Purpose
To estimate the number of people visually impaired or blind due to macular diseases except those caused by diabetic maculopathy.
Design
Meta-analysis.
Methods
Based on the Global Burden of Disease Study 2010 and ongoing literature research, we examined how many people were affected by vision impairment (presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60) due to macular diseases, with diabetic maculopathy excluded.
Results
In 2010, of 32.4 million blind people and 191 million vision-impaired people, 2.1 million (95% uncertainty interval [UI]: 1.9, 2.7) people were blind, and 6.0 million (95% UI: 5.2, 8.1) million were visually impaired due to macular diseases. In 2010, macular diseases caused 6.6% (95% UI: 6.0, 7.9) of all blindness and 3.1% (95% UI: 2.7, 4.0) of all vision impairment, worldwide. These figures were lower in regions with young populations than in high-income regions. Between 1990 and 2010, the number of people who were blind or visually impaired due to macular diseases increased by 36%, or 0.6 million people (95% UI: 0.5, 0.8) and by 81%, or 2.7 million (95% UI: 2.6, 3.9) people, respectively, whereas the global population increased by 30%. Age-standardized global prevalence of macula-related blindness and vision impairment in adults 50 years of age and older decreased from 0.2% (95% UI: 0.2, 0.2) in 1990 to 0.1% (95% UI: 0.1, 0.2) in 2010 and remained unchanged from 0.4% (95% UI: 0.3, 0.5) to 0.4% (95% UI: 0.4, 0.6), respectively.
Conclusions
In 2010, 2.1 million people were blind and 6.0 million people were visually impaired due to macular diseases, except those caused by diabetic maculopathy. Of every 15 blind people, 1 was blind due to macular disease, and of every 32 visually impaired people, 1 was visually impaired due to macular disease.
Macular diseases, in particular, age-related macular degeneration, have profoundly increased in importance in public health, because of generally aging populations, and in clinics, because of the development of new treatments. In particular, large randomized controlled trials have shown the efficacy of intravitreal antivascular endothelial growth factor drugs against exudative age-related macular degeneration and myopic maculopathy. Population-based studies performed in all regions worldwide and meta-analyses of these studies have revealed that macular diseases, in particular age-related macular degeneration, are a major cause of vision loss in elderly people, with a steep increase in prevalence beyond the age of 75 years. It has been estimated that age-related macular degeneration alone is responsible for 8.7% of all global blindness and that it is the most common cause of blindness in developed countries, particularly in elderly people older than 60 years of age. However, previous studies had some limitations. For example, these estimations were based on meta-analyses that did not include studies from all regions of the world, did not comprise all available population-based studies, did not assess changes during the past 2 decades, and did not report the number of people blind or visually impaired due to macular diseases. For public health purposes, however, the number of patients functionally affected is more important than the number of patients with any stage of the disease because the burden of a disease as compared to the presence of a disease is of particular importance for the individual patient and for the society in general.
As part of the Global Burden of Disease Study, we conducted this meta-analysis of all available population-based studies performed worldwide within the past 2 decades and assessed the number of people affected by blindness and moderate to severe visual impairment due to macular diseases except macular changes due to diabetic retinopathy. We evaluated changes in that figure during the period from 1990 to 2010, examined regional differences in the prevalence of blindness and moderate and severe vision impairment related to macular diseases, and finally compared the number of people blind and visually impaired due to macular diseases with the number of people blind and visually impaired due to other diseases.
Methods
We systematically reviewed articles published between January 1980 and January 2012, we primarily identified 14 908 relevant manuscripts out of which 243 articles of high-quality, population-based studies remained after application of rigorous selection criteria and review by an expert panel. The study was approved by the ethics committee II of the Medical Faculty Mannheim of the University of Heidelberg. We used MEDLINE, Embase and the World Health Organization library information system. We found additional unpublished data sources through personal communication with researchers identified in the literature search. The method applied in our study has been described in detail recently. Of the 243 high-quality population-based studies, 128 studies reported prevalence of blindness and moderate and severe visual impairment disaggregated by cause. These formed the database for calculating the proportion of blindness and moderate and severe visual impairment that was due to macular diseases. Macular diseases were defined as any disorder of the macula or posterior pole, except macular changes due to diabetic retinopathy. It included such disorders as age-related macular degeneration, myopic maculopathy and macular holes. A full list of data sources used for macular diseases and other causes of blindness and moderate and severe visual impairment has been presented recently. At least 2 studies were identified for 18 of 21 Global Burden of Disease Study regions, but there were no studies with cause-specific data identified in 2 of the regions (central Africa and east Europe), and only 1 study was identified for central Europe. No study reporting prevalence separated by cause was identified for 126 of 191 countries. Blindness was defined as presenting visual acuity less than 3/60 in the better eye, and moderate to severe visual impairmentwas defined as visual acuity in the better eye lower than 6/18 but at least 3/60 at presentation.
As also described in detail previously, we estimated trends in causes of vision impairment, including analysis of uncertainties by age, gender and geographic region in 21 regions as defined by the Global Burden of Disease Study. The statistical analysis was performed in 3 steps. The first step included the data identification and access; the second step consisted of the estimation of fractions for each cause, stratified by the severity of vision impairment, gender, age, and region; and the third step included the application of cause fractions to the prevalence of all-cause presenting vision impairment, which has been assessed previously. For the statistical analysis, the DisMod-MR model from the Global Burden of Disease was used to calculate the fraction of moderate to severe visual impairment due to macular diseases. It has been described in detail recently. Briefly, DisMod-MR is a negative binomial regression model that includes the following elements: covariates that predict variation in the true proportion of moderate to severe visual impairment caused by each disease (eg, year); fixed effects that adjust for definitional differences (eg, whether the causes of presenting vs best-corrected moderate to severe visual impairment were reported); a hierarchical model structure that fits random intercepts in individual countries derived from the data observed in the country, in its region and in other regions, based on the availability and consistency of country- and region-specific data; age-specific fixed-effects allowing for a nonlinear age pattern; and a fixed effect for data on males. For the assessment of the fractions of blindness and moderate to severe visual impairment due to macular diseases, we fit one DisMod-MR model using 3 covariates: an indicator variable describing whether the data were for blindness or for vision impairment; an indicator variable describing whether the data were based on presenting visual acuity or best-corrected visual acuity measurements; and a country-level covariate reflecting health-systems access. We made 2 sets of the prediction for macular diseases, 1 for best-corrected blindness and 1 for best-corrected vision impairment. For the presentation of the data, we age-standardized prevalences using the World Health Organization reference population. We also calculated the numbers of people with moderate to severe visual impairment and blindness due to macular diseases, which reflected each region’s population size and age structure.
Results
Of 32.4 million people who were blind and 191 million people who were vision impaired in 2010, 2.1 million (95% uncertainty interval (UI): 1.9, 2.7) people were blind, and 6.0 million (95% UI: 5.2, 8.1) million were visually impaired due to macular diseases, worldwide ( Table 1 ).
| World Region | Blindness/Moderate to Severe Vision Impairment | Total Population 2010 | Number of People Affected in 2010 | Age-Standardized Prevalence in People Aged 50+ Years in 2010 | Proportion of Blindness/Visual Impairment by Macular Diseases in 2010 | ||||
|---|---|---|---|---|---|---|---|---|---|
| Mean Value | Lower Value | Upper Value | Mean Value | Lower Value | Upper Value | ||||
| World | Blind | 6 890 000 000 | 2 135 900 | 1 874 080 | 2 652 650 | 0.10% | 0.10% | 0.20% | 6.6 (6.0, 7.9) |
| Asia Pacific, high income | Blind | 169 000 000 | 68 808 | 34 615 | 133 321 | 0.10% | 0.00% | 0.10% | 19.5 (12.3, 28.8) |
| Asia, central | Blind | 68 800 000 | 17 946 | 12 037 | 29 639 | 0.10% | 0.10% | 0.20% | 13.3 (9.4, 18.1) |
| Asia, east | Blind | 1 190 000 000 | 363 866 | 227 258 | 611 335 | 0.10% | 0.10% | 0.20% | 6.9 (4.5, 11.0) |
| Asia, south | Blind | 1 120 000 000 | 270 230 | 172 783 | 451 290 | 0.10% | 0.10% | 0.30% | 2.6 (1.7, 4.2) |
| Asia, southeast | Blind | 460 000 000 | 205 091 | 148 128 | 301 749 | 0.20% | 0.20% | 0.40% | 5.9 (4.7, 8.3) |
| Australasia | Blind | 20 500 000 | 6 798 | 3668 | 18 919 | 0.10% | 0.00% | 0.20% | 17.7 (11.1, 26.3) |
| Caribbean | Blind | 34 300 000 | 12 052 | 7889 | 18 191 | 0.10% | 0.10% | 0.20% | 6.1 (4.3, 8.9) |
| Europe, central | Blind | 122 000 000 | 50 473 | 34 339 | 104 998 | 0.10% | 0.10% | 0.20% | 15.4 (10.9, 20.8) |
| Europe, east | Blind | 222 000 000 | 97 783 | 44 030 | 183 929 | 0.10% | 0.10% | 0.20% | 16.6 (10.1, 25.1) |
| Europe, west | Blind | 381 000 000 | 153 855 | 104 094 | 248 279 | 0.10% | 0.00% | 0.10% | 16.1 (12.5, 20.1) |
| Latin America, Andean | Blind | 38 600 000 | 12 170 | 6818 | 20 579 | 0.10% | 0.10% | 0.30% | 6.2 (4.1, 9.2) |
| Latin America, central | Blind | 166 000 000 | 61 650 | 40 193 | 96 914 | 0.20% | 0.10% | 0.30% | 6.8 (4.9, 9.9) |
| Latin America, south | Blind | 48 900 000 | 44 020 | 29 376 | 71 964 | 0.20% | 0.20% | 0.40% | 19.5 (13.2, 26.8) |
| Latin America, tropical | Blind | 154 000 000 | 72 557 | 39 743 | 147 788 | 0.20% | 0.10% | 0.40% | 9.1 (5.7, 13.3) |
| North Africa/Middle East | Blind | 301 000 000 | 320 335 | 216 494 | 468 902 | 0.60% | 0.40% | 0.90% | 10.3 (7.8, 13.6) |
| North America, High Income | Blind | 281 000 000 | 77 690 | 44 574 | 131 585 | 0.00% | 0.00% | 0.10% | 16.4 (10.8, 23.4) |
| Oceania | Blind | 5 814 186 | 1505 | 819 | 2766 | 0.20% | 0.10% | 0.40% | 4.6 (3.1, 7.6) |
| Sub-Saharan Africa, central | Blind | 53 400 000 | 19 499 | 9712 | 42 318 | 0.30% | 0.20% | 0.70% | 6.9 (4.7, 11.0) |
| Sub-Saharan Africa, east | Blind | 208 000 000 | 120 884 | 83 741 | 170 573 | 0.50% | 0.30% | 0.70% | 5.8 (4.6, 7.7) |
| Sub-Saharan Africa, south | Blind | 52 600 000 | 29 100 | 14 092 | 45 385 | 0.40% | 0.20% | 0.60% | 9.7 (6.7, 14.1) |
| Sub-Saharan Africa, west | Blind | 201 000 000 | 131 012 | 91 407 | 183 939 | 0.60% | 0.40% | 0.80% | 6.2 (4.8, 8.4) |
| World | MSVI | 6 890 000 000 | 5 994 300 | 5 174 390 | 8 123 310 | 0.40% | 0.40% | 0.60% | 3.1 (2.7, 4.0) |
| Asia Pacific, high income | MSVI | 169 000 000 | 116 405 | 63 028 | 436 778 | 0.10% | 0.10% | 0.40% | 6.0 (3.8, 9.8) |
| Asia, central | MSVI | 68 800 000 | 58 672 | 35 531 | 125 122 | 0.50% | 0.30% | 1.00% | 5.0 (3.5, 7.5) |
| Asia, east | MSVI | 1 190 000 000 | 1 744 733 | 1 038 766 | 2 775 881 | 0.60% | 0.30% | 0.90% | 5.2 (3.3, 8.0) |
| Asia, south | MSVI | 1 120 000 000 | 705 446 | 447 089 | 1 266 346 | 0.30% | 0.20% | 0.60% | 0.98 (0.65, 1.6) |
| Asia, southeast | MSVI | 460 000 000 | 334 853 | 213 902 | 675 460 | 0.40% | 0.20% | 0.80% | 1.8 (1.3, 2.7) |
| Australasia | MSVI | 20 500 000 | 36 571 | 15 682 | 97 066 | 0.30% | 0.10% | 0.90% | 8.0 (5.1, 12.6) |
| Caribbean | MSVI | 34 300 000 | 14 716 | 8 741 | 25 315 | 0.20% | 0.10% | 0.30% | 1.2 (0.90, 1.9) |
| Europe, central | MSVI | 122 000 000 | 246 285 | 129 283 | 518 097 | 0.50% | 0.30% | 1.10% | 7.4 (5.2, 11.0) |
| Europe, east | MSVI | 222 000 000 | 398 568 | 175 847 | 820 277 | 0.50% | 0.20% | 1.00% | 6.8 (4.0, 10.9) |
| Europe, west | MSVI | 381 000 000 | 402 828 | 272 912 | 734 163 | 0.20% | 0.10% | 0.30% | 5.4 (4.1, 7.5) |
| Latin America, Andean | MSVI | 38 600 000 | 42 917 | 25 322 | 73 210 | 0.50% | 0.30% | 0.90% | 3.1 (2.0, 5.1) |
| Latin America, central | MSVI | 166 000 000 | 161 750 | 100 899 | 258 897 | 0.40% | 0.30% | 0.70% | 3.2 (2.2, 5.0) |
| Latin America, south | MSVI | 48 900 000 | 114 983 | 68 485 | 245 231 | 0.60% | 0.40% | 1.40% | 7.2 (4.5, 11.5) |
| Latin America, tropical | MSVI | 154 000 000 | 291 453 | 162 394 | 500 368 | 0.70% | 0.40% | 1.30% | 6.0 (3.7, 9.2) |
| North Africa/Middle East | MSVI | 301 000 000 | 558 470 | 385 992 | 890 307 | 1.00% | 0.70% | 1.60% | 4.1 (3.0, 6.2) |
| North America, high income | MSVI | 281 000 000 | 169 367 | 111 781 | 349 536 | 0.10% | 0.10% | 0.20% | 5.5 (3.5, 8.0) |
| Oceania | MSVI | 5 814 186 | 6642 | 3085 | 11 974 | 0.90% | 0.40% | 1.60% | 2.7 (1.7, 4.8) |
| Sub-Saharan Africa, central | MSVI | 53 400 000 | 49 922 | 25 693 | 116 494 | 0.80% | 0.40% | 1.70% | 3.6 (2.1, 6.2) |
| Sub-Saharan Africa, east | MSVI | 208 000 000 | 283 239 | 194 996 | 420 362 | 1.00% | 0.70% | 1.50% | 4.0 (3.0, 5.5) |
| Sub-Saharan Africa, south | MSVI | 52 600 000 | 45 002 | 25 208 | 91 961 | 0.60% | 0.30% | 1.10% | 4.8 (2.8, 7.7) |
| Sub-Saharan Africa, west | MSVI | 201 000 000 | 208 749 | 150 669 | 341 386 | 0.80% | 0.60% | 1.30% | 2.9 (2.0, 4.3) |
Between 1990 and 2010, the number of people blind due to macular diseases increased by 0.6 million people, or 36%, and the number of visually impaired people by 2.7 million people, or 81%. During the same period the global population increased by 30% ( Table 1 , Table 2 ). For people 50 years of age or older, the number of those blind due to macular diseases increased by 31%, from 1.6 million in 1990 to 2.1 million in 2010. The number of people with moderate to severe visual impairment related to macular diseases increased by 62%, from 3.3 million in 1990 to 6.0 million in 2010. In the same period, the world population older than 50 years of age increased by 60%.
| Region | Number of People Affected in 1990 | Mean Difference in the Number of People Affected 2010–1990 | Age-Standardized Prevalence in People Aged 50+ Years in 1990 | Proportion of Blindness/Visual Impairment by Macular Diseases in 1990 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Mean | Lower Value | Upper Value | Mean | Lower Value | Upper Value | Mean | Lower Value | Upper Value | |||
| World | Blind | 1 568 800 | 1 362 100 | 1 892 100 | 567 100 | 511 980 | 760 550 | 0.20% | 0.20% | 0.20% | 4.9 (4.4, 5.8) |
| Asia Pacific, high income | Blind | 41 881 | 24 655 | 79 063 | 26 927 | 9960 | 54 258 | 0.10% | 0.10% | 0.20% | 14.9 (10.3, 21.3) |
| Asia, central | Blind | 23 367 | 16 276 | 34 457 | −5421 | −4239 | −4818 | 0.20% | 0.20% | 0.40% | 11.6 (8.8, 15.3) |
| Asia, east | Blind | 301 671 | 184 170 | 494 124 | 62 195 | 43 088 | 117 211 | 0.20% | 0.10% | 0.30% | 5.0 (3.2, 7.9) |
| Asia, south | Blind | 134 289 | 97 192 | 183 936 | 135 941 | 75 591 | 267 354 | 0.10% | 0.10% | 0.20% | 1.4 (1.0, 1.9) |
| Asia, southeast | Blind | 125 835 | 85 007 | 165 079 | 79 256 | 63 121 | 136 670 | 0.30% | 0.20% | 0.40% | 3.7 (2.9, 5.0) |
| Australasia | Blind | 5836 | 3828 | 14 189 | 962 | −160 | 4730 | 0.10% | 0.10% | 0.20% | 16.8 (12.9, 22.2) |
| Caribbean | Blind | 9319 | 6078 | 13 522 | 2733 | 1811 | 4669 | 0.20% | 0.10% | 0.20% | 4.5 (3.4, 6.0) |
| Europe, central | Blind | 50 232 | 35 204 | 107 356 | 241 | −865 | −2358 | 0.20% | 0.10% | 0.30% | 12.2 (9.3, 15.6) |
| Europe, east | Blind | 124 924 | 68 406 | 217 874 | −27 141 | −24 376 | −33 945 | 0.20% | 0.10% | 0.30% | 13.1 (9.1, 19.2) |
| Europe, west | Blind | 189 652 | 138 762 | 289 270 | −35 797 | −34 668 | −40 991 | 0.10% | 0.10% | 0.20% | 16.1 (13.4, 19.6) |
| Latin America, Andean | Blind | 7092 | 4375 | 10 862 | 5078 | 2443 | 9717 | 0.20% | 0.10% | 0.30% | 3.7 (2.6, 5.5) |
| Latin America, central | Blind | 38 817 | 26 806 | 56 360 | 22 833 | 13 387 | 40 554 | 0.20% | 0.20% | 0.30% | 4.6 (3.5, 6.2) |
| Latin America, south | Blind | 34 101 | 22 049 | 56 700 | 9919 | 7327 | 15 264 | 0.30% | 0.20% | 0.60% | 14.6 (10.6, 19.6) |
| Latin America, tropical | Blind | 37 026 | 18 701 | 75 476 | 35 531 | 21 042 | 72 312 | 0.20% | 0.10% | 0.50% | 5.0 (3.1, 8.0) |
| North Africa/Middle East | Blind | 191 239 | 129 163 | 274 038 | 129 096 | 87 331 | 194 864 | 0.80% | 0.50% | 1.10% | 6.4 (5.2, 8.0) |
| North America, high income | Blind | 73 840 | 47 458 | 114 618 | 3850 | −2884 | 16 967 | 0.10% | 0.00% | 0.10% | 16.4 (12.2, 21.4) |
| Oceania | Blind | 915 | 490 | 1588 | 590 | 329 | 1178 | 0.30% | 0.20% | 0.50% | 3.3 (2.3, 4.7) |
| Sub-Saharan Africa, central | Blind | 13 322 | 7603 | 28 197 | 6177 | 2109 | 14 121 | 0.40% | 0.20% | 0.80% | 4.8 (3.5, 7.1) |
| Sub-Saharan Africa, east | Blind | 67 610 | 50 046 | 90 732 | 53 274 | 33 695 | 79 841 | 0.50% | 0.40% | 0.70% | 4.1 (3.4, 5.1) |
| Sub-Saharan Africa, south | Blind | 21 367 | 11 634 | 29 601 | 7733 | 2458 | 15 784 | 0.60% | 0.30% | 0.80% | 6.9 (5.5, 8.9) |
| Sub-Saharan Africa, west | Blind | 77 357 | 53 822 | 101 363 | 53 655 | 37 585 | 82 576 | 0.60% | 0.40% | 0.70% | 4.1 (3.4, 5.4) |
| World | MSVI | 3 307 200 | 2 623 500 | 4 181 700 | 2 687 100 | 2 550 890 | 3 941 610 | 0.40% | 0.30% | 0.50% | 1.9 (1.6, 2.4) |
| Asia Pacific, high income | MSVI | 55 762 | 33 200 | 194 839 | 60 643 | 29 828 | 241 939 | 0.10% | 0.10% | 0.40% | 3.5 (2.4, 5.1) |
| Asia, central | MSVI | 48 771 | 28 521 | 84 173 | 9901 | 7010 | 40 949 | 0.50% | 0.30% | 0.90% | 3.3 (2.4, 4.6) |
| Asia, east | MSVI | 989 498 | 523 428 | 1 612 265 | 755 235 | 515 338 | 1 163 616 | 0.60% | 0.30% | 0.90% | 3.1 (1.9, 5.2) |
| Asia, south | MSVI | 266 190 | 175 671 | 381 442 | 439 256 | 271 418 | 884 904 | 0.20% | 0.20% | 0.40% | 0.45 (0.32, 0.61) |
| Asia,southeast | MSVI | 149 545 | 99 613 | 229 494 | 185 308 | 114 289 | 445 966 | 0.30% | 0.20% | 0.50% | 0.93 (0.72, 1.3) |
| Australasia | MSVI | 26 728 | 12 582 | 64 894 | 9843 | 3100 | 32 172 | 0.40% | 0.20% | 1.10% | 6.6 (4.6, 9.5) |
| Caribbean | MSVI | 8475 | 4712 | 12 443 | 6241 | 4029 | 12 872 | 0.10% | 0.10% | 0.20% | 0.74 (0.57, 1.0) |
| Europe, central | MSVI | 179 174 | 89 974 | 310 812 | 67 111 | 39 309 | 207 285 | 0.50% | 0.30% | 0.90% | 4.7 (3.4, 6.5) |
| Europe, east | MSVI | 344 165 | 166 872 | 624 992 | 54 403 | 8975 | 195 285 | 0.50% | 0.30% | 1.00% | 4.3 (2.7, 6.9) |
| Europe, west | MSVI | 352 395 | 228 028 | 590 886 | 50 433 | 44 884 | 143 277 | 0.20% | 0.20% | 0.40% | 4.1 (3.3, 5.2) |
| Latin America, Andean | MSVI | 17 367 | 9074 | 27 863 | 25 550 | 16 248 | 45 347 | 0.40% | 0.20% | 0.70% | 1.4 (0.99, 2.2) |
| Latin America, central | MSVI | 74 996 | 43 646 | 114 570 | 86 754 | 57 253 | 144 327 | 0.40% | 0.20% | 0.60% | 1.7 (1.2, 2.5) |
| Latin America, south | MSVI | 66 571 | 39 350 | 126 099 | 48 412 | 29 135 | 119 132 | 0.60% | 0.40% | 1.20% | 4.2 (2.9, 6.2) |
| Latin America, tropical | MSVI | 119 970 | 61 511 | 199 545 | 171 483 | 100 883 | 300 823 | 0.70% | 0.30% | 1.10% | 2.8 (1.7, 4.6) |
| North Africa/Middle East | MSVI | 216 316 | 144 735 | 300 316 | 342 154 | 241 257 | 589 991 | 0.80% | 0.50% | 1.10% | 1.8 (1.4, 2.6) |
| North America, high income | MSVI | 132 277 | 93 698 | 231 801 | 37 090 | 18 083 | 117 735 | 0.10% | 0.10% | 0.20% | 4.5 (3.2, 6.1) |
| Oceania | MSVI | 2639 | 1363 | 3956 | 4003 | 1722 | 8018 | 0.70% | 0.40% | 1.00% | 1.4 (0.99, 2.1) |
| Sub-Saharan Africa, central | MSVI | 23 775 | 13 449 | 44 080 | 26 147 | 12 244 | 72 414 | 0.60% | 0.30% | 1.10% | 1.9 (1.3, 2.9) |
| Sub-Saharan Africa, east | MSVI | 128 963 | 95 061 | 184 627 | 154 276 | 99 935 | 235 735 | 0.90% | 0.60% | 1.20% | 2.5 (1.9, 3.2) |
| Sub-Saharan Africa, south | MSVI | 23 681 | 15 132 | 39 889 | 21 321 | 10 076 | 52 072 | 0.60% | 0.40% | 0.90% | 2.8 (2.0, 4.2) |
| Sub-Saharan Africa, west | MSVI | 81 348 | 56 217 | 116 564 | 127 401 | 94 452 | 224 822 | 0.50% | 0.40% | 0.80% | 1.4 (1.1, 1.9) |
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