Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Authors: Valery L Feigin, Emma Nichols, Tahiya Alam, Marlena S Bannick, Ettore Beghi, Natacha Blake, William J Culpepper, E Ray Dorsey, Alexis Elbaz, Richard G Ellenbogen, James L Fisher, Christina Fitzmaurice, Giorgia Giussani, Linda Glennie, Spencer L James, Catherine Owens Johnson, Nicholas J Kassebaum, Giancarlo Logroscino, Benoît Marin, W Cliff Mountjoy-Venning, Minh Nguyen, Richard Ofori-Asenso, Anoop P Patel, Marco Piccininni, Gregory A Roth, Timothy J Steiner, Lars Jacob Stovner, Cassandra E I Szoeke, Alice Theadom, Stein Emil Vollset, Mitchell Taylor Wallin, Claire Wright, Joseph Raymond Zunt, Nooshin Abbasi, Foad Abd-Allah, Ahmed Abdelalim, Ibrahim Abdollahpour, Victor Aboyans, Haftom Niguse Abraha, Dilaram Acharya, Abdu A Adamu, Oladimeji M Adebayo, Abiodun Moshood Adeoye, Jose C Adsuar, Mohsen Afarideh, Sutapa Agrawal, Alireza Ahmadi, Muktar Beshir Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Rufus Olusola Akinyemi, Nadia Akseer, Ayman Al-Eyadhy, Rustam Al-Shahi Salman, Fares Alahdab, Kefyalew Addis Alene, Syed Mohamed Aljunid, Khalid Altirkawi, Nelson Alvis-Guzman, Nahla Hamed Anber, Carl Abelardo T Antonio, Jalal Arabloo, Olatunde Aremu, Johan Ärnlöv, Hamid Asayesh, Rana Jawad Asghar, Hagos Tasew Atalay, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Tambe B Ayuk, Alaa Badawi, Maciej Banach, Joseph Adel Mattar Banoub, Miguel A Barboza, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Bernhard T Baune, Neeraj Bedi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Abate Bekele Belachew, Derrick A Bennett, Isabela M Bensenor, Adugnaw Berhane, Mircea Beuran, Krittika Bhattacharyya, Zulfiqar A Bhutta, Belete Biadgo, Ali Bijani, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Christopher Kynrint Blazes, Carol Brayne, Zahid A Butt, Ismael R Campos-Nonato, Carlos Cantu-Brito, Mate Car, Rosario Cárdenas, Juan J Carrero, Félix Carvalho, Carlos A Castañeda-Orjuela, Franz Castro, Ferrán Catalá-López, Ester Cerin, Yazan Chaiah, Jung-Chen Chang, Irini Chatziralli, Peggy Pei-Chia Chiang, Hanne Christensen, Devasahayam J Christopher, Cyrus Cooper, Paolo Angelo Cortesi, Vera M Costa, Michael H Criqui, Christopher Stephen Crowe, Albertino Antonio Moura Damasceno, Ahmad Daryani, Vanessa De la Cruz-Góngora, Fernando Pio De la Hoz, Diego De Leo, Gebre Teklemariam Demoz, Kebede Deribe, Samath Dhamminda Dharmaratne, Daniel Diaz, Mesfin Tadese Dinberu, Shirin Djalalinia, David Teye Doku, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, David Edvardsson, Ziad El-Khatib, Matthias Endres, Aman Yesuf Endries, Sharareh Eskandarieh, Alireza Esteghamati, Sadaf Esteghamati, Farzaneh Farhadi, Andre Faro, Farshad Farzadfar, Mohammad Hosein Farzaei, Batool Fatima, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Garumma Tolu Feyissa, Irina Filip, Florian Fischer, Takeshi Fukumoto, Morsaleh Ganji, Fortune Gbetoho Gankpe, Miguel A Garcia-Gordillo, Abadi Kahsu Gebre, Teklu Gebrehiwo Gebremichael, Belayneh K Gelaw, Johanna M Geleijnse, Demeke Geremew, Kebede Embaye Gezae, Maryam Ghasemi-Kasman, Mahari Y Gidey, Paramjit Singh Gill, Tiffany K Gill, Efrata Tufa Girma, Elena V Gnedovskaya, Alessandra C Goulart, Ayman Grada, Giuseppe Grosso, Yuming Guo, Rahul Gupta, Rajeev Gupta, Juanita A Haagsma, Tekleberhan B Hagos, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Randah R Hamadeh, Samer Hamidi, Graeme J Hankey, Yuantao Hao, Josep Maria Haro, Hadi Hassankhani, Hamid Yimam Hassen, Rasmus Havmoeller, Simon I Hay, Mohamed I Hegazy, Behnam Heidari, Andualem Henok, Fatemeh Heydarpour, Chi Linh Hoang, Michael K Hole, Enayatollah Homaie Rad, Seyed Mostafa Hosseini, Guoqing Hu, Ehimario U Igumbor, Olayinka Stephen Ilesanmi, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Mihajlo Jakovljevic, Mehdi Javanbakht, Ravi Prakash Jha, Yash B Jobanputra, Jost B Jonas, Jacek Jerzy Jozwiak, Mikk Jürisson, Amaha Kahsay, Rizwan Kalani, Yogeshwar Kalkonde, Teshome Abegaz Kamil, Tanuj Kanchan, Manoochehr Karami, André Karch, Narges Karimi, Amir Kasaeian, Tesfaye Dessale Kassa, Zemenu Yohannes Kassa, Anil Kaul, Adane Teshome Kefale, Peter Njenga Keiyoro, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Ibrahim A Khalil, Ejaz Ahmad Khan, Young-Ho Khang, Habibolah Khazaie, Aliasghar A Kiadaliri, Daniel N Kiirithio, Anthony S Kim, Daniel Kim, Young-Eun Kim, Yun Jin Kim, Adnan Kisa, Yoshihiro Kokubo, Ai Koyanagi, Rita V Krishnamurthi, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Manasi Kumar, Ben Lacey, Alessandra Lafranconi, Van C Lansingh, Arman Latifi, Cheru Tesema Leshargie, Shanshan Li, Yu Liao, Shai Linn, Warren David Lo, Jaifred Christian F Lopez, Stefan Lorkowski, Paulo A Lotufo, Robyn M Lucas, Raimundas Lunevicius, Mark T Mackay, Narayan Bahadur Mahotra, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Navid Manafi, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Winfried März, Tivani Phosa Mashamba-Thompson, Benjamin Ballard Massenburg, Kedar K V Mate, Colm McAlinden, John J McGrath, Varshil Mehta, Toni Meier, Hagazi Gebre Meles, Addisu Melese, Peter T N Memiah, Ziad A Memish, Walter Mendoza, Desalegn Tadese Mengistu, Getnet Mengistu, Atte Meretoja, Tuomo J Meretoja, Tomislav Mestrovic, Bartosz Miazgowski, Tomasz Miazgowski, Ted R Miller, GK Mini, Erkin M Mirrakhimov, Babak Moazen, Bahram Mohajer, Naser Mohammad Gholi Mezerji, Moslem Mohammadi, Maryam Mohammadi-Khanaposhtani, Roghayeh Mohammadibakhsh, Mousa Mohammadnia-Afrouzi, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Lorenzo Monasta, Stefania Mondello, Yoshan Moodley, Mahmood Moosazadeh, Ghobad Moradi, Maziar Moradi-Lakeh, Mehdi Moradinazar, Paula Moraga, Ilais Moreno Velásquez, Shane Douglas Morrison, Seyyed Meysam Mousavi, Oumer Sada Muhammed, Walter Muruet, Kamarul Imran Musa, Ghulam Mustafa, Mehdi Naderi, Gabriele Nagel, Aliya Naheed, Gurudatta Naik, Farid Najafi, Vinay Nangia, Ionut Negoi, Ruxandra Irina Negoi, Charles Richard James Newton, Josephine W Ngunjiri, Cuong Tat Nguyen, Long Hoang Nguyen, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Molly R Nixon, Bo Norrving, Jean Jacques Noubiap, Malihe Nourollahpour Shiadeh, Peter S Nyasulu, Okechukwu Samuel Ogah, In-Hwan Oh, Andrew T Olagunju, Tinuke O Olagunju, Pedro R Olivares, Obinna E Onwujekwe, Eyal Oren, Mayowa Ojo Owolabi, Mahesh PA, Amir H Pakpour, Wen-Harn Pan, Songhomitra Panda-Jonas, Jeyaraj Durai Pandian, Sangram Kishor Patel, David M Pereira, Max Petzold, Julian David Pillay, Michael A Piradov, Guilherme V Polanczyk, Suzanne Polinder, Maarten J Postma, Richie Poulton, Hossein Poustchi, Swayam Prakash, V Prakash, Mostafa Qorbani, Amir Radfar, Anwar Rafay, Alireza Rafiei, Fakher Rahim, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, Fatemeh Rajati, Usha Ram, Anna Ranta, David Laith Rawaf, Salman Rawaf, Nickolas Reinig, Cesar Reis, Andre M N Renzaho, Serge Resnikoff, Shahab Rezaeian, Mohammad Sadegh Rezai, Carlos Miguel Rios González, Nicholas L S Roberts, Leonardo Roever, Luca Ronfani, Elias Merdassa Roro, Gholamreza Roshandel, Ali Rostami, 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, Yahya Salimi, Abdallah M Samy, Juan Sanabria, Itamar S Santos, Milena M Santric Milicevic, Nizal Sarrafzadegan, Benn Sartorius, Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy, Arundhati R Sawant, Monika Sawhney, Ione J C Schneider, Ben Schöttker, David C Schwebel, Soraya Seedat, Sadaf G Sepanlou, Hosein Shabaninejad, Azadeh Shafieesabet, Masood Ali Shaikh, Raad A Shakir, Mehran Shams-Beyranvand, Morteza Shamsizadeh, Mehdi Sharif, Mahdi Sharif-Alhoseini, Jun She, Aziz Sheikh, Kevin N Sheth, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Ivy Shiue, Soraya Siabani, Tariq J Siddiqi, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, Donald H Silberberg, João Pedro Silva, Dayane Gabriele Alves Silveira, Jasvinder A Singh, Dhirendra Narain Sinha, Eirini Skiadaresi, Mari Smith, Badr Hasan Sobaih, Soheila Sobhani, Moslem Soofi, Ireneous N Soyiri, Luciano A Sposato, Dan J Stein, Murray B Stein, Mark A Stokes, Mu'awiyyah Babale Sufiyan, Bryan L Sykes, PN Sylaja, Rafael Tabarés-Seisdedos, Braden James Te Ao, Arash Tehrani-Banihashemi, Mohamad-Hani Temsah, Omar Temsah, Jarnail Singh Thakur, Amanda G Thrift, Roman Topor-Madry, Miguel Tortajada-Girbés, 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 Shariq Usman, Olalekan A Uthman, Pascual R Valdez, Tommi Juhani Vasankari, Rajagopalan Vasanthan, Yousef Veisani, Narayanaswamy Venketasubramanian, Francesco S Violante, Vasily Vlassov, Kia Vosoughi, Giang Thu Vu, Isidora S Vujcic, Fasil Shiferaw Wagnew, Yasir Waheed, Yuan-Pang Wang, Elisabete Weiderpass, Jordan Weiss, Harvey A Whiteford, Tissa Wijeratne, Andrea Sylvia Winkler, Charles Shey Wiysonge, Charles D A Wolfe, Gelin Xu, Ali Yadollahpour, Tomohide Yamada, Yuichiro Yano, Mehdi Yaseri, Hiroshi Yatsuya, Ebrahim M Yimer, Paul Yip, Engida Yisma, Naohiro Yonemoto, Mahmoud Yousefifard, Chuanhua Yu, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Hamed Zandian, Zohreh Zare, Yunquan Zhang, Sanjay Zodpey, Mohsen Naghavi, Christopher J L Murray, Theo Vos
Journal: The Lancet Neurology (2019)

<h2>Summary</h2><h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Findings</h3> 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). <h3>Interpretation</h3> 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. <h3>Funding</h3> Bill & Melinda Gates Foundation.