Supplementary Material for: Prevalence and incidence of dry eye disease in Asia: a systematic review and meta-analysis

Background: Dry eye disease (DED) is the most common ocular surface disease, which severely affects the quality of life. An overall estimate of the prevalence, incidence, and risk factors of DED in Asia would help in planning and implementing appropriate public health strategies. Objectives: The present study aimed to study the epidemiology of DED in Asia. Methods: A comprehensive and systematic search was performed using several databases, including PubMed, Cochrane Library, and Web of Science, in January 2021. A random-effects meta-analysis was performed on logit-transformed prevalence and incidence rates to calculate pooled prevalence and incidence estimates. Meta-regression and subgroup analyses were performed to explain the heterogeneity. Results: Among the 6,742 articles identified, 23 were included in the analysis, with a total sample size of 1,488,935 subjects. Twenty studies reported the prevalence of DED in Asia, two studies reported the incidence, and one study reported both prevalence and incidence. The estimated pooled prevalence of DED in any population in Asia was 20.1% (95% confidence interval [1]: 13.9%–28.3%), and the incidence 16.7% (95% CI: 0 %–34.9%). The prevalence rate of DED in males and females was 16.4% (95% CI: 10.0%–25.8%) and 21.7% (95% CI: 14.7%–30.8%; P < 0.001), respectively. In general, the prevalence increased with age. The risk factors considered for specific populations were not significant, and the prevalence in the general population, excluding the populations considered at risk, was similar at 20.9% (95% CI: 12.8%–32.1%). Conclusions: DED is common in Asian populations and causes a significant disease burden. Its prevalence is higher in females than that in males, and it tends to increase in severity with age. Further research on additional risk factors is needed to adequately explain the epidemiology of DED in Asia.

背景：干眼症（Dry eye disease, DED）是最常见的眼表疾病，严重影响患者生活质量。针对亚洲地区干眼症的患病率、发病率及危险因素开展整体评估，有助于规划并实施适宜的公共卫生策略。
目的：本研究旨在探究亚洲地区干眼症的流行病学特征。
方法：2021年1月，研究者通过PubMed、Cochrane Library、Web of Science等多个数据库开展全面系统的文献检索。对经对数转换的患病率及发病率数据采用随机效应模型进行Meta分析，以合并计算患病率与发病率的估计值；同时开展Meta回归与亚组分析，以阐释研究间的异质性。
结果：初检共检索到6742篇文献，最终纳入23篇符合标准的文献进行分析，总样本量达1488935名受试者。其中20篇文献报告了亚洲人群干眼症的患病率，2篇报告了发病率，1篇同时报告了患病率与发病率。亚洲任意人群的干眼症合并患病率估计为20.1%（95%置信区间（95% confidence interval）[1]：13.9%~28.3%），合并发病率为16.7%（95% CI：0%~34.9%）。男性干眼症患病率为16.4%（95% CI：10.0%~25.8%），女性为21.7%（95% CI：14.7%~30.8%；P<0.001）。总体而言，患病率随年龄增长而升高。针对特定高危人群的危险因素分析未显示统计学显著性；排除高危人群后的普通人群干眼症患病率为20.9%（95% CI：12.8%~32.1%），与整体水平相近。
结论：干眼症在亚洲人群中较为普遍，造成了显著的疾病负担。其患病率女性高于男性，且随年龄增长病情严重程度趋于加重。未来仍需开展更多针对潜在危险因素的研究，以充分阐释亚洲地区干眼症的流行病学特征。