The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990–2019
Gagandeep Singh, Meenakshi Sharma, G Anil Kumar, Nivedita Rao, Kameshwar Prasad, Prashant Mathur, Jeyaraj Pandian, Jaimie D Steinmetz, Atanu Biswas, Pramod Kumar Pal, Sanjay Prakash, PN Sylaja, Emma Nichols, Tarun Dua, Harkiran Kaur, Suvarna Alladi, Vivek Agarwal, Sumit Aggarwal, Atul Ambekar, Bhavani Shankara Bagepally, Tapas Kumar Banerjee, Rose Bender, Sadhana Bhagwat, Stuti Bhargava, Rohit Bhatia, Joy Kumar Chakma, Neerja Chowdhary, Subhojit Dey, M Ashworth Dirac, Valery L. Feigin, Atreyi Ganguli, Mahaveer Golechha, Mandaville Gourie‐Devi, Vinay Goyal, Gaurav Gupta, Prakash C. Gupta, Rajeev Gupta, Gopalkrishna Gururaj, Hemalatha Rajkumar, Panniyammakal Jeemon, Catherine O. Johnson, Pradeep Joshi, Rajni Kant, Amal Kataki, Dheeraj Khurana, Rinu P Krishnankutty, Hmwe Hmwe Kyu, Stephen S Lim, Rakesh Lodha, Rui Ma, Rajesh Malhotra, Ridhima Malhotra, Matthews Mathai, Ravi Mehrotra, U. K. Misra, Parul Mutreja, Mohsen Naghavi, Nitish Naik, Minh Nguyen, Anamika Pandey, Priya Parmar, Arokiasamy Perianayagam, Dorairaj Prabhakaran, Goura Kishor Rath, Nickolas Reinig, Gregory A. Roth, Rajesh Sagar, Mari Jeeva Sankar, K S Shaji, R S Sharma, S. Sharma, Ravinder Singh, M.V. Padma Srivastava, Benjamin Stark, Nikhil Tandon, JS Thakur, Akhil Soman ThekkePurakkal, Sanjeev V. Thomas, Manjari Tripathi, Avina Vongpradith, Han Yong Wunrow, Denis Xavier, Deepak Shukla, K. Srinath Reddy, Samiran Panda, Rakhi Dandona, Christopher J L Murray, Theo Vos, Rupinder Singh Dhaliwal, Lalit Dandona
Abstract
BACKGROUND: A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India. METHODS: Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates. FINDINGS: The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2-5·0) in 1990 to 8·2% (6·6-10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2-0·3) to 0·6% (0·5-0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5-4·8) to 1·1% (0·9-1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9-46·1]), headache disorders (17·5% [3·6-32·5]), epilepsy (11·3% [9·0-14·3]), cerebral palsy (5·7% [4·2-7·7]), and encephalitis (5·3% [3·7-8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution. INTERPRETATION: The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation. FUNDING: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.