Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Abstract
<h4>Background</h4>Neurological disorders are increasingly recognised as major causes
of death and disability worldwide. The aim of this analysis from the Global Burden
of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive
and up-to-date estimates of the global, regional, and national burden from neurological
disorders.<h4>Methods</h4>We estimated prevalence, incidence, deaths, and disability-adjusted
life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability
[YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis,
encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal
cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple
sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache,
and a residual category for other less common neurological disorders) in 195 countries
from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method
of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm)
was used for mortality estimation. We quantified the contribution of 84 risks and
combinations of risk to the disease estimates for the 15 neurological disorder categories
using the GBD comparative risk assessment approach.<h4>Findings</h4>Globally, in 2016,
neurological disorders were the leading cause of DALYs (276 million [95% UI 247-308])
and second leading cause of deaths (9·0 million [8·8-9·4]). The absolute number of
deaths and DALYs from all neurological disorders combined increased (deaths by 39%
[34-44] and DALYs by 15% [9-21]) whereas their age-standardised rates decreased (deaths
by 28% [26-30] and DALYs by 27% [24-31]) between 1990 and 2016. The only neurological
disorders that had a decrease in rates and absolute numbers of deaths and DALYs were
tetanus, meningitis, and encephalitis. The four largest contributors of neurological
DALYs were stroke (42·2% [38·6-46·1]), migraine (16·3% [11·7-20·8]), Alzheimer's and
other dementias (10·4% [9·0-12·1]), and meningitis (7·9% [6·6-10·4]). For the combined
neurological disorders, age-standardised DALY rates were significantly higher in males
than in females (male-to-female ratio 1·12 [1·05-1·20]), but migraine, multiple sclerosis,
and tension-type headache were more common and caused more burden in females, with
male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less
than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5-90·9)
of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease
and other dementias (22·3% [11·8-35·1] of DALYs are risk attributable) and idiopathic
epilepsy (14·1% [10·8-17·5] of DALYs are risk attributable).<h4>Interpretation</h4>Globally,
the burden of neurological disorders, as measured by the absolute number of DALYs,
continues to increase. As populations are growing and ageing, and the prevalence of
major disabling neurological disorders steeply increases with age, governments will
face increasing demand for treatment, rehabilitation, and support services for neurological
disorders. The scarcity of established modifiable risks for most of the neurological
burden demonstrates that new knowledge is required to develop effective prevention
and treatment strategies.<h4>Funding</h4>Bill & Melinda Gates Foundation.
Type
Journal articleSubject
GBD 2016 Neurology CollaboratorsHumans
Nervous System Diseases
Dementia
Disability Evaluation
Incidence
Prevalence
Cause of Death
Risk Factors
Age Factors
Sex Factors
Quality-Adjusted Life Years
Socioeconomic Factors
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Male
Global Burden of Disease
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https://hdl.handle.net/10161/25701Published Version (Please cite this version)
10.1016/s1474-4422(18)30499-xPublication Info
GBD 2016 Neurology Collaborators (2019). Global, regional, and national burden of neurological disorders, 1990-2016: a systematic
analysis for the Global Burden of Disease Study 2016. The Lancet. Neurology, 18(5). pp. 459-480. 10.1016/s1474-4422(18)30499-x. Retrieved from https://hdl.handle.net/10161/25701.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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