Epidemiology of pediatric dry eye disease in Eastern China, 2017-2021: a retrospective population-based study

The purpose of the study is to investigate epidemiological trends in pediatric dry eye disease (PeDED) among individuals aged 0-17 years in Yinzhou, China, from 2017 to 2021, in a retrospective, population-based study. A dynamic cohort was established using the Yinzhou Health Information System. Children aged 0-17 years were included. PeDED cases were identified by diagnostic terms or ICD-10 codes in electronic medical records. Period prevalence (2017-2021) was defined as the number of individuals ever-diagnosed with PeDED. Incidence (2019-2021) was defined as the number of first diagnoses per 100 person-years. Multivariable Poisson regression estimated incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Among 227,095 participants aged 0-17 years, 14,571 (6.4%) were diagnosed with PeDED. Compared with non-PeDED participants, the PeDED group had slightly higher proportions of males (52.9% vs 52.0%; p = 0.04), rural residents (32.6% vs 27.6%; p < 0.001), Sjögren syndrome (0.2% vs < 0.1%; p < 0.001), and insurance coverage (96.2% vs 92.6%; p < 0.001). Cumulative prevalence was 2.3% in 2017 and 6.9% in 2021, consistently higher among males, rural residents, and those aged 12-14 years. From 2019 to 2021, 8343 incident cases were identified, yielding an incidence of 1.58 per 100 person-years (95% CI, 1.55-1.62). Incidence rates peaked at ages 6-11 years and were slightly higher in rural than urban residents, with minimal sex differences.

PeDED prevalence increased in Yinzhou, China, and the incidence burden was greatest among children aged 6-11 years, underscoring the need for early detection and intervention. Further research should examine how age, sex, and residential location influence PeDED risk and care disparities.

• Adult DED is female-predominant; pediatric epidemiology is limited, and estimates depend on case definitions and data sources. • Claims-based pediatric estimates vary widely across settings and may over-represent severe cases.

• In a population-based cohort of 227,095 children aged 0-17 years in Yinzhou, China (2017-2021), cumulative prevalence increased from 2.3% to 6.9%; the overall incidence reate was 1.58 per 100 person-years (2019-2021), with higher rates in rural residents. • Peak incidence occurred earlier (ages 6-11) than peak prevalence (ages 12-14), signaling a critical window for early intervention.