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. 2021 Feb 1;78(2):165-176.
doi: 10.1001/jamaneurol.2020.4152.

Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study

GBD 2017 US Neurological Disorders Collaborators; Valery L Feigin  1   2   3 , Theo Vos  2   4 , Fares Alahdab  5 , Arianna Maever L Amit  6   7 , Till Winfried Bärnighausen  8   9 , Ettore Beghi  10 , Mahya Beheshti  11 , Prachi P Chavan  12 , Michael H Criqui  13 , Rupak Desai  14 , Samath Dhamminda Dharmaratne  2   4   15 , E Ray Dorsey  16 , Arielle Wilder Eagan  17   18 , Islam Y Elgendy  19   20 , Irina Filip  21   22 , Simona Giampaoli  23 , Giorgia Giussani  24 , Nima Hafezi-Nejad  25   26 , Michael K Hole  27 , Takayoshi Ikeda  28 , Catherine Owens Johnson  2 , Rizwan Kalani  29 , Khaled Khatab  30   31 , Jagdish Khubchandani  32 , Daniel Kim  33 , Walter J Koroshetz  34 , Vijay Krishnamoorthy  35   36 , Rita V Krishnamurthi  1 , Xuefeng Liu  37 , Warren David Lo  38   39 , Giancarlo Logroscino  40   41 , George A Mensah  42   43 , Ted R Miller  44   45 , Salahuddin Mohammed  46   47 , Ali H Mokdad  2   4 , Maziar Moradi-Lakeh  48 , Shane Douglas Morrison  49 , Veeresh Kumar N Shivamurthy  50 , Mohsen Naghavi  2   4 , Emma Nichols  2 , Bo Norrving  51 , Christopher M Odell  2 , Elisabetta Pupillo  10 , Amir Radfar  52 , Gregory A Roth  2   4   53 , Azadeh Shafieesabet  54   55 , Aziz Sheikh  56   57 , Sara Sheikhbahaei  25 , Jae Il Shin  58 , Jasvinder A Singh  59   60 , Timothy J Steiner  61   62 , Lars Jacob Stovner  61   63 , Mitchell Taylor Wallin  64   65 , Jordan Weiss  66 , Chenkai Wu  67   68 , Joseph Raymond Zunt  29 , Jaimie D Adelson  2 , Christopher J L Murray  2   4
Affiliations

Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study

GBD 2017 US Neurological Disorders Collaborators et al. JAMA Neurol. .

Abstract

Importance: Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US.

Objective: To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017.

Design, setting, and participants: This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus.

Exposures: Any of the 14 listed neurological diseases.

Main outcome and measure: Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated.

Results: The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (-29.1% [95% UI, -32.4% to -25.8%]); spinal cord injury prevalence (-38.5% [95% UI, -43.1% to -34.0%]); meningitis prevalence (-44.8% [95% UI, -47.3% to -42.3%]), deaths (-64.4% [95% UI, -67.7% to -50.3%]), and DALYs (-66.9% [95% UI, -70.1% to -55.9%]); and encephalitis DALYs (-25.8% [95% UI, -30.7% to -5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus.

Conclusions and relevance: There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Beghi reports grants from Italian Ministry of Health, Italian Ministry of Health, American ALS Association, and SOBI and personal fees from Arvelle Therapeutics and Eisai, outside the submitted work. Dr Dorsey reports personal fees from American Academy of Neurology courses, American Neurological Association, University of Michigan, 23andMe, Abbott, AbbVie, American Well, Biogen, BrainNeuroBio, Clintrex, Curasen Therapeutics, DeciBio, Denali Therapeutics, GlaxoSmithKline, Grand Rounds, Karger, Lundbeck, MC10, MedAvante, Medical-Legal services, Mednick Associates, National Institute of Neurological Disorders and Stroke, Olson Research Group, Optio, Origent Data Sciences Inc, Otsuka, Prilenia, Putnam Associates, Roche, Sanofi, Shire, Spark, Sunovion Pharma, Teva, Theravance, UCB, and Voyager Therapeutics; grants from AbbVie, Acadia Pharmaceuticals, AMC Health, Biosensics, Burroughs Wellcome Fund, Davis Phinney Foundation, Duke University, Food and Drug Administration, GlaxoSmithKline, Greater Rochester Health Foundation, Huntington Study Group, Michael J. Fox Foundation, National Institutes of Health/National Institute of Neurological Disorders and Stroke, National Science Foundation, Nuredis Pharmaceuticals, Patient-Centered Outcomes Research Institute, Pfizer, Prana Biotechnology, Raptor Pharmaceuticals, Roche, Safra Foundation, Teva Pharmaceuticals, and University of California, Irvine; editorial services from Karger Publications; and an ownership interest in Grand Rounds (a second-opinion service), outside the submitted work. Dr Norrving reports personal fees from AstraZeneca and Bayer, outside the submitted work. Dr Pupillo reports grants from American Amyotrophic Lateral Sclerosis Association and other support from Revalesio Corporation outside the submitted work. Dr Sheikh reports grants from Health Data Research UK, outside the submitted work; personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio Health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, Practice Point Communications, the National Institutes of Health, the American College of Rheumatology, and Simply Speaking; ownership in stock options from Amarin Pharmaceuticals and Viking Pharmaceuticals; other support from Vaxart Pharmaceuticals; and nonfinancial support from the US Food and Drug Administration Arthritis Advisory Committee, the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, and Veterans Affairs Rheumatology Field Advisory Committee, the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside the submitted work. In addition, Dr Singh is the chair of the Veterans Affairs Rheumatology Field Advisory Committee, the editor and director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, and a former member of the following committees: the American College of Rheumatology's Annual Meeting Planning Committee and Quality of Care Committees, the Chair of the American College of Rheumatology Meet the Professor, Workshop and Study Group Subcommittee and the cochair of the American College of Rheumatology Criteria and Response Criteria subcommittee. Dr Steiner reports personal fees from Eli Lilly outside the submitted work. Dr Stovner reports grants and personal fees from Allergan, Teva, and Novartis and personal fees from Lundbeck, Lilly, and Springer Publisher, outside the submitted work. Dr Wu reports personal fees from Health Keepers and grants from Suzhou Science and Technology Bureau, Kunshan Government, and Duke Kunshan University, outside the submitted work. Dr Roth reported grants from the Bill and Melinda Gates Foundation and Cardiovascular Medical Research and Education Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Temporal Trends in Aggregate US-Wide Age-Standardized Disability-Adjusted Life-Year (DALY) Rates per 100 000 Persons per Year for Neurological Disorders From 1990 to 2017
Figure 2.
Figure 2.. Disability-Adjusted Life-Year Rates per 100 000 Persons for Neurological Disorders in the US States in 2017
MS indicates multiple sclerosis.
Figure 3.
Figure 3.. Disability-Adjusted Life-Year Rates per 100 000 Persons for Neurological Disorders in the US States in 2017
NS indicates nervous system.
See this image and copyright information in PMC

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