text{cataract}\text{surgeries}\text{at}\text{minor}\text{centers }\times \text{weight}\text{of}\text{minor}\text{centers}\text{of}\text{the}\text{province}\right]\end{array}}{\text{Population}\text{of}\text{the}\text{province}\text{in}\text{the}\text{given}\text{year}}$$

Results

Table 1 summarizes our findings by sector. Overall, CSR increased by 25%. The number of CS increased by 33%; there was a 16% decrease from 28,463 to 23,871 in the public sector and a 157% increase from 12,552 to 32,241 in the private sector. In 2006, the public sector contributed to 69% of the CSR, and by 2010, this rate had decreased to 43% (Fig. 1).

Table 1.

Five year changes in cataract surgical rate (CSR) and number of cataract surgeries (CS) in Fars from 2006 to 2010.

Year	Number of CS	Percentage increase in number of CS compared to the previous year	CSR (95% confidence interval)	Percentage CSR increase compared to the previous year	Number of CS in the public sector	Number of CS in the private sector
2006	41,275	–	9517 (9426–9609)	–	28,463	12,552
2007	45,078	+9	10,190 (10,097–10,284)	+7	28,562	17,704
2008	67,956	+51	15,186 (15,073–15,299)	+49	37,800	26,889
2009	48,511	−29	10,695 (10,601–10,790)	−30	25,160	26,910
2010	54,847	+13	11,932 (11,833–12,031)	+12	23,871	32,241

Fig. 1.

Five year contribution trend of private and public sectors to the national cataract surgical rate in Fars province.

Discussion

Cataract causes a decrease in vision related quality of life (VRQoL),⁸ its surgery can tangibly improve VRQoL.⁹ During the 2006–2010 period, the number of CS in Fars province increased by 33% and the increase in the over 50 year old population was 30%¹⁰; i.e., the two indices increased proportionately. Fars Province CSR is well above the minimum of 3000 recommended by WHO,¹ However, the distribution gap between private and public sectors is increasing. During 2006–2010, public sector's contribution to CSR experienced a 25% decline, while the role of the private sector enhanced. We observed a 49% CSR increase in Fars Province in 2008. The number of surgeries at one private center increased fivefold in 2008 compared to 2007, while it considerably decreased at two public centers in 2009, and thus, CSR returned close to the total in 2007. Possible reasons include shortage of ophthalmologists, shortage of phacoemulsification machines, or long waiting times. Also, improved coverage of insurance companies for private sectors and improvement in private facilities may contribute to this finding. More studies are needed to pinpoint the causes of this decline. Also, private sector CSR might have been overestimated due to health tourism and serving patients from neighboring provinces and countries in this region.¹¹

CSR in Fars has increased well in proportion to the over 50 year population growth. Although CS numbers are increasing in the public sector, boosting its role and its share of the total CSR requires further investigation to eliminate possible causes.