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Lancet Neurol. 2019 May;18(5):459-480. doi: 10.1016/S1474-4422(18)30499-X. Epub 2019 Mar 14.

Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Collaborators (510)

Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N, Culpepper WJ, Dorsey ER, Elbaz A, Ellenbogen RG, Fisher JL, Fitzmaurice C, Giussani G, Glennie L, James SL, Johnson CO, Kassebaum NJ, Logroscino G, Marin B, Mountjoy-Venning WC, Nguyen M, Ofori-Asenso R, Patel AP, Piccininni M, Roth GA, Steiner TJ, Stovner LJ, Szoeke CEI, Theadom A, Vollset SE, Wallin MT, Wright C, Zunt JR, Abbasi N, Abd-Allah F, Abdelalim A, Abdollahpour I, Aboyans V, Abraha HN, Acharya D, Adamu AA, Adebayo OM, Adeoye AM, Adsuar JC, Afarideh M, Agrawal S, Ahmadi A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemi RO, Akseer N, Al-Eyadhy A, Al-Shahi Salman R, Alahdab F, Alene KA, Aljunid SM, Altirkawi K, Alvis-Guzman N, Anber NH, Antonio CAT, Arabloo J, Aremu O, Ärnlöv J, Asayesh H, Asghar RJ, Atalay HT, Awasthi A, Ayala Quintanilla BP, Ayuk TB, Badawi A, Banach M, Banoub JAM, Barboza MA, Barker-Collo SL, Bärnighausen TW, Baune BT, Bedi N, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Bennett DA, Bensenor IM, Berhane A, Beuran M, Bhattacharyya K, Bhutta ZA, Biadgo B, Bijani A, Bililign N, Bin Sayeed MS, Blazes CK, Brayne C, Butt ZA, Campos-Nonato IR, Cantu-Brito C, Car M, Cárdenas R, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castro F, Catalá-López F, Cerin E, Chaiah Y, Chang JC, Chatziralli I, Chiang PP, Christensen H, Christopher DJ, Cooper C, Cortesi PA, Costa VM, Criqui MH, Crowe CS, Damasceno AAM, Daryani A, De la Cruz-Góngora V, De la Hoz FP, De Leo D, Demoz GT, Deribe K, Dharmaratne SD, Diaz D, Dinberu MT, Djalalinia S, Doku DT, Dubey M, Dubljanin E, Duken EE, Edvardsson D, El-Khatib Z, Endres M, Endries AY, Eskandarieh S, Esteghamati A, Esteghamati S, Farhadi F, Faro A, Farzadfar F, Farzaei MH, Fatima B, Fereshtehnejad SM, Fernandes E, Feyissa GT, Filip I, Fischer F, Fukumoto T, Ganji M, Gankpe FG, Garcia-Gordillo MA, Gebre AK, Gebremichael TG, Gelaw BK, Geleijnse JM, Geremew D, Gezae KE, Ghasemi-Kasman M, Gidey MY, Gill PS, Gill TK, Girma ET, Gnedovskaya EV, Goulart AC, Grada A, Grosso G, Guo Y, Gupta R, Gupta R, Haagsma JA, Hagos TB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Hankey GJ, Hao Y, Haro JM, Hassankhani H, Hassen HY, Havmoeller R, Hay SI, Hegazy MI, Heidari B, Henok A, Heydarpour F, Hoang CL, Hole MK, Homaie Rad E, Hosseini SM, Hu G, Igumbor EU, Ilesanmi OS, Irvani SSN, Islam SMS, Jakovljevic M, Javanbakht M, Jha RP, Jobanputra YB, Jonas JB, Jozwiak JJ, Jürisson M, Kahsay A, Kalani R, Kalkonde Y, Kamil TA, Kanchan T, Karami M, Karch A, Karimi N, Kasaeian A, Kassa TD, Kassa ZY, Kaul A, Kefale AT, Keiyoro PN, Khader YS, Khafaie MA, Khalil IA, Khan EA, Khang YH, Khazaie H, Kiadaliri AA, Kiirithio DN, Kim AS, Kim D, Kim YE, Kim YJ, Kisa A, Kokubo Y, Koyanagi A, Krishnamurthi RV, Kuate Defo B, Kucuk Bicer B, Kumar M, Lacey B, Lafranconi A, Lansingh VC, Latifi A, Leshargie CT, Li S, Liao Y, Linn S, Lo WD, Lopez JCF, Lorkowski S, Lotufo PA, Lucas RM, Lunevicius R, Mackay MT, Mahotra NB, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Manafi N, Mansournia MA, Mantovani LG, März W, Mashamba-Thompson TP, Massenburg BB, Mate KKV, McAlinden C, McGrath JJ, Mehta V, Meier T, Meles HG, Melese A, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Miller TR, Mini GK, Mirrakhimov EM, Moazen B, Mohajer B, Mohammad Gholi Mezerji N, Mohammadi M, Mohammadi-Khanaposhtani M, Mohammadibakhsh R, Mohammadnia-Afrouzi M, Mohammed S, Mohebi F, Mokdad AH, Monasta L, Mondello S, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Moreno Velásquez I, Morrison SD, Mousavi SM, Muhammed OS, Muruet W, Musa KI, Mustafa G, Naderi M, Nagel G, Naheed A, Naik G, Najafi F, Nangia V, Negoi I, Negoi RI, Newton CRJ, Ngunjiri JW, Nguyen CT, Nguyen LH, Ningrum DNA, Nirayo YL, Nixon MR, Norrving B, Noubiap JJ, Nourollahpour Shiadeh M, Nyasulu PS, Ogah OS, Oh IH, Olagunju AT, Olagunju TO, Olivares PR, Onwujekwe OE, Oren E, Owolabi MO, Pa M, Pakpour AH, Pan WH, Panda-Jonas S, Pandian JD, Patel SK, Pereira DM, Petzold M, Pillay JD, Piradov MA, Polanczyk GV, Polinder S, Postma MJ, Poulton R, Poustchi H, Prakash S, Prakash V, Qorbani M, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rajati F, Ram U, Ranta A, Rawaf DL, Rawaf S, Reinig N, Reis C, Renzaho AMN, Resnikoff S, Rezaeian S, Rezai MS, Rios González CM, Roberts NLS, Roever L, Ronfani L, Roro EM, Roshandel G, Rostami A, Sabbagh P, Sacco RL, Sachdev PS, Saddik B, Safari H, Safari-Faramani R, Safi S, Safiri S, Sagar R, Sahathevan R, Sahebkar A, Sahraian MA, Salamati P, Salehi Zahabi S, Salimi Y, Samy AM, Sanabria J, Santos IS, Santric Milicevic MM, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Schneider IJC, Schöttker B, Schwebel DC, Seedat S, Sepanlou SG, Shabaninejad H, Shafieesabet A, Shaikh MA, Shakir RA, Shams-Beyranvand M, Shamsizadeh M, Sharif M, Sharif-Alhoseini M, She J, Sheikh A, Sheth KN, Shigematsu M, Shiri R, Shirkoohi R, Shiue I, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silberberg DH, Silva JP, Silveira DGA, Singh JA, Sinha DN, Skiadaresi E, Smith M, Sobaih BH, Sobhani S, Soofi M, Soyiri IN, Sposato LA, Stein DJ, Stein MB, Stokes MA, Sufiyan MB, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Te Ao BJ, Tehrani-Banihashemi A, Temsah MH, Temsah O, Thakur JS, Thrift AG, Topor-Madry R, Tortajada-Girbés M, Tovani-Palone MR, Tran BX, Tran KB, Truelsen TC, Tsadik AG, Tudor Car L, Ukwaja KN, Ullah I, Usman MS, Uthman OA, Valdez PR, Vasankari TJ, Vasanthan R, Veisani Y, Venketasubramanian N, Violante FS, Vlassov V, Vosoughi K, Vu GT, Vujcic IS, Wagnew FS, Waheed Y, Wang YP, Weiderpass E, Weiss J, Whiteford HA, Wijeratne T, Winkler AS, Wiysonge CS, Wolfe CDA, Xu G, Yadollahpour A, Yamada T, Yano Y, Yaseri M, Yatsuya H, Yimer EM, Yip P, Yisma E, Yonemoto N, Yousefifard M, Yu C, Zaidi Z, Zaman SB, Zamani M, Zandian H, Zare Z, Zhang Y, Zodpey S, Naghavi M, Murray CJL, Vos T.

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.

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