Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Steinmetz, J. D., Seeher, K. M., Schiess, N. , Nichols, E., Cao, B., Servili, C., Cavallera, V., Cousin, E., Hagins, H., Moberg, M. E., Mehlman, M. L., Abate, Y. H., Abbas, J., Abbasi, M. A., Abbasian, M., Abbastabar, H., Abdelmasseh, M., Abdollahi, M., Abdollahi, M., Abdollahifar, M-A., Abd-Rabu, R., Abdulah, D. M., Abdullahi, A., Abedi, A., Abedi, V., Abeldaño Zuñiga, R. A., Abidi, H., Abiodun, O., Aboagye, R. G., Abolhassani, H., Aboyans, V., Abrha, W. A., Abualhasan, A., Abu-Gharbieh, E., Aburuz, S., Adamu, L. H., Addo, I. Y., Adebayo, O. M., Adekanmbi, V., Adekiya, T. A., Adikusuma, W., Adnani, Q. E. S., Adra, S., Afework, T., Afolabi, A. A., Afraz, A., Afzal, S., Aghamiri, S., Agodi, A., Agyemang-Duah, W., Ahinkorah, B. O., Ahmad, A., Ahmad, D., Ahmad, S., Ahmadzade, A. M., Ahmed, A., Ahmed, A., Ahmed, H., Ahmed, J. Q., Ahmed, L. A., Ahmed, M. B., Ahmed, S. A., Ajami, M., Aji, B., Ajumobi, O., Akade, S. E., Akbari, M., Akbarialiabad, H., Akhlaghi, S., Akinosoglou, K., Akinyemi, R. O., Akonde, M., Al Hasan, S. M., Alahdab, F., AL-Ahdal, T. M. A., Al-amer, R. M., Albashtawy, M., AlBataineh, M. T., Aldawsari, K. A., Alemi, H., Alemi, S., Algammal, A. M., Al-Gheethi, A. A. S., Alhalaiqa, F. A. N., Alhassan, R. K., Ali, A., Ali, E. A., Ali, L., Ali, M. U., Ali, M. M., Ali, R., Ali, S., Ali, S. S. S., Ali, Z., Alif, S. M., Alimohamadi, Y., Aliyi, A. A., Aljofan, M., Aljunid, S. M., Alladi, S., Almazan, J. U., Almustanyir, S., Al-Omari, B., Alqahtani, J. S., Alqasmi, I., Alqutaibi, A. Y., Al-Shahi Salman, R., Altaany, Z., Al-Tawfiq, J. A., Altirkawi, K. A., Alvis-Guzman, N., Al-Worafi, Y. M., Aly, H., Aly, S., Alzoubi, K. H., Amani, R., Amindarolzarbi, A., Amiri, S., Amirzade-Iranaq, M. H., Amu, H., Amugsi, D. A., Amusa, G. A., Amzat, J., Ancuceanu, R., Anderlini, D., Anderson, D. B., Andrei, C. L., Androudi, S., Angappan, D., Angesom, T. W., Anil, A., Ansari-Moghaddam, A., Anwer, R., Arafat, M., Aravkin, A. Y., Areda, D., Ariffin, H., Arifin, H., Arkew, M., Ärnlöv, J., Arooj, M., Artamonov, A. A., Artanti, K. D., Aruleba, R. T., Asadi-Pooya, A. A., Asena, T. F., Asghari-Jafarabadi, M., Ashraf, M., Ashraf, T., Atalell, K. A., Athari, S. S., Atinafu, B. T. T., Atorkey, P., Atout, M. M. W., Atreya, A., Aujayeb, A., Avan, A., Ayala Quintanilla, B. P., Ayatollahi, H., Ayinde, O. O., Ayyoubzadeh, S. M., Azadnajafabad, S., Azizi, Z., Azizian, K., Azzam, A. Y., Babaei, M., Badar, M., Badiye, A. D., Baghdadi, S., Bagherieh, S., Bai, R., Baig, A. A., Balakrishnan, S., Balalla, S., Baltatu, O. C., Banach, M., Bandyopadhyay, S., Banerjee, I., Baran, M. F., Barboza, M. A., Barchitta, M., Bardhan, M., Barker-Collo, S. L., Bärnighausen, T. W., Barrow, A., Bashash, D., Bashiri, H., Bashiru, H. A., Basiru, A., Basso, J. D., Basu, S., Batiha, A-M. M., Batra, K., Baune, B. T., Bedi, N., Begde, A., Begum, T., Behnam, B., Behnoush, A. H., Beiranvand, M., Béjot, Y., Bekele, A., Belete, M. A., Belgaumi, U. I., Bemanalizadeh, M., Bender, R. G., Benfor, B., Bennett, D. A., Bensenor, I. M., Berice, B., Bettencourt, P. J. G., Beyene, K. A., Bhadra, A., Bhagat, D. S., Bhangdia, K., Bhardwaj, N., Bhardwaj, P., Bhargava, A., Bhaskar, S., Bhat, A. N., Bhat, V., Bhatti, G. K., Bhatti, J. S., Bhatti, R., Bijani, A., Bikbov, B., Bilalaga, M. M., Biswas, A., Bitaraf, S., Bitra, V. R., Bjørge, T., Bodolica, V., Bodunrin, A. O., Boloor, A., Braithwaite, D., Brayne, C., Brenner, H., Briko, A., Bringas Vega, M. L., Brown, J., Budke, C. M., Buonsenso, D., Burkart, K., Burns, R. A., Bustanji, Y., Butt, M. H., Butt, N. S., Butt, Z. A., Cabral, L. S., Caetano dos Santos, F. L., Calina, D., Campos-Nonato, I. R., Cao, C., Carabin, H., Cárdenas, R., Carreras, G., Carvalho, A. F., Castañeda-Orjuela, C. A., Casulli, A., Catalá-López, F., Catapano, A. L., Caye, A., Cegolon, L., Cenderadewi, M., Cerin, E., Chacón-Uscamaita, P. R. U., Chan, J. 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M., Garg, N., Gau, S-Y., Gautam, R. K., Gebre, T., Gebrehiwot, M., Gebremeskel, G. G., Gebreslassie, H. G., Getacher, L., Ghaderi Yazdi, B., Ghadirian, F., Ghaffarpasand, F., Ghanbari, R., Ghasemi, M., Ghazy, R. M., Ghimire, S., Gholami, A., Gholamrezanezhad, A., Ghotbi, E., Ghozy, S., Gialluisi, A., Gill, P. S., Glasstetter, L. M., Gnedovskaya, E. V., Golchin, A., Golechha, M., Goleij, P., Golinelli, D., Gomes-Neto, M., Goulart, A. C., Goyal, A., Gray, R. J., Grivna, M., Guadie, H. A., Guan, B., Guarducci, G., Guicciardi, S., Gunawardane, D. A., Guo, H., Gupta, B., Gupta, R., Gupta, S., Gupta, V. B., Gupta, V. K., Gutiérrez, R. A., Habibzadeh, F., Hachinski, V., Haddadi, R., Hadei, M., Hadi, N. R., Haep, N., Haile, T. G., Haj-Mirzaian, A., Hall, B. J., Halwani, R., Hameed, S., Hamiduzzaman, M., Hammoud, A., Han, H., Hanifi, N., Hankey, G. J., Hannan, M. A., Hao, J., Harapan, H., Hareru, H. E., Hargono, A., Harlianto, N. I., Haro, J. M., Hartman, N. N., Hasaballah, A. I., Hasan, F., Hasani, H., Hasanian, M., Hassan, A., Hassan, S., Hassanipour, S., Hassankhani, H., Hassen, M. B., Haubold, J., Hay, S. I., Hayat, K., Hegazy, M. I., Heidari, G., Heidari, M., Heidari-Soureshjani, R., Hesami, H., Hezam, K., Hiraike, Y., Hoffman, H. J., Holla, R., Hopf, K. P., Horita, N., Hossain, M. M., Hossain, M. B., Hossain, S., Hosseinzadeh, H., Hosseinzadeh, M., Hostiuc, S., Hu, C., Huang, J., Huda, M. N., Hussain, J., Hussein, N. R., Huynh, H-H., Hwang, B-F., Ibitoye, S. E., Ilaghi, M., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Immurana, M., Iravanpour, F., Islam, S. M. S., Ismail, F., Iso, H., Isola, G., Iwagami, M., Iwu, C. C. D., Iyer, M., Jaan, A., Jacob, L., Jadidi-Niaragh, F., Jafari, M., Jafarinia, M., Jafarzadeh, A., Jahankhani, K., Jahanmehr, N., Jahrami, H., Jaiswal, A., Jakovljevic, M., Jamora, R. D. G., Jana, S., Javadi, N., Javed, S., Javeed, S., Jayapal, S. K., Jayaram, S., Jiang, H., Johnson, C. O., Johnson, W. D., Jokar, M., Jonas, J. B., Joseph, A., Joseph, N., Joshua, C. E., Jürisson, M., Kabir, A., Kabir, Z., Kabito, G. G., Kadashetti, V., Kafi, F., Kalani, R., Kalantar, F., Kaliyadan, F., Kamath, A., Kamath, S., Kanchan, T., Kandel, A., Kandel, H., Kanmodi, K. K., Karajizadeh, M., Karami, J., Karanth, S. D., Karaye, I. M., Karch, A., Karimi, A., Karimi, H., Karimi Behnagh, A., Kasraei, H., Kassebaum, N. J., Kauppila, J. H., Kaur, H., Kaur, N., Kayode, G. A., Kazemi, F., Keikavoosi-Arani, L., Keller, C., Keykhaei, M., Khadembashiri, M. A., Khader, Y. S., Khafaie, M. A., Khajuria, H., Khalaji, A., Khamesipour, F., Khammarnia, M., Khan, M., Khan, M. A. B., Khan, Y. H., Khan Suheb, M. Z., Khanmohammadi, S., Khanna, T., Khatab, K., Khatatbeh, H., Khatatbeh, M. M., Khateri, S., Khatib, M. N., Khayat Kashani, H. R., Khonji, M. S., khorashadizadeh, F., Khormali, M., Khubchandani, J., Kian, S., Kim, G., Kim, J., Kim, M. S., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimäki, M., Kochhar, S., Kolahi, A-A., Koly, K. N., Kompani, F., Koroshetz, W. J., Kosen, S., Kourosh Arami, M., Koyanagi, A., Kravchenko, M. A., Krishan, K., Krishnamoorthy, V., Kuate Defo, B., Kuddus, M. A., Kumar, A., Kumar, G. A., Kumar, M., Kumar, N., Kumsa, N. B., Kundu, S., Kurniasari, M. D., Kusuma, D. 
ORCID: 0000-0002-1909-9341, Kuttikkattu, A., Kyu, H. H., La Vecchia, C., Ladan, M. A., Lahariya, C., Laksono, T., Lal, D. K., Lallukka, T., Lám, J., Lami, F. H., Landires, I., Langguth, B., Lasrado, S., Latief, K., Latifinaibin, K., Lau, K. M-M., Laurens, M. B., Lawal, B. K., Le, L. K. D., Le, T. T. T., Ledda, C., Lee, M., Lee, S-W., Lee, S. W., Lee, W-C., Lee, Y. H., Leonardi, M., Lerango, T. L., Li, M-C., Li, W., Ligade, V. S., Lim, S. S., Linehan, C., Liu, C., Liu, J., Liu, W., Lo, C-H., Lo, W. D., Lobo, S. W., Logroscino, G., Lopes, G., Lopukhov, P. D., Lorenzovici, L., Lorkowski, S., Loureiro, J. A., Lubinda, J., Lucchetti, G., Lutzky Saute, R., Ma, Z. F., Mabrok, M., Machoy, M., Madadizadeh, F., Magdy Abd El Razek, M., Maghazachi, A. A., Maghbouli, N., Mahjoub, S., Mahmoudi, M., Majeed, A., Malagón-Rojas, J. N., Malakan Rad, E., Malhotra, K., Malik, A. A., Malik, I., Mallhi, T. H., Malta, D. C., Manilal, A., Mansouri, V., Mansournia, M. A., Marasini, B. P., Marateb, H. R., Maroufi, S. F., Martinez-Raga, J., Martini, S., Martins-Melo, F. R., Martorell, M., März, W., Marzo, R. R., Massano, J., Mathangasinghe, Y., Mathews, E., Maude, R. J., Maugeri, A., Maulik, P. K., Mayeli, M., Mazaheri, M., McAlinden, C., McGrath, J. J., Meena, J. K., Mehndiratta, M. M., Mendez-Lopez, M. A. M., Mendoza, W., Mendoza-Cano, O., Menezes, R. G., Merati, M., Meretoja, A., Merkin, A., Mersha, A. M., Mestrovic, T., Mi, T., Miazgowski, T., Michalek, I. M., Mihretie, E. T., Minh, L. H. N., Mirfakhraie, R., Mirica, A., Mirrakhimov, E. M., Mirzaei, M., Misganaw, A., Misra, S., Mithra, P., Mizana, B. A., Mohamadkhani, A., Mohamed, N. S., Mohammadi, E., Mohammadi, H., Mohammadi, S., Mohammadi, S., Mohammadshahi, M., Mohammed, M., Mohammed, S., Mohammed, S., Mohan, S., Mojiri-forushani, H., Moka, N., Mokdad, A. H., Molinaro, S., Möller, H., Monasta, L., Moniruzzaman, M., Montazeri, F., Moradi, M., Moradi, Y., Moradi-Lakeh, M., Moraga, P., Morovatdar, N., Morrison, S. 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T., Sethi, Y., SeyedAlinaghi, S., Seylani, A., Shabani, M., Shabany, M., Shafie, M., Shahabi, S., Shahbandi, A., Shahid, S., Shahraki-Sanavi, F., Shahsavari, H. R., Shahwan, M. J., Shaikh, M. A., Shaji, K. S., Sham, S., Shama, A. T. T., Shamim, M. A., Shams-Beyranvand, M., Shamsi, M. A., Shanawaz, M., Sharath, M., Sharfaei, S., Sharifan, A., Sharma, M., Sharma, R., Shashamo, B. B., Shayan, M., Sheikhi, R. A., Shekhar, S., Shen, J., Shenoy, S. M., Shetty, P. H., Shiferaw, D. S., Shigematsu, M., Shiri, R., Shittu, A., Shivakumar, K. M., Shokri, F., Shool, S., Shorofi, S. A., Shrestha, S., Siankam Tankwanchi, A. B., Siddig, E. E., Sigfusdottir, I. D., Silva, J. P., Silva, L. M. L. R., Sinaei, E., Singh, B. B., Singh, G., Singh, P., Singh, S., Sirota, S. B., Sivakumar, S., Sohag, A. A. M., Solanki, R., Soleimani, H., Solikhah, S., Solomon, Y., Solomon, Y., Song, S., Song, Y., Sotoudeh, H., Spartalis, M., Stark, B. A., Starnes, J. R., Starodubova, A. V., Stein, D. J., Steiner, T. 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Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021.
The Lancet Neurology, 23(4),
pp. 344-381.
doi: 10.1016/s1474-4422(24)00038-3
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.
| Publication Type: | Article |
|---|---|
| Additional Information: | © 2024 World Health Organization. Published by Elsevier Ltd. All rights reserved. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL. |
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry |
| Departments: | School of Health & Psychological Sciences School of Health & Psychological Sciences > Healthcare Services Research & Management |
| SWORD Depositor: |
Available under License Creative Commons: Attribution 3.0.
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