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. 2025 Aug 30;25(1):2977.
doi: 10.1186/s12889-025-24097-x.

Trends and inequalities in the global burden of alzheimer's disease and other dementias, 1990-2021: a Chinese perspective

Wenhao Zhu #  1 , Xianfeng Yu #  1 , Chaojuan Huang #  1 , Shuqing Deng #  2 , Mengmeng Ren  1 , Mingxu Li  1 , Xia Zhou  1 , Ziyuan Shen  3 , Guoqi Cai  3   4 , Xiaoqun Zhu  5 , Zhongwu Sun  6
Affiliations

Trends and inequalities in the global burden of alzheimer's disease and other dementias, 1990-2021: a Chinese perspective

Wenhao Zhu et al. BMC Public Health. .

Abstract

Background: Given the growing global burden of Alzheimer's Disease and Other Dementias (ADODs) and inequalities in its distribution, it is of great necessity to analyze the trends and cross-country inequalities in the burden of ADODs globally and in China from 1990 to 2021.

Methods: Estimates and 95% uncertainty intervals (UIs) for incidence, prevalence, and disability-adjusted life years (DALYs) of ADODs were obtained from the Global Burden of Diseases Study (GBD) 2021. We described the epidemiology of ADODs at global, regional, and national levels, conducting temporal trend analyses using estimated annual percentage change, joinpoint regression, and age-period-cohort model. Additionally, we performed spatial autocorrelation, decomposition, and cross-country inequality analyses, comparing the burden in China to global trends.

Results: The global burden of ADODs increased overall from 1990 to 2021. GBD 2021 estimated 9,837,056 incident cases, 56,856,688 prevalent cases, and 36,332,687 DALYs for ADODs worldwide in 2021, with the highest case number in East Asia and highest age-standardized rate of DALYs in central sub-Saharan Africa. Spatial trends analyses showed hot spots in sub-Saharan Africa, the Middle East and North Africa, Europe, and High-income North America. Decomposition analysis revealed that changes in DALYs were primarily driven by population growth and aging, followed by prevalence, case fatality, and disease severity. Significant increases in absolute and relative sociodemographic index (SDI)-related inequalities in DALYs were observed from 1990 to 2021, with 318.19 to 759.97, and 0.43 to 0.49, respectively.

Conclusion: The burden of ADODs globally and in China showed overall increasing trends from 1990 to 2021. This increase was primarily driven by population growth and aging. Countries with high SDI values faced a disproportionately large burden of dementia, and SDI-related inequalities among countries exacerbated over time. These findings highlight significant challenges for the prevention and control of ADODs globally and in China.

Keywords: China-specific epidemiology; Dementia epidemiology; Global burden; Health inequalities; Sociodemographic index.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: No ethical approval was required for the use of deidentified and secondary data in the GBD study. Consent for publication: All authors consent to the publication of this research. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(A) The ASIR in 2021; (B) The ASPR in 2021; (C) The ASDR in 2021; of ADODs worldwide. Abbreviations: ASIR, ASR of incidence; ASPR, ASR of prevalence; ASDR, ASR of DALYs; ASR, age-standardized rate; EAPC, estimated annual percentage change; DALYs, disability-adjusted life-years; ADODs, Alzheimer’s disease and other dementias
Fig. 2
Fig. 2
(A) The joinpoint regression analysis on the ASIR in China; (B) The joinpoint regression analysis on the ASPR in China; (C) The joinpoint regression analysis on the ASDR in China. Abbreviations: ASIR, ASR of incidence; ASPR, ASR of prevalence; ASDR, ASR of DALYs; ASR, age-standardized rate; DALYs, disability-adjusted life-years
Fig. 3
Fig. 3
The effects of age, period, and cohort on the relative risk of ADODs (A) incidence and (B) prevalence compared between China and globally. Abbreviations: ADODs, Alzheimer’s disease and other dementias
Fig. 4
Fig. 4
The decomposition analysis on DALYs of ADODs in 5 SDI quintiles and China. Abbreviations: DALYs, disability-adjusted life-years; ADODs, Alzheimer’s disease and other dementias; SDI, sociodemographic index
Fig. 5
Fig. 5
The (A) absolute and (B) relative SDI-associated inequalities on DALYs of ADODs burden globally in 1990 and 2021. Abbreviations: SDI, sociodemographic index; DALYs, disability-adjusted life-years; ADODs, Alzheimer’s disease and other deme
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