Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Masayuki Teramoto, Katrin Seeher, Nicoline Schiess, Emma Nichols, Bochen Cao, Chiara Servili, Vanessa Cavallera, Ewerton Cousin, Hailey Hagins, Madeline E Moberg, Max L. Mehlman, Yohannes Abate, Jaffar Abbas, Madineh Abbasi, Mohammadreza Abbasian, Hedayat Abbastabar, Michael Abdelmasseh, Mohammad Abdollahı, Mozhan Abdollahi, Mohammad‐Amin Abdollahifar, Rami Abd‐Rabu, Deldar Morad Abdulah, Auwal Abdullahi, Aidin Abedi, Vida Abedi, Roberto Ariel Abeldaño Zúñiga, Hassan Abidi, Olumide Abiodun, Richard Gyan Aboagye, Hassan Abolhassani, Victor Aboyans, Woldu Aberhe Abrha, Ahmed Abualhasan, Eman Abu‐Gharbieh, Salahdein Aburuz, Lawan Hassan Adamu, Isaac Yeboah Addo, Oladimeji Adebayo, Victor Adekanmbi, Tayo Alex Adekiya, Wirawan Adikusuma, Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Tsion Afework, Aanuoluwapo Adeyimika Afolabi, Ali Afraz, Saira Afzal, Shahin Aghamiri, Antonella Agodi, Williams Agyemang‐Duah, Bright Opoku Ahinkorah, Aqeel Ahmad, Danish Ahmad, Sajjad Ahmad, Amir Mahmoud Ahmadzade, Ali Ahmed, Ayman Ahmed, Haroon Ahmed, Jivan Qasim Ahmed, Luai A. Ahmed, Muktar Beshir Ahmed, Syed Anees Ahmed, Marjan Ajami, Budi Aji, Olufemi Ajumobi, Seyed Esma'il Akade, Morteza Akbari, Hossein Akbarialiabad, Shiva Akhlaghi, Karolina Akinosoglou, Rufus Akinyemi, Maxwell Akonde, Syed Mahfuz Al Hasan, Fares Alahdab, Tareq Mohammed Ali AL-Ahdal, Rasmieh Al‐Amer, Mohammed ALBashtawy, Mohammad T AlBataineh, Khalifah A Aldawsari, Hediyeh Alemi, Sharifullah Alemi, Abdelazeem M. Algammal, Adel Al‐Gheethi, Fadwa Alhalaiqa, Robert Kaba Alhassan, Abid Ali, Endale Alemayehu Ali, Liaqat Ali, Mohammed Usman Ali, Musa Mohammed Ali, Rafat Ali, Shahid Ali, Syed Shujait Ali, Zahid Ali, Sheikh Mohammad Alif, Yousef Alimohamadi, Ahmednur Adem Aliyi, Mohamad Aljofan, Syed Mohamed Aljunid, Suvarna Alladi
Abstract
BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. FUNDING: Bill & Melinda Gates Foundation.