Global, Regional, and National Burden of Cataracts Attributable to Household Air Pollution from 1990 to 2021, with Projections to 2035

PURPOSE: Household air pollution (HAP) is a major environmental risk factor affecting nearly 3 billion people worldwide, and is strongly associated with cataract formation. However, the temporal dynamic and future trends of the global cataract burden attributable specific to HAP remain insufficiently understood. Unlike previous studies focusing on the overall cataract burden, this study quantifies the independent contribution of HAP as an intervenable environmental risk factor. METHODS: Using data from the Global Burden of Disease database, we assessed global, regional, and national cataract burden attributable to HAP from 1990 to 2021. Joinpoint regression evaluated temporal trends, Age-Period-Cohort modeling elucidated drivers of burden changes, and health inequality was examined. Future burden was projected using ARIMA and ARIMA-LSTM hybrid models. RESULTS: In 2021, global HAP-attributable cataract burden reached 1956.32 thousand years lived with disability (YLDs), with age-standardized YLDs rate (ASYR) of 22.84 per 100,000. From 1990 to 2021, global YLDs increased steadily, with females consistently exhibiting higher burden than males, while ASYR declined. South Asia and East Asia bore the highest burden, with low socio-demographic index (SDI) regions most affected. Forecasts indicate global YLDs will rise to 1987.94 thousand by 2035, although ASYR will continue declining. CONCLUSION: HAP is strongly associated with cataracts globally. Females and people living in low-SDI regions are disproportionately affected. There is an urgent need to strengthen clean energy promotion, public health education, and targeted prevention programs in high-burden settings to reduce the cataract burden attributed to HAP.