Sex Differences in Waiting Times for Cataract Surgery in Sweden, 2010–2022: Nationwide Analysis of 1.4 Million Patients

Background Sex-based disparities in healthcare access and outcomes remain a challenge. Understanding differences in waiting times for cataract surgery between males and females can reveal inequities in care delivery. Methods This nationwide retrospective cohort study used data from the Swedish National Cataract Register, which covers > 93% of all cataract surgeries in Sweden. A total of 1,413,652 patients aged > 40 years who underwent first-eye cataract surgery between 2010 and 2022 were included. Exclusions were made for patients with waiting times > 24 months, those residing outside Sweden, and those with missing sex data. The primary outcome was waiting time, defined as the interval between preoperative assessment and surgery. Secondary analyses included stratification by visual acuity, regional variations, and the influence of demographic and clinical factors. Results The mean waiting time was 64 days for females (SD 126) and 60 days for males (SD 102), with a significant difference (P < 0.001). This disparity persisted across all visual acuity strata and regions. Multivariate Cox regression identified female sex, older age, specific comorbidities, and residence region as significant predictors of longer waiting times. Differences in comorbidities, including higher rates of pseudoexfoliation syndrome in females and endophthalmitis in males, were observed. Despite fluctuations in overall waiting times, the sex-based disparity remained consistent over the study period. Conclusions Persistent sex-based differences in waiting times for cataract surgery were identified in Sweden over 13 years. While small and unlikely to affect clinical outcomes, these differences highlight systemic inequities that merit further investigation and intervention to ensure equitable access to care.