{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T18:13:21Z","timestamp":1778523201910,"version":"3.51.4"},"reference-count":60,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Astigmatism is one of the most common refractive errors and represents a risk factor for other ocular conditions, including myopia and amblyopia. In Mexico, comprehensive epidemiological data on refractive astigmatism, particularly its axis-related subtypes, remain limited. This study aimed to estimate the prevalence and distribution of axis subtypes of refractive astigmatism in a nationwide, clinic-based cohort of Mexican outpatients. Methods: We conducted a retrospective, cross-sectional, multicenter study using anonymized electronic health records (EHRs) from Salud Digna clinics across all 32 states of Mexico. Individuals aged 5\u201390 years who underwent routine non-cycloplegic eye examinations between 2021 and 2023 were included. Refractive astigmatism was defined as a cylinder power (Cyl) of \u2264\u22120.75 D. Age-adjusted prevalence and distribution of axis subtypes (with-the-rule [WTR], against-the-rule [ATR], and oblique [OBL]) were determined according to sex, age groups, and geographic locations. Logistic regression models evaluated potential associations between demographic variables and refractive astigmatism. Results: Data from 8,622,191 individuals were analyzed (median age: 45 years; 63.4% females). The age-standardized prevalence of refractive astigmatism was 41.59% (95% CI: 41.54\u201341.64%) and was higher in males (45.43%) than females (39.32%). WTR astigmatism predominated among younger individuals, peaking at ages 15\u201319 (48.97%), whereas ATR astigmatism increased with age, reaching 35.36% among those aged 80\u201390 years. In multivariable analysis, refractive astigmatism was significantly associated with age, sex, and state of residence, showing a non-linear, non-monotonic age pattern with peaks in adolescence (aOR = 1.47; 95% CI, 1.456\u20131.484) and older (aOR = 1.177; 95% CI, 1.161\u20131.193) age, higher odds in males (aOR = 1.269; 95% CI, 1.265\u20131.272), and marked geographic variability, with the highest in Tlaxcala (aOR = 3.581; 95% CI, 3.491\u20133.675). Conclusions: Refractive astigmatism was more prevalent in males and showed a clear age-related shift in the axis subtype beginning in the early 40s. These findings provide large-scale, real-world evidence that enhances the understanding of astigmatism epidemiology in Mexico and may inform future research and public health planning.<\/jats:p>","DOI":"10.3390\/jcm15093522","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T10:01:30Z","timestamp":1777975290000},"page":"3522","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Distribution of Axis Subtypes of Refractive Astigmatism in Mexican Outpatients: A Nationwide Multicenter Clinic-Based Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1534-6832","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"Maga\u00f1a-Liz\u00e1rraga","sequence":"first","affiliation":[{"name":"Innovation and Research Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6930-805X","authenticated-orcid":false,"given":"Abraham","family":"Garc\u00eda-Gil","sequence":"additional","affiliation":[{"name":"Innovation and Research Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo Daniel","family":"Contreras-Espinoza","sequence":"additional","affiliation":[{"name":"Optometry Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Espinoza-Angulo","sequence":"additional","affiliation":[{"name":"Optometry Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9ctor","family":"Machado-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Optometry Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5836-7732","authenticated-orcid":false,"given":"Marco Antonio","family":"Luna-Ruiz-Esparza","sequence":"additional","affiliation":[{"name":"Innovation and Research Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Humberto","family":"G\u00f3mez-Campa\u00f1a","sequence":"additional","affiliation":[{"name":"Medical Direction, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham","family":"Campos-Romero","sequence":"additional","affiliation":[{"name":"Innovation and Research Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5302-4223","authenticated-orcid":false,"given":"Jonathan","family":"Alc\u00e1ntar-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Innovation and Research Department, Salud Digna, Culiacan 80184, Sinaloa, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2019). 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