PURPOSE. To estimate the prevalence and associations of primary open angle glaucoma (POAG) in a rural population of northern China. METHODS. In a rural county in Handan, China, 6716 adults residing in 13 villages were randomly selected and participated in the study. All participants completed a comprehensive eye examination, including intraocular pressure (IOP), slit-lamp examination, and fundus evaluation. Visual fields were obtained with on glaucoma suspects. RESULTS. Sixty-five persons (1.2%) had POAG, with an adjusted prevalence of 1.0% (95% confidence interval [CI], 0.7% - 1.3%) in those aged 40 years and older. Sex was not significantly associated with POAG (P > 0.05). Age (odds ratio [OR], 1.9; 95% CI, 1.4-2.5, for each 10-year increase), IOP (OR, 1.5; 95% CI 1.2-2.0 for each 5-mm Hg increase), axial length (OR, 1.3; 95% CI, 1.1-1.6), and moderate myopia (3.1-6.0 D; OR, 4.7; 95% CI, 1.6-13.5) increased the risk for POAG in multivariate analysis. The mean IOP of persons with POAG was 16.3 +/- 3.5 mm Hg, and 90% of them presented with an IOP <= 21 mm Hg. Of those with POAG, 4.5% were blind from glaucoma in at least one eye. CONCLUSIONS. Approximately 1% of adults aged 40 years and older living in rural China have POAG. As seen in other populations, increasing age, higher IOP, greater axial length, and having myopia were associated with POAG. Given the rapid aging and myopic shift (acquired myopia) in China's population, POAG is likely to increase in prevalence in the coming decades. (Invest Ophthalmol Vis Sci. 2011;52:8250-8257) DOI: 10.1167/iovs.11-7472