Socioeconomic inequality in visual impairments among older adults in India

• Over one-third of older adults in India have some form of visual impairment. • Near vision loss is most prevalent, followed by distance vision loss and blindness. • Visual impairment is higher among low-income, rural, and female populations. • Socioeconomic factors like education and caste significantly influence visual impairment. • Significant state-level and age-related disparities exist in the prevalence of visual impairment. Globally, 1.1 billion people have some form of visual impairment (VI), and 90 percent of them live in low and middle-income countries. Though evidence suggests a global reduction in the age-standardised prevalence of blindness, the prevalence of visual impairment has been increasing, and the adverse social and economic impact of visual impairment is profound. VI intensify poverty and inequality by reducing employment opportunities and increasing medical spending. Data from the Longitudinal Ageing Study in India (LASI), 2017–18, were analysed to estimate the prevalence of visual conditions among older adults (45+). Descriptive statistics and binary logistic regression identified factors associated with visual impairments. Concentration indices, curves, and Wagstaff decomposition were employed to assess inequality in visual impairments. Among older adults, 12.78 % had distance vision loss, 31.63 % near vision loss, 1.63 % blindness, and 35.95 % had any visual impairment. Visual impairments increased with age and were more prevalent among females and rural residents, even after adjusting for socioeconomic factors. A strong socioeconomic gradient was observed, with higher rates among low-income and less-educated groups. Gender-specific patterns showed near vision loss was higher among females, while blindness was more prevalent among males. Concentration indices and curves indicated that visual impairments were concentrated in low-income groups. The high prevalence of undiagnosed and untreated visual impairments highlights the need for improved access to diagnosis and treatment, including spectacles and lenses. Integrating public health services across primary, secondary, and tertiary levels is essential to address the growing burden of visual impairments among older adults in India.