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Original Investigation
September 2017

Trends in Visual Health Inequalities in Childhood Through Associations of Visual Function With Sex and Social Position Across 3 UK Birth Cohorts

Author Affiliations
  • 1Life Course Epidemiology and Biostatistics Section, Population, Policy, and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, England
  • 2Ulverscroft Vision Research Group, London, England
  • 3Great Ormond Street Hospital, Biomedical Research Centre, London, England
  • 4Moorfields Eye Hospital National Health Service Foundation Trust, National Institute for Health Research, Moorfields Biomedical Research Centre, London, England
  • 5University College London Institute of Ophthalmology, London, England
JAMA Ophthalmol. 2017;135(9):954-961. doi:10.1001/jamaophthalmol.2017.2812
Key Points

Question  Has the distribution of visual function in childhood changed over time, and are there associations with social position?

Findings  In this longitudinal cohort study, harmonized data from 3 UK birth cohorts spanning 25 years suggest that social position at birth and during childhood were independently associated with visual function, across the full spectrum from normal acuity to blindness, in a complex pattern that changed over time.

Meaning  Early-life social position contributed to a temporal decline in visual function in childhood, which supports the hypothesis that it contributes to the current known social patterning in visual function in older adults.


Importance  Despite the existing country-specific strategies tackling social inequalities in visual health in adults, little is known about trends in visual function in childhood and its association with social position.

Objective  To investigate the distribution of childhood visual function in the United Kingdom and associations with early-life social position between 1961 and 1986, a period of significant social change.

Design, Setting, and Participants  Longitudinal cohort study using harmonized data sets from the British 1946, 1958, and 1970 national birth cohorts. In total, 14 283 cohort members with complete data on visual acuity at age 15 or 16 years, measured in 1961, 1974, and 1986, respectively, for each cohort, and social position were assessed.

Main Outcomes and Measures  Using habitual distance visual acuity (with correction if prescribed), participants were assigned to a visual function category ranging from bilateral normal to visual impairment/severe visual impairment/blindness (International Statistical Classification of Diseases, Tenth Revision, Clinical Modification). Distribution of visual function over time and associations with social position (risk ratios [RRs] and 95% confidence intervals) were analyzed.

Results  Complete data were available for 3152 participants (aged 15 years; 53% boys [n = 1660]) in the 1946 Medical Research Council National Survey of Health and Development, 6683 participants (aged 16 years; 51% boys [n = 3420]) in the 1958 National Child Development Study, and 4448 participants (aged 16 years; 48% boys [n = 2156]) in the 1970 British Birth Cohort Study. The proportion of children with bilateral normal vision decreased by 1.3% (95% CI, −5.1% to 2.7%) in 1974 and 1.7% (95% CI, −5.9% to 2.7%) in 1986. The risk of overall impaired vision increased by 1.20 times (95% CI, 1.01-1.43) and the risk of visual impairment/severe visual impairment/blindness by 1.75 times (95% CI, 1.03-2.98) during this period. Girls were consistently at increased risk of all vision impairment categories. Higher social position at birth and in childhood was associated with reduced risk of visual impairment/severe visual impairment/blindness (RR, 0.58; 95% CI, 0.20-1.68) and unilateral impairment (RR, 0.89; 95% CI, 0.72-1.11), respectively.

Conclusions and Relevance  Our study provides evidence of temporal decline in childhood visual function between 1961 and 1986. Despite the limited power of the analysis owing to the small sample size of those with impaired vision, we found an emergence of a contribution of sociodemographic status to the cohort effect that may be the antecedent of the current picture of childhood blindness. Equally, early-life social position may also have contributed to the current social patterning in visual function in older adults in the United Kingdom. These findings highlight the potential value of targeting children in national ophthalmic public policies tackling inequalities.