The burden of neurological conditions in north Africa and the Middle East, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

Abstract

Background: The burden of neurological conditions in north Africa and the Middle East is increasing. We aimed to assess the changes in the burden of neurological conditions in this super-region to aid with future decision making.

Methods: In this analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 data, we examined temporal trends of disability-adjusted life-years (DALYs; deaths and disabilities combined), deaths, incident cases, and prevalent cases of 14 major neurological conditions and eight subtypes in 21 countries in the north Africa and the Middle East super-region. Additionally, we assessed neurological DALYs due to 22 potentially modifiable risk factors, within four levels of classification, during the period 1990-2019. We used a Bayesian modelling estimation approach, and generated 95% uncertainty intervals (UIs) for final estimates on the basis of the 2·5th and 97·5th percentiles of 1000 draws from the posterior distribution.

Findings: In 2019, there were 441·1 thousand (95% UI 347·2-598·4) deaths and 17·6 million (12·5-24·7) neurological DALYs in north Africa and the Middle East. The leading causes of neurological DALYs were stroke, migraine, and Alzheimer's disease and other dementias (hereafter dementias). In north Africa and the Middle East in 2019, 85·8% (82·6-89·1) of stroke and 39·9% (26·4-54·7) of dementia age-standardised DALYs were attributable to modifiable risk factors. North Africa and the Middle East had the highest age-standardised DALY rates per 100 000 population due to dementia (387·0 [172·0-848·5]), Parkinson's disease (84·4 [74·7-103·2]), and migraine (601·4 [107·0-1371·8]) among the global super-regions. Between 1990 and 2019, there was a decrease in the age-standardised DALY rates related to meningitis (-75·8% [-81·1 to -69·5]), tetanus (-88·2% [-93·9 to -76·1]), stroke (-32·0% [-39·1 to -23·3]), intracerebral haemorrhage (-51·7% [-58·2 to -43·8]), idiopathic epilepsy (-26·2% [-43·6 to -1·1]), and subarachnoid haemorrhage (-62·8% [-71·6 to -41·0]), but for all other neurological conditions there was no change. During 1990-2019, the number of DALYs due to dementias, Parkinson's disease, multiple sclerosis, ischaemic stroke, and headache disorder (ie, migraine and tension-type headache) more than doubled in the super-region, and the burden of years lived with disability (YLDs), incidence, and prevalence of multiple sclerosis, motor neuron disease, Parkinson's disease, and ischaemic stroke increased both in age-standardised rate and count. During this period, the absolute burden of YLDs due to head and spinal injuries almost doubled.

Interpretation: The increasing burden of neurological conditions in north Africa and the Middle East accompanies the increasing ageing population. Stroke and dementia are the primary causes of neurological disability and death, primarily attributable to common modifiable risk factors. Synergistic, systematic, lifetime, and multi-sectoral interventions aimed at preventing or mitigating the burden are needed.

Funding: Bill & Melinda Gates Foundation.

Translations: For the Persian, Arabic and Turkish translations of the abstract see Supplementary Materials section.

Figure 1

Heat maps of the burden of neurological conditions in north Africa and the Middle East, 2019 For head injuries and spinal injuries, since there is no fatal compoenet, DALYs are equivalent to years lived with disability (YLDs). DALYs=disability-adjusted life-years.

Figure 1

Heat maps of the burden of neurological conditions in north Africa and the Middle East, 2019 For head injuries and spinal injuries, since there is no fatal compoenet, DALYs are equivalent to years lived with disability (YLDs). DALYs=disability-adjusted life-years.

Figure 1

Heat maps of the burden of neurological conditions in north Africa and the Middle East, 2019 For head injuries and spinal injuries, since there is no fatal compoenet, DALYs are equivalent to years lived with disability (YLDs). DALYs=disability-adjusted life-years.

Figure 1

Heat maps of the burden of neurological conditions in north Africa and the Middle East, 2019 For head injuries and spinal injuries, since there is no fatal compoenet, DALYs are equivalent to years lived with disability (YLDs). DALYs=disability-adjusted life-years.

Figure 2

Ranks of age-standardised DALY rates related to neurological conditions in countries in north Africa and the Middle East, 2019 Ranks range from 1 (dark red) with the highest rate to 21 (dark green) with the lowest rate. Stroke includes ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage. Neurological disorders include Alzheimer's disease and other dementias, Parkinson's disease, idiopathic epilepsy, multiple sclerosis, headache disorders, motor neuron disease, and other neurological disorders. Headache disorders include migraine and tension-type headache. DALY=disability-adjusted life-year.

Figure 3

Ranks of age-standardised DALY rates for stroke and dementia, per 100 000 population, attributable to modifiable risk factors in countries in north Africa and the Middle East, 2019 Ranks range from 1 (dark red) with the highest rate to 21 (dark green) with the lowest rate. Stroke includes ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage. Dementia includes Alzheimer's disease and other dementias. DALYs=disability-adjusted life-years.

Figure 4

Burden of neurological diseases in north Africa and the Middle East, in YLDs (A) and YLLs (B), in 2019 We accounted for potential overlaps in health status and the causes depicted in this figure are distinct from each other. YLDs=years lived with disability. YLLs=years of life lost.