Global_Trends_in_Vision_Loss_Supplemental_online_material

<b>Background:</b> Vision loss remains a major public health issue worldwide, yet the contribution of modifiable risk factors to long-term trends and health inequalities has not been systematically analyzed.<b>Objective</b><b>:</b>To analyze 4 modifiable risks in vision loss and quantify their DALYs via GBD 2021 data.<b>Methods:</b> Using data from the Global Burden of Disease 2021 study covering 204 countries (1990–2021), we estimated disability-adjusted life years (DALYs) attributable to four modifiable risk factors: smoking, air pollution, high body mass index (BMI), and high fasting plasma glucose (HFPG). Age-standardized DALY rates were assessed by sex, age, and sociodemographic index (SDI). Temporal trends were evaluated with Joinpoint regression, and socioeconomic gradients were quantified using concentration indices.<b>Results:</b> In 2021, modifiable risk factors accounted for 21.7 DALYs per 100,000 population. Air pollution and HFPG were the leading contributors, while smoking-attributable burden declined substantially. From 1990 to 2021, age-standardized DALYs decreased by 36% for smoking and 38% for air pollution, but increased by 59% for high BMI and 16% for HFPG. Metabolic risks rose fastest in low- and middle-SDI regions and among women over age 60. Inequality analyses revealed stark geographic disparities, with South Asia experiencing air pollution–attributable DALY rates more than 100-fold higher than high-income countries.<b>Conclusions:</b> These findings highlight an ongoing epidemiologic transition in which metabolic disorders have surpassed traditional behavioral and environmental risks as major drivers of vision loss. Persistent inequalities across SDI levels emphasize the need for equity-focused prevention strategies and closer integration of metabolic disease control into eye health policies.