Socioeconomic Development, COVID-19, and Visual Health in Chinese Youth: A 30-Year Trend and Frontier Analysis of the Burden of Blindness Due to Refractive Error

Purpose: To evaluate long-term trends of refractive error-related blindness in Chinese children and adolescents (1990-2021) and project future trajectories to 2035, assessing impacts of COVID-19 and socioeconomic development. Methods: Retrospective and predictive analysis using Global Burden of Disease (GBD) 2021 data. Primary outcomes were age-specific prevalence and DALY rates in youth (<20 years). Secondary outcomes included age-standardized rates, EAPCs, decomposition components, and projections via BAPC and ARIMA models. Results: Refractive error-related blindness affected 26.97 million individuals in China (1990-2021), including nearly 3 million youth. Primary outcomes showed consistent increases in age-specific prevalence (0-14 years: +15.0%; 15-19 years: +16.8%). Secondary analyses revealed declining age-standardized rates (ASPR EAPC: -0.18%), with population aging as the dominant driver (83.4-93.0%). During COVID-19, adolescent prevalence declined sharply (-10.61%). ARIMA projections suggest a turning point, with youth prevalence expected to decline by 30.5-36.3% by 2036. Global analysis revealed >10-fold variation in adolescent burden across countries. Conclusion: Despite declining age-standardized rates, rising youth prevalence demands targeted interventions. Encouraging projections suggest delayed policy impacts, while COVID-19 disruptions highlight health system vulnerabilities. Prioritizing early screening and adolescent-focused strategies remains critical.