Global, regional, and national burden of neurological disorders, 1990–2016

a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Neurology Collaborators, Amanda Thrift

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)459-480
Number of pages22
JournalThe Lancet Neurology
Volume18
Issue number5
DOIs
Publication statusPublished - 1 May 2019

Cite this

@article{3cc8965b07a742f3a977d80ca9772197,
title = "Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016",
abstract = "Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: Bill & Melinda Gates Foundation.",
author = "Feigin, {Valery L.} and Emma Nichols and Tahiya Alam and Bannick, {Marlena S.} and Ettore Beghi and Natacha Blake and Culpepper, {William J.} and Dorsey, {E. Ray} and Alexis Elbaz and Ellenbogen, {Richard G.} and Fisher, {James L.} and Christina Fitzmaurice and Giorgia Giussani and Linda Glennie and James, {Spencer L.} and Johnson, {Catherine Owens} and Kassebaum, {Nicholas J.} and Giancarlo Logroscino and Beno{\^i}t Marin and Mountjoy-Venning, {W. Cliff} and Minh Nguyen and Richard Ofori-Asenso and Patel, {Anoop P.} and Marco Piccininni and Roth, {Gregory A.} and Steiner, {Timothy J.} and Stovner, {Lars Jacob} and Szoeke, {Cassandra E.I.} and Alice Theadom and Vollset, {Stein Emil} and Wallin, {Mitchell Taylor} and Claire Wright and Zunt, {Joseph Raymond} and Nooshin Abbasi and Foad Abd-Allah and Ahmed Abdelalim and Ibrahim Abdollahpour and Victor Aboyans and Abraha, {Haftom Niguse} and Dilaram Acharya and Adamu, {Abdu A.} and Adebayo, {Oladimeji M.} and Adeoye, {Abiodun Moshood} and Adsuar, {Jose C.} and Mohsen Afarideh and Sutapa Agrawal and Alireza Ahmadi and Ahmed, {Muktar Beshir} and Aichour, {Amani Nidhal} and Ibtihel Aichour and Aichour, {Miloud Taki Eddine} and Akinyemi, {Rufus Olusola} and Nadia Akseer and Ayman Al-Eyadhy and {Al-Shahi Salman}, Rustam and Fares Alahdab and Alene, {Kefyalew Addis} and Aljunid, {Syed Mohamed} and Khalid Altirkawi and Nelson Alvis-Guzman and Anber, {Nahla Hamed} and Antonio, {Carl Abelardo T.} and Jalal Arabloo and Olatunde Aremu and Johan {\"A}rnl{\"o}v and Hamid Asayesh and Asghar, {Rana Jawad} and Atalay, {Hagos Tasew} and Ashish Awasthi and {Ayala Quintanilla}, {Beatriz Paulina} and Ayuk, {Tambe B.} and Alaa Badawi and Maciej Banach and Banoub, {Joseph Adel Mattar} and Barboza, {Miguel A.} and Barker-Collo, {Suzanne Lyn} and B{\"a}rnighausen, {Till Winfried} and Baune, {Bernhard T.} and Neeraj Bedi and Masoud Behzadifar and Meysam Behzadifar and Yannick B{\'e}jot and Bekele, {Bayu Begashaw} and Belachew, {Abate Bekele} and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Adugnaw Berhane and Mircea Beuran and Krittika Bhattacharyya and Bhutta, {Zulfiqar A.} and Belete Biadgo and Ali Bijani and Nigus Bililign and {Bin Sayeed}, {Muhammad Shahdaat} and Blazes, {Christopher Kynrint} and Carol Brayne and Butt, {Zahid A.} and Campos-Nonato, {Ismael R.} and Carlos Cantu-Brito and Mate Car and Rosario C{\'a}rdenas and Carrero, {Juan J.} and F{\'e}lix Carvalho and Casta{\~n}eda-Orjuela, {Carlos A.} and Franz Castro and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Ester Cerin and Yazan Chaiah and Chang, {Jung Chen} and Irini Chatziralli and Chiang, {Peggy Pei Chia} and Hanne Christensen and Christopher, {Devasahayam J.} and Cyrus Cooper and Cortesi, {Paolo Angelo} and Costa, {Vera M.} and Criqui, {Michael H.} and Crowe, {Christopher Stephen} and Damasceno, {Albertino Antonio Moura} and Ahmad Daryani and {De la Cruz-G{\'o}ngora}, Vanessa and {De la Hoz}, {Fernando Pio} and {De Leo}, Diego and Demoz, {Gebre Teklemariam} and Kebede Deribe and Dharmaratne, {Samath Dhamminda} and Daniel Diaz and Dinberu, {Mesfin Tadese} and Shirin Djalalinia and Doku, {David Teye} and Manisha Dubey and Eleonora Dubljanin and Duken, {Eyasu Ejeta} and David Edvardsson and Ziad El-Khatib and Matthias Endres and Endries, {Aman Yesuf} and Sharareh Eskandarieh and Alireza Esteghamati and Sadaf Esteghamati and Farzaneh Farhadi and Andre Faro and Farshad Farzadfar and Farzaei, {Mohammad Hosein} and Batool Fatima and Fereshtehnejad, {Seyed Mohammad} and Eduarda Fernandes and Feyissa, {Garumma Tolu} and Irina Filip and Florian Fischer and Takeshi Fukumoto and Morsaleh Ganji and Gankpe, {Fortune Gbetoho} and Garcia-Gordillo, {Miguel A.} and Gebre, {Abadi Kahsu} and Gebremichael, {Teklu Gebrehiwo} and Gelaw, {Belayneh K.} and Geleijnse, {Johanna M.} and Demeke Geremew and Gezae, {Kebede Embaye} and Maryam Ghasemi-Kasman and Gidey, {Mahari Y.} and Gill, {Paramjit Singh} and Gill, {Tiffany K.} and Girma, {Efrata Tufa} and Gnedovskaya, {Elena V.} and Goulart, {Alessandra C.} and Ayman Grada and Giuseppe Grosso and Yuming Guo and Rahul Gupta and Rajeev Gupta and Haagsma, {Juanita A.} and Hagos, {Tekleberhan B.} and Arvin Haj-Mirzaian and Arya Haj-Mirzaian and Hamadeh, {Randah R.} and Samer Hamidi and Hankey, {Graeme J.} and Yuantao Hao and Haro, {Josep Maria} and Hadi Hassankhani and Hassen, {Hamid Yimam} and Rasmus Havmoeller and Hay, {Simon I.} and Hegazy, {Mohamed I.} and Behnam Heidari and Andualem Henok and Fatemeh Heydarpour and Hoang, {Chi Linh} and Hole, {Michael K.} and {Homaie Rad}, Enayatollah and Hosseini, {Seyed Mostafa} and Guoqing Hu and Igumbor, {Ehimario U.} and Ilesanmi, {Olayinka Stephen} and Irvani, {Seyed Sina Naghibi} and Islam, {Sheikh Mohammed Shariful} and Mihajlo Jakovljevic and Mehdi Javanbakht and Jha, {Ravi Prakash} and Jobanputra, {Yash B.} and Jonas, {Jost B.} and Jozwiak, {Jacek Jerzy} and Mikk J{\"u}risson and Amaha Kahsay and Rizwan Kalani and Yogeshwar Kalkonde and Kamil, {Teshome Abegaz} and Tanuj Kanchan and Manoochehr Karami and Andr{\'e} Karch and Narges Karimi and Amir Kasaeian and Kassa, {Tesfaye Dessale} and Kassa, {Zemenu Yohannes} and Anil Kaul and Kefale, {Adane Teshome} and Keiyoro, {Peter Njenga} and Khader, {Yousef Saleh} and Khafaie, {Morteza Abdullatif} and Khalil, {Ibrahim A.} and Khan, {Ejaz Ahmad} and Khang, {Young Ho} and Habibolah Khazaie and Kiadaliri, {Aliasghar A.} and Kiirithio, {Daniel N.} and Kim, {Anthony S.} and Daniel Kim and Kim, {Young Eun} and Kim, {Yun Jin} and Adnan Kisa and Yoshihiro Kokubo and Ai Koyanagi and Krishnamurthi, {Rita V.} and {Kuate Defo}, Barthelemy and {Kucuk Bicer}, Burcu and Manasi Kumar and Ben Lacey and Alessandra Lafranconi and Lansingh, {Van C.} and Arman Latifi and Leshargie, {Cheru Tesema} and Shanshan Li and Yu Liao and Shai Linn and Lo, {Warren David} and Lopez, {Jaifred Christian F.} and Stefan Lorkowski and Renzaho, {Andre M.N.} and {GBD 2016 Neurology Collaborators} and Amanda Thrift",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/S1474-4422(18)30499-X",
language = "English",
volume = "18",
pages = "459--480",
journal = "The Lancet Neurology",
issn = "1474-4422",
publisher = "Elsevier",
number = "5",

}

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016. / GBD 2016 Neurology Collaborators ; Thrift, Amanda.

In: The Lancet Neurology, Vol. 18, No. 5, 01.05.2019, p. 459-480.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Global, regional, and national burden of neurological disorders, 1990–2016

T2 - a systematic analysis for the Global Burden of Disease Study 2016

AU - Feigin, Valery L.

AU - Nichols, Emma

AU - Alam, Tahiya

AU - Bannick, Marlena S.

AU - Beghi, Ettore

AU - Blake, Natacha

AU - Culpepper, William J.

AU - Dorsey, E. Ray

AU - Elbaz, Alexis

AU - Ellenbogen, Richard G.

AU - Fisher, James L.

AU - Fitzmaurice, Christina

AU - Giussani, Giorgia

AU - Glennie, Linda

AU - James, Spencer L.

AU - Johnson, Catherine Owens

AU - Kassebaum, Nicholas J.

AU - Logroscino, Giancarlo

AU - Marin, Benoît

AU - Mountjoy-Venning, W. Cliff

AU - Nguyen, Minh

AU - Ofori-Asenso, Richard

AU - Patel, Anoop P.

AU - Piccininni, Marco

AU - Roth, Gregory A.

AU - Steiner, Timothy J.

AU - Stovner, Lars Jacob

AU - Szoeke, Cassandra E.I.

AU - Theadom, Alice

AU - Vollset, Stein Emil

AU - Wallin, Mitchell Taylor

AU - Wright, Claire

AU - Zunt, Joseph Raymond

AU - Abbasi, Nooshin

AU - Abd-Allah, Foad

AU - Abdelalim, Ahmed

AU - Abdollahpour, Ibrahim

AU - Aboyans, Victor

AU - Abraha, Haftom Niguse

AU - Acharya, Dilaram

AU - Adamu, Abdu A.

AU - Adebayo, Oladimeji M.

AU - Adeoye, Abiodun Moshood

AU - Adsuar, Jose C.

AU - Afarideh, Mohsen

AU - Agrawal, Sutapa

AU - Ahmadi, Alireza

AU - Ahmed, Muktar Beshir

AU - Aichour, Amani Nidhal

AU - Aichour, Ibtihel

AU - Aichour, Miloud Taki Eddine

AU - Akinyemi, Rufus Olusola

AU - Akseer, Nadia

AU - Al-Eyadhy, Ayman

AU - Al-Shahi Salman, Rustam

AU - Alahdab, Fares

AU - Alene, Kefyalew Addis

AU - Aljunid, Syed Mohamed

AU - Altirkawi, Khalid

AU - Alvis-Guzman, Nelson

AU - Anber, Nahla Hamed

AU - Antonio, Carl Abelardo T.

AU - Arabloo, Jalal

AU - Aremu, Olatunde

AU - Ärnlöv, Johan

AU - Asayesh, Hamid

AU - Asghar, Rana Jawad

AU - Atalay, Hagos Tasew

AU - Awasthi, Ashish

AU - Ayala Quintanilla, Beatriz Paulina

AU - Ayuk, Tambe B.

AU - Badawi, Alaa

AU - Banach, Maciej

AU - Banoub, Joseph Adel Mattar

AU - Barboza, Miguel A.

AU - Barker-Collo, Suzanne Lyn

AU - Bärnighausen, Till Winfried

AU - Baune, Bernhard T.

AU - Bedi, Neeraj

AU - Behzadifar, Masoud

AU - Behzadifar, Meysam

AU - Béjot, Yannick

AU - Bekele, Bayu Begashaw

AU - Belachew, Abate Bekele

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Berhane, Adugnaw

AU - Beuran, Mircea

AU - Bhattacharyya, Krittika

AU - Bhutta, Zulfiqar A.

AU - Biadgo, Belete

AU - Bijani, Ali

AU - Bililign, Nigus

AU - Bin Sayeed, Muhammad Shahdaat

AU - Blazes, Christopher Kynrint

AU - Brayne, Carol

AU - Butt, Zahid A.

AU - Campos-Nonato, Ismael R.

AU - Cantu-Brito, Carlos

AU - Car, Mate

AU - Cárdenas, Rosario

AU - Carrero, Juan J.

AU - Carvalho, Félix

AU - Castañeda-Orjuela, Carlos A.

AU - Castro, Franz

AU - Catalá-López, Ferrán

AU - Cerin, Ester

AU - Chaiah, Yazan

AU - Chang, Jung Chen

AU - Chatziralli, Irini

AU - Chiang, Peggy Pei Chia

AU - Christensen, Hanne

AU - Christopher, Devasahayam J.

AU - Cooper, Cyrus

AU - Cortesi, Paolo Angelo

AU - Costa, Vera M.

AU - Criqui, Michael H.

AU - Crowe, Christopher Stephen

AU - Damasceno, Albertino Antonio Moura

AU - Daryani, Ahmad

AU - De la Cruz-Góngora, Vanessa

AU - De la Hoz, Fernando Pio

AU - De Leo, Diego

AU - Demoz, Gebre Teklemariam

AU - Deribe, Kebede

AU - Dharmaratne, Samath Dhamminda

AU - Diaz, Daniel

AU - Dinberu, Mesfin Tadese

AU - Djalalinia, Shirin

AU - Doku, David Teye

AU - Dubey, Manisha

AU - Dubljanin, Eleonora

AU - Duken, Eyasu Ejeta

AU - Edvardsson, David

AU - El-Khatib, Ziad

AU - Endres, Matthias

AU - Endries, Aman Yesuf

AU - Eskandarieh, Sharareh

AU - Esteghamati, Alireza

AU - Esteghamati, Sadaf

AU - Farhadi, Farzaneh

AU - Faro, Andre

AU - Farzadfar, Farshad

AU - Farzaei, Mohammad Hosein

AU - Fatima, Batool

AU - Fereshtehnejad, Seyed Mohammad

AU - Fernandes, Eduarda

AU - Feyissa, Garumma Tolu

AU - Filip, Irina

AU - Fischer, Florian

AU - Fukumoto, Takeshi

AU - Ganji, Morsaleh

AU - Gankpe, Fortune Gbetoho

AU - Garcia-Gordillo, Miguel A.

AU - Gebre, Abadi Kahsu

AU - Gebremichael, Teklu Gebrehiwo

AU - Gelaw, Belayneh K.

AU - Geleijnse, Johanna M.

AU - Geremew, Demeke

AU - Gezae, Kebede Embaye

AU - Ghasemi-Kasman, Maryam

AU - Gidey, Mahari Y.

AU - Gill, Paramjit Singh

AU - Gill, Tiffany K.

AU - Girma, Efrata Tufa

AU - Gnedovskaya, Elena V.

AU - Goulart, Alessandra C.

AU - Grada, Ayman

AU - Grosso, Giuseppe

AU - Guo, Yuming

AU - Gupta, Rahul

AU - Gupta, Rajeev

AU - Haagsma, Juanita A.

AU - Hagos, Tekleberhan B.

AU - Haj-Mirzaian, Arvin

AU - Haj-Mirzaian, Arya

AU - Hamadeh, Randah R.

AU - Hamidi, Samer

AU - Hankey, Graeme J.

AU - Hao, Yuantao

AU - Haro, Josep Maria

AU - Hassankhani, Hadi

AU - Hassen, Hamid Yimam

AU - Havmoeller, Rasmus

AU - Hay, Simon I.

AU - Hegazy, Mohamed I.

AU - Heidari, Behnam

AU - Henok, Andualem

AU - Heydarpour, Fatemeh

AU - Hoang, Chi Linh

AU - Hole, Michael K.

AU - Homaie Rad, Enayatollah

AU - Hosseini, Seyed Mostafa

AU - Hu, Guoqing

AU - Igumbor, Ehimario U.

AU - Ilesanmi, Olayinka Stephen

AU - Irvani, Seyed Sina Naghibi

AU - Islam, Sheikh Mohammed Shariful

AU - Jakovljevic, Mihajlo

AU - Javanbakht, Mehdi

AU - Jha, Ravi Prakash

AU - Jobanputra, Yash B.

AU - Jonas, Jost B.

AU - Jozwiak, Jacek Jerzy

AU - Jürisson, Mikk

AU - Kahsay, Amaha

AU - Kalani, Rizwan

AU - Kalkonde, Yogeshwar

AU - Kamil, Teshome Abegaz

AU - Kanchan, Tanuj

AU - Karami, Manoochehr

AU - Karch, André

AU - Karimi, Narges

AU - Kasaeian, Amir

AU - Kassa, Tesfaye Dessale

AU - Kassa, Zemenu Yohannes

AU - Kaul, Anil

AU - Kefale, Adane Teshome

AU - Keiyoro, Peter Njenga

AU - Khader, Yousef Saleh

AU - Khafaie, Morteza Abdullatif

AU - Khalil, Ibrahim A.

AU - Khan, Ejaz Ahmad

AU - Khang, Young Ho

AU - Khazaie, Habibolah

AU - Kiadaliri, Aliasghar A.

AU - Kiirithio, Daniel N.

AU - Kim, Anthony S.

AU - Kim, Daniel

AU - Kim, Young Eun

AU - Kim, Yun Jin

AU - Kisa, Adnan

AU - Kokubo, Yoshihiro

AU - Koyanagi, Ai

AU - Krishnamurthi, Rita V.

AU - Kuate Defo, Barthelemy

AU - Kucuk Bicer, Burcu

AU - Kumar, Manasi

AU - Lacey, Ben

AU - Lafranconi, Alessandra

AU - Lansingh, Van C.

AU - Latifi, Arman

AU - Leshargie, Cheru Tesema

AU - Li, Shanshan

AU - Liao, Yu

AU - Linn, Shai

AU - Lo, Warren David

AU - Lopez, Jaifred Christian F.

AU - Lorkowski, Stefan

AU - Renzaho, Andre M.N.

AU - GBD 2016 Neurology Collaborators

AU - Thrift, Amanda

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: Bill & Melinda Gates Foundation.

AB - Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: Bill & Melinda Gates Foundation.

UR - http://www.scopus.com/inward/record.url?scp=85064086327&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(18)30499-X

DO - 10.1016/S1474-4422(18)30499-X

M3 - Article

VL - 18

SP - 459

EP - 480

JO - The Lancet Neurology

JF - The Lancet Neurology

SN - 1474-4422

IS - 5

ER -