LAUSR

INTRODUCTION Smoking is a major modifiable risk factor for cataract, with strong biological and epidemiological evidence supporting this association. Nevertheless, the global burden and regional variations in vision impairment attributable to smoking-related cataract have not been comprehensively assessed. METHODS Using data from the Global Burden of Disease (GBD) 2021 study, we performed a secondary analysis of the global years lived with disability (YLDs) due to smoking-related cataract vision impairment, from 1990 to 2021. Analyses were stratified by age group (30–34 to ≥95 years). Trends were evaluated using age-standardized YLDs rates (ASYLDsR) and estimated annual percentage change (EAPC). Future burden was projected to 2050 using a Bayesian age-period-cohort (BAPC) model. RESULTS In 2021, global YLDs due to smoking-related cataract reached 225174 cases (95% uncertainty interval, UI: 151200–325529), representing a 38.9% (95% UI: 35.2–42.5) increase compared with 1990. However, the ASYLDsR declined significantly (EAPC= -1.41%, 95% CI: -1.48 – -1.33). Population growth contributed over 360% to the increase in YLDs in low sociodemographic index (SDI) regions, whereas population aging was the dominant factor in high-SDI regions (contributing 165%). Males accounted for 82% of the global burden. In 2021, the male ASYLDsR was 5.3 times higher than that of females (4.59; 95% UI: 3.24–6.39 vs 0.87; 95% UI: 0.61–1.23, per 100000 population). Countries in Asia bore the heaviest absolute burden, with China and India collectively accounting for 53% of the global total. The BAPC model projected a continued decline in ASYLDsR through 2050, with predicted rates of 2.69 (95% CI: 0.59–4.77) males and 0.42 (95% CI: 0.09–0.82) females. CONCLUSIONS Despite a declining age-standardized burden globally, the absolute burden is increasing due to population growth and aging, presenting ongoing challenges, particularly for low- and middle-income countries. Strengthening tobacco control and improving access to cataract surgery are recommended.