Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021
- PMID: 38493795
- PMCID: PMC10949203
- DOI: 10.1016/S1474-4422(24)00038-3
Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021
Erratum in
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Correction to Lancet Neurol 2024; 23: 344-81.Lancet Neurol. 2024 May;23(5):e9. doi: 10.1016/S1474-4422(24)00114-5. Epub 2024 Mar 18. Lancet Neurol. 2024. PMID: 38513680 Free PMC article. No abstract available.
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Correction to Lancet Neurol 2024; 23: 344-81.Lancet Neurol. 2024 Jul;23(7):e11. doi: 10.1016/S1474-4422(24)00231-X. Lancet Neurol. 2024. PMID: 38876752 No abstract available.
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.
© 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.
Conflict of interest statement
Declaration of interests V Aboyans reports consulting fees from Bayer Healthcare, Amarin, Boehringer Ingelheim, and NovoNordisk; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from NovoNordisk and Amarin; and unpaid leadership or fiduciary roles in board, society, committee, or advocacy groups with the European Society of Cardiology and the French Society of Cardiology, all outside the submitted work. S Afzal reports payment or honoraria from educational events and webinars with King Edward Medical University and collaborative partners, including University of Johns Hopkins, University of California, and University of Massachusetts; participation on a data safety monitoring board or advisory board with National Bioethics Committee Pakistan, King Edward Medical University Institutional Ethical Review Board, Ethical Review Board Fatima Jinnah Medical University, and Sir Ganga Ram Hospital; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Pakistan Association of Medical Editors, the Faculty of Public Health Royal Colleges UK (Fellowship of Faculty of Public Health) as a fellow, the Society of Prevention, Advocacy And Research, King Edward Medical University as a member, and with the Pakistan Society of Infectious Diseases, outside the submitted work. K Akinosoglou reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events paid to the University of Patras from Pfizer Hellas, MSD, Gilead, ViiV/GSK, 3M, and Sobi and support for meeting and travel registration and accommodation costs from Pfizer Hellas, MSD, Gilead, Normal Hellas, and LEO Pharmaceuticals Hellas, outside the submitted work. R Ancuceanu reports consulting fees from Abbvie and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Abbvie, Sandoz, B Braun, and Laropharm, outside the submitted work. P Atorkey reports support for the present manuscript from the Australian College of Applied Professions, Discipline of Psychological Sciences and The University of Newcastle, School of Medicine and Public Health. J Ärnlöv reports payment for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca and Novartis and participation on an advisory board with AstraZeneca, Boerhinger Ingelheim, and Astella, outside the submitted work. R Bai reports support for the present manuscript from the National Natural Science Foundation of China (grant number 72204112), the Social Science Fund of Jiangsu Province (grant number 21GLD008), and the Fundamental Research Funds for the Central Universities (grant number 30923011101). M A Barboza reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Pfizer and Roche Pharmaceuticals and support for attending meetings and travel from Boehringer Ingelheim, outside the submitted work. T W Bärnighausen reports grants from the EU (Horizon 2020 and European Institute of Innovation and Technology Health), German Research Foundation, US National Institutes of Health, German Ministry of Education and Research, Alexander von Humboldt Foundation, Else-Kröner-Fresenius-Foundation, Wellcome Trust, Gates Foundation, KfW Development Bank, UNAIDS, and WHO; consulting fees for KfW on the OSCAR Initiative in Viet Nam; participation on a data safety monitoring board or advisory board with NIH-funded study Healthy Options as chair of the data safety and monitoring board, participation on a data safety monitoring board with the German National Committee on the Future of Public Health Research and Education, participation as chair of the scientific advisory board to the European and Developing Countries Clinical Trials Partnership Evaluation, and participation as a member of the UNAIDS Evaluation Expert Advisory Committee, National Institutes of Health Study Section Member on Population and Public Health Approaches to HIV/AIDS, US National Academies of Sciences, Engineering, and Medicine's Committee for the Evaluation of Human Resources for Health in the Republic of Rwanda under the President's Emergency Plan for AIDS Relief, and University of Pennsylvania (UPenn) Population Aging Research Center (PARC) External Advisory Board; and leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Global Health Hub Germany as co-chair (which was initiated by the German Ministry of Health), outside the submitted work. S Bhaskar reports grants or contracts from Japan Society for Promotion Science; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Rotary District 9675 Diversity, Equity and Inclusion as a chair and with Global Health and Migration, Global Health Hub Germany as a founding member, manager, and chair. H Carabin reports grants or contracts from WHO. M Endres reports grants from Bayer (unrestricted grant to Charité for MonDAFIS study and Berlin AFib registry, with no personal fees); consulting fees paid to the institution from Bayer; payment (paid to institution) for honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Bayer, Pfizer, Amgen, GSK, and Novartis; participation on a data safety monitoring board or advisory board (no personal fees) with BMS (country principal investigator for Axiomatic-SSP), Bayer (country principal investigator for NAVIGATE-ESUS), and Daiichi Sankyo; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the European Academy of Neurology as a member at large on the board of directors and as an unpaid fellow, the German Center for Neurodegenerative Diseases as an unpaid member, the International Society for Cerebral Blood Flow and Metabolism as an unpaid member, the American Health Association and American Stroke Association as an unpaid member, the European Stroke Organisation as an unpaid fellow, the World Stroke Organization as an unpaid member, German Centre of Cardiovascular Research as an unpaid principal investigator, and German Center of Neurodegenerative Diseases as a paid principal investigator under a personal contract; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Amgen, outside the submitted work. L M Force reports support for the present manuscript from the Gates Foundation; grants or contracts from Conquer Cancer Foundation, St Jude Children's Research Hospital, St Baldrick's Foundation, and National Institutes of Health Loan Repayment Program; and leadership or fiduciary roles in board, society, committee, or advocacy groups, unpaid with the Lancet Oncology International Advisory Board. Q Gan reports other financial or non-financial interests from the International Agency for Research on Cancer as the beneficiary of the International Agency for Research on Cancer Research and Training Programme. J F Mosser reports grant funding support for the present manuscript for Global Burden of Disease estimation from the Gates Foundation; grants from Gavi, the Vaccine Alliance; and support for attending meetings and travel from the Gates Foundation. S Muthu support for attending meetings and travel from ON Foundation (International Cartilage Regeneration and Joint Preservation Society 2023) and leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the International Society of Orthopaedic Surgery and Traumatology on the Research Grants Committee and the International Cartilage Regeneration and Joint Preservation Society on the NextGEN Committee, outside the submitted work. L Ronfani reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo. S Zadey reports honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Think Global Health, Harvard Public Health Magazine, and The Wire Science and leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the Association for Socially Applicable Research as a co-founding director, The G4 Alliance as a permanent council member, Surgical, Obstetric, Trauma and Anesthesia Care in South Asia Working Group as a chair, and Maharashtra State Mental Health Policy as a drafting committee member, outside the submitted work. The authors alone are responsible for the views expressed in this Article, and they do not necessarily represent the views, decisions, or policies of the institutions or funders with which they are affiliated.
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