Summary
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.
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