Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Valery L. Feigin(University of Washington), Emma Nichols(University of Washington), Shazia Alam(University of Washington), Marlena S. Bannick(University of Washington), Ettore Beghi(University of Washington), Natacha Blake(University of Washington), William J. Culpepper(University of Washington), E. Ray Dorsey(University of Washington), Alexis Elbaz(University of Washington), Richard G. Ellenbogen(University of Washington), James L. Fisher(University of Washington), Christina Fitzmaurice(University of Washington), Giorgia Giussani(University of Washington), Linda Glennie(University of Washington), Spencer L James(University of Washington), Catherine O. Johnson(University of Washington), Nicholas J Kassebaum(University of Washington), Giancarlo Logroscino(University of Washington), Benôıt Marin(University of Washington), W Cliff Mountjoy-Venning(University of Washington), Minh Nguyen(University of Washington), Richard Ofori‐Asenso(University of Washington), Anoop P. Patel(University of Washington), Marco Piccininni(University of Washington), Gregory A. Roth(University of Washington), Timothy J. Steiner(University of Washington), Lars Jacob Stovner(University of Washington), Cassandra Szoeke(University of Washington), Alice Theadom(University of Washington), Stein Emil Vollset(University of Washington), Mitchell T. Wallin(University of Washington), Claire Wright(University of Washington), Joseph R. Zunt(University of Washington), Nooshin Abbasi(University of Washington), Foad Abd-Allah(University of Washington), Ahmed Abdelalim(University of Washington), Ibrahim Abdollahpour(University of Washington), Victor Aboyans(University of Washington), Haftom Niguse Abraha(University of Washington), Dilaram Acharya(University of Washington), Abdu A. Adamu(University of Washington), Oladimeji Adebayo(University of Washington), Abiodun M. Adeoye(University of Washington), José Carmelo Adsuar(University of Washington), Mohsen Afarideh(University of Washington), Sutapa Agrawal(University of Washington), Alireza Ahmadi(University of Washington), Muktar Beshir Ahmed(University of Washington), Amani Nidhal Aichour(University of Washington), Ibtihel Aichour(University of Washington), Miloud Taki Eddine Aichour(University of Washington), Rufus Akinyemi(University of Washington), Nadia Akseer(University of Washington), Ayman Al‐Eyadhy(University of Washington), Rustam Al‐Shahi Salman(University of Washington), Fares Alahdab(University of Washington), Kefyalew Addis Alene(University of Washington), Syed Mohamed Aljunid(University of Washington), Khalid A Altirkawi(University of Washington), Nelson Alvis‐Guzmán(University of Washington), Nahla Anber(University of Washington), Carl Abelardo T. Antonio(University of Washington), Jalal Arabloo(University of Washington), Olatunde Aremu(University of Washington), Johan Ärnlöv(University of Washington), Hamid Asayesh(University of Washington), Rana Jawad Asghar(University of Washington), Hagos Tasew Atalay(University of Washington), Ashish Awasthi(University of Washington), Beatriz Paulina Ayala Quintanilla(University of Washington), Ayuk Betrand Tambe(University of Washington), Alaa Badawi(University of Washington), Maciej Banach(University of Washington), Joseph Adel Mattar Banoub(University of Washington), Miguel A. Barboza(University of Washington), Suzanne Barker‐Collo(University of Washington), Till Bärnighausen(University of Washington), Bernhard T. Baune(University of Washington), Neeraj Bedi(University of Washington), Masoud Behzadifar(University of Washington), Meysam Behzadifar(University of Washington), Yannick Béjot(University of Washington), Bayu Begashaw Bekele(University of Washington), Abate Bekele Belachew(University of Washington), Derrick Bennett(University of Washington), Isabela M. Benseñor(University of Washington), Adugnaw Berhane(University of Washington), Mircea Beuran(University of Washington), Krittika Bhattacharyya(University of Washington), Zulfiqar A Bhutta(University of Washington), Belete Biadgo(University of Washington), Ali Bijani(University of Washington), Nigus Bililign(University of Washington), Muhammad Shahdaat Bin Sayeed(University of Washington), Christopher Kynrint Blazes(University of Washington), Carol Brayne(University of Washington), Zahid A Butt(University of Washington), Ismael Campos‐Nonato(University of Washington), Carlos Cantú‐Brito(University of Washington), Mate Car(University of Washington), Rosario Cárdenas(University of Washington), Juan Jesús Carrero(University of Washington), Félix Carvalho(University of Washington), Carlos A Castañeda-Orjuela(University of Washington), Franz Castro(University of Washington), Ferrán Catalá-López(University of Washington), Ester Cerin(University of Washington), Yazan Chaiah(University of Washington), Jung‐Chen Chang(University of Washington), Irini Chatziralli(University of Washington), Peggy Pei-Chia Chiang(University of Washington), Hanne Christensen(University of Washington), Devasahayam J Christopher(University of Washington), Cyrus Cooper(University of Washington), Paolo Angelo Cortesi(University of Washington), Vera Marisa Costa(University of Washington), Michael H Criqui(University of Washington), Christopher S. Crowe(University of Washington), Albertino Damasceno(University of Washington), Ahmad Daryani(University of Washington), Vanessa De la Cruz‐Góngora(University of Washington), Fernando de la Hoz, Diego De Leo(University of Washington), Gebre Teklemariam Demoz(University of Washington), Kebede Deribe(University of Washington), Samath Dhamminda Dharmaratne(University of Washington), Daniel Díaz(University of Washington), Mesfin Tadese Dinberu(University of Washington), Shirin Djalalinia(University of Washington), David Teye Doku(University of Washington), Manisha Dubey(University of Washington), Eleonora Dubljanin(University of Washington), Eyasu Ejeta Duken(University of Washington), David Edvardsson(University of Washington), Ziad El‐Khatib(University of Washington), Matthias Endres(University of Washington), Aman Yesuf Endries(University of Washington), Sharareh Eskandarieh(University of Washington), Alireza Esteghamati(University of Washington), Sadaf Esteghamati(University of Washington), Farzaneh Farhadi(University of Washington), André Faro(University of Washington), Farshad Farzadfar(University of Washington), Mohammad Hosein Farzaei(University of Washington), Batool Fatima(University of Washington), Seyed‐Mohammad Fereshtehnejad(University of Washington), Eduarda Fernandes(University of Washington), Garumma Tolu Feyissa(University of Washington), Irina Filip(University of Washington), Florian Fischer(University of Washington), Takeshi Fukumoto(University of Washington), Morsaleh Ganji(University of Washington), Fortuné Gbètoho Gankpé(University of Washington), Miguel Ángel García-Gordillo(University of Washington), Abadi Kahsu Gebre(University of Washington), Teklu Gebrehiwo Gebremichael(University of Washington), Belayneh K Gelaw(University of Washington), Johanna M. Geleijnse(University of Washington), Demeke Geremew(University of Washington), Kebede Embaye Gezae(University of Washington), Maryam Ghasemi‐Kasman(University of Washington), Mahari Y Gidey(University of Washington), Paramjit Gill(University of Washington), Tiffany K Gill(University of Washington), Efrata Tufa Girma(University of Washington), E. V. Gnedovskaya(University of Washington), Alessandra C. Goulart(University of Washington), Ayman Grada(University of Washington), Giuseppe Grosso(University of Washington), Yuming Guo(University of Washington), Rahul Gupta(University of Washington), Rajeev Gupta(University of Washington), Juanita A. Haagsma(University of Washington), Tekleberhan B Hagos(University of Washington), Arvin Haj‐Mirzaian(University of Washington), Arya Haj‐Mirzaian(University of Washington), Randah R Hamadeh(University of Washington), Samer Hamidi(University of Washington), Graeme J. Hankey(University of Washington), Yuantao Hao(University of Washington), Josep María Haro(University of Washington), Hadi Hassankhani(University of Washington), Hamid Yimam Hassen(University of Washington), Rasmus Havmoeller(University of Washington), Simon I Hay(University of Washington), Mohamed Hegazy(University of Washington), Behnam Heidari(University of Washington), Andualem Henok(University of Washington), Fatemeh Heydarpour(University of Washington), Chi Linh Hoang(University of Washington), Michael K. Hole(University of Washington), Enayatollah Homaie Rad, Seyed Mostafa Hosseini(University of Washington), Guoqing Hu(University of Washington), Ehimario Igumbor, Olayinka Stephen Ilesanmi(University of Washington), Seyed Sina Naghibi Irvani(University of Washington), Sheikh Mohammed Shariful Islam(University of Washington), Mihajlo Jakovljević(University of Washington), Mehdi Javanbakht(University of Washington), Ravi Prakash Jha(University of Washington), Yash Jobanputra(University of Washington), Jost B. Jonas, Jacek Jerzy Jozwiak(University of Washington), Mikk Jürisson(University of Washington), Amaha Kahsay(University of Washington), Rizwan Kalani(University of Washington), Yogeshwar Kalkonde(University of Washington), Teshome Abegaz Kamil(University of Washington), Tanuj Kanchan(University of Washington), Manoochehr Karami(University of Washington), André Karch(University of Washington), Narges Karimi(University of Washington), Amir Kasaeian(University of Washington), Tesfaye Kassa(University of Washington), Zemenu Yohannes Kassa(University of Washington), Anil Kaul(University of Washington), Adane Teshome Kefale(University of Washington), Peter Njenga Keiyoro(University of Washington), Yousef Khader(University of Washington), Morteza Abdullatif Khafaie(University of Washington), Ibrahim A Khalil(University of Washington), Ejaz Ahmad Khan(University of Washington), Young‐Ho Khang(University of Washington), Habibolah Khazaie(University of Washington), Ali Kiadaliri(University of Washington), Daniel N Kiirithio(University of Washington), Anthony S Kim(University of Washington), Daniel Kim(University of Washington), Young‐Eun Kim(University of Washington), Yun Jin Kim(University of Washington), Adnan Kısa(University of Washington), Yoshihiro Kokubo(University of Washington), Ai Koyanagi(University of Washington), Rita Krishnamurthi, Barthélémy Kuate Defo(University of Washington), Burcu Küçük Biçer(University of Washington), Manasi Kumar(University of Washington), Ben Lacey(University of Washington), Alessandra Lafranconi(University of Washington), Van Charles Lansingh(University of Washington), Arman Latifi(University of Washington), Cheru Tesema Leshargie(University of Washington), Shanshan Li(University of Washington), Yu Liao(University of Washington), Shai Linn(University of Washington), Warren Lo(University of Washington), Alan D Lopez(University of Washington), Stefan Lorkowski(University of Washington), Paulo A. Lotufo(University of Washington), Robyn Lucas(University of Washington), Raimundas Lunevičius(University of Washington), Mark T. Mackay(University of Washington), Narayan Bahadur Mahotra(University of Washington), Marek Majdán(University of Washington), Reza Majdzadeh(University of Washington), Azeem Majeed(University of Washington), Reza Malekzadeh(University of Washington), Déborah Carvalho Malta(University of Washington), Navid Manafi(University of Washington), Mohammad Alì Mansournia, LG Mantovani(University of Washington), Winfried März(University of Washington), Tivani P. Mashamba-Thompson(University of Washington), Benjamin B. Massenburg(University of Washington), Kedar Mate, Colm McAlinden, John J. McGrath, Varshil Mehta, Toni Meier(University of Washington), Hagazi Gebre Meles, Addisu Melese, Peter Memiah, Ziad A. Memish(University of Washington), Walter Mendoza, Desalegn Tadese Mengistu, Getnet Mengistu, Atte Meretoja, Tuomo J Meretoja, Tomislav Meštrović, Bartosz Miazgowski, Tomasz Miazgowski, Ted R. Miller, GK Mini, Erkin М Мirrakhimov, Babak Moazen, Bahram Mohajer, Naser Mohammad Gholi Mezerji, Moslem Mohammadi, Maryam Mohammadi‐Khanaposhtani(University of Washington), Roghayeh Mohammadibakhsh, Mousa Mohammadnia‐Afrouzi, Shafiu Mohammed(University of Washington), Farnam Mohebi, Ali H. Mokdad, Lorenzo Monasta(University of Washington), Stefania Mondello, Yoshan Moodley, Mahmood Moosazadeh, Ghobad Moradi, Maziar Moradi‐Lakeh, Mehdi Moradinazar(University of Washington), Paula Moraga, Ilais Moreno Velásquez, Shane D. Morrison, Seyyed Meysam Mousavi, Oumer Sada Muhammed, Walter Muruet-Gutierrez, Kamarul Imran Musa, Ghulam Mustafa, Mehdi Naderi(University of Washington), Gabriele Nagel(University of Washington), Aliya Naheed, Gurudatta Naik, Farid Najafi(University of Washington), Vinay Nangia, Ionuţ Negoi, Ruxandra Irina Negoi, Charles R. Newton, Josephine W Ngunjiri, Cuong Tat Nguyen(University of Washington), Long Hoang Nguyen(University of Washington), Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Molly R Nixon, Bo Norrving(University of Washington), Jean Jacques Noubiap, Malihe Nourollahpour Shiadeh, Peter S. Nyasulu, Okechukwu S. Ogah, In‐Hwan Oh(University of Washington), Andrew T Olagunju, Tinuke O Olagunju, Pedro R. Olivares, Obinna Onwujekwe, Eyal Oren(University of Washington), Mayowa Owolabi, P A Mahesh(University of Washington), Amir H. Pakpour, Wen-Harn Pan, Songhomitra Panda‐Jonas, Jeyaraj Pandian, Sangram Kishor Patel(University of Washington), David M. Pereira, Max Petzold, Julian David Pillay, М. А. Пирадов(University of Washington), Guilherme V. Polanczyk, Suzanne Polinder(University of Washington), Maarten J. Postma, Richie Poulton, Hossein Poustchi(University of Washington), Swayam Prakash(University of Washington), V. Prakash(University of Washington), Mostafa Qorbani(University of Washington), Amir Radfar(University of Washington), Anwar Rafay, Alireza Rafiei(University of Washington), Fakher Rahim(University of Washington), Vafa Rahimi‐Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, Fatemeh Rajati(University of Washington), Usha Ram(University of Washington), Annemarei Ranta(University of Washington), David Laith Rawaf, Salman Rawaf, Nickolas Reinig, Cesar Reis, André M. N. Renzaho, Serge Resnikoff, Shahab Rezaeian, Mohammad Sadegh Rezai, Carlos Miguel Ríos-González, Nicholas L S Roberts, Leonardo Roever, Luca Ronfani(University of Washington), Elias Merdassa Roro, Gholamreza Roshandel, Ali Rostami(University of Washington), Parisa Sabbagh, Ralph L. Sacco, Perminder S. Sachdev, Basema Saddik, Hosein Safari, Roya Safari‐Faramani, Sare Safi, Saeid Safiri, Rajesh Sagar, Ramesh Sahathevan, Amirhossein Sahebkar, Mohammad Ali Sahraian, Payman Salamati, Saleh Salehi Zahabi(University of Washington), Yahya Salimi, Abdallah M Samy, Juan Sanabria(University of Washington), Itamar S Santos, Milena M Santric-Milicevic, Nizal Sarrafzadegan, Benn Sartorius(University of Washington), Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy, Arundhati R Sawant, Monika Sawhney, Ione Jayce Ceola Schneider, Ben Schöttker(University of Washington), David C. Schwebel, Soraya Seedat, Sadaf G Sepanlou, Hosein Shabaninejad, Azadeh Shafieesabet, Masood Ali Shaikh, Raad Shakir, Mehran Shams-Beyranvand, Morteza Shamsizadeh(University of Washington), Mehdi Sharif(University of Washington), Mahdi Sharif-Alhoseini, Jun She(University of Washington), Aziz Sheikh, Kevin N. Sheth, Mika Shigematsu(University of Washington), Rahman Shiri(University of Washington), Reza Shirkoohi(University of Washington), Ivy Shiue, Soraya Siabani, Tariq Jamal Siddiqi, Inga Dóra Sigfúsdóttir, Rannveig Sigurvinsdóttir, Donald H. Silberberg, João Pedro Silva, Dayane Gabriele Alves Silveira, Jasvinder A. Singh(University of Washington), Dhirendra Narain Sinha, Eirini Skiadaresi, Mari Smith(University of Washington), Badr Hasan Sobaih, Soheila Sobhani, Moslem Soofi, Ireneous N Soyiri, Luciano A. Sposato, Dan J. Stein(University of Washington), Murray B. Stein(University of Washington), Mark A. Stokes(University of Washington), Mu’awiyyah Babale Sufiyan, Bryan L. Sykes, PN Sylaja, Rafael Tabarés‐Seisdedos, Braden Te Ao, Arash Tehrani‐Banihashemi, Mohamad‐Hani Temsah, Omar Temsah, Jarnail Singh Thakur, Amanda G. Thrift, Roman Topór-Mądry, Miguel Tortajada‐Girbés(University of Washington), Marcos Roberto Tovani‐Palone, Bach Xuan Tran, Khanh Bao Tran, Thomas Clement Truelsen, Afewerki Gebremeskel Tsadik, Lorainne Tudor Car, Kingsley Nnanna Ukwaja, Irfan Ullah, Muhammad Usman, Olalekan A. Uthman, Pascual Valdéz, Tommi Vasankari, Vasanthan Rajagopalan, Yousef Veisani(University of Washington), Narayanaswamy Venketasubramanian, Francesco Saverio Violante, Vasily Vlassov, Kia Vosoughi(University of Washington), Giang Thu Vu, Isidora S Vujcic, Fasil Shiferaw Wagnew, Yasir Waheed, Yuan‐Pang Wang, Elisabete Weiderpass, Jordan Weiss, Harvey Whiteford, Tissa Wijeratne, Andrea Sylvia Winkler, Charles Shey Wiysonge, Charles Wolfe, Gelin Xu, Ali Yadollahpour(University of Washington), Tomohide Yamada, Yuichiro Yano, Mehdi Yaseri(University of Washington), Hiroshi Yatsuya, Ebrahim M Yimer, Paul Yip(University of Washington), Engida Yisma, Naohiro Yonemoto, Mahmoud Yousefifard, Chuanhua Yu(University of Washington), Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani(University of Washington), Hamed Zandian(University of Washington), Zohreh Zare, Yunquan Zhang, Sanjay Zodpey, Mohsen Naghavi(University of Washington), Christopher J L Murray, Theo Vos(University of Washington)
Cited by 5,660Open Access
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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