Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

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Résumé

BACKGROUND: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. METHODS: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. FINDINGS: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247-308]) and second leading cause of deaths (9·0 million [8·8-9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34-44] and DALYs by 15% [9-21]) whereas their age-standardised rates decreased (deaths by 28% [26-30] and DALYs by 27% [24-31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6-46·1]), migraine (16·3% [11·7-20·8]), Alzheimer's and other dementias (10·4% [9·0-12·1]), and meningitis (7·9% [6·6-10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05-1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5-90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8-35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8-17·5] of DALYs are risk attributable). INTERPRETATION: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. FUNDING: Bill & Melinda Gates Foundation.

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La notice

Revue

The Lancet Neurology

Thématique

Acute Ischemic Stroke Management

Domaine

Medicine

Établissements canadiens

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Organismes subventionnaires

Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentFogarty International CenterNational Human Genome Research InstituteNational Institute of Mental HealthFaculty of Medicine and Health, University of SydneyDipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaInstitute of Biomedical Sciences, Academia SinicaErasmus Universitair Medisch Centrum RotterdamResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesFundação para a Ciência e a TecnologiaNational Health and Medical Research CouncilBiomedical Research CouncilAustralian Research CouncilMedical Research CouncilInstitute for Physical Activity and NutritionResearch Institute, Nationwide Children's HospitalUniversity of California, IrvineUniversity of California, San DiegoUniwersytet OpolskiDebre Tabor UniversityUniversity of Health and Allied SciencesAlfaisal UniversityUniversitätsklinikum HeidelbergMoscow Institute of Physics and TechnologyLaboratório Associado para a Química VerdeWestern Sydney UniversityMinistry of Health of the Russian FederationLomonosov Moscow State UniversityAmbo UniversityBispebjerg HospitalUniversidad Autónoma de SinaloaUniversidade Federal de SergipeMuhimbili University of Health and Allied SciencesApplied Molecular Biosciences UnitWageningen University and ResearchSamara UniversityKurdistan University Of Medical SciencesLorestan University of Medical SciencesAlborz University of Medical SciencesUniversity Of Nigeria NsukkaCharotar University of Science and TechnologyAlexandria UniversityNational Center of Neurology and PsychiatryMansoura UniversityInternational Centre for Diarrhoeal Disease Research, BangladeshNanjing UniversityThe Wellcome Trust DBT India AllianceUniversità degli Studi di MessinaUniversity of PeradeniyaUniversity of GondarGolestan University of Medical SciencesShahid Beheshti University of Medical SciencesUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiUniversidad Nacional Autónoma de MéxicoNational Research University Higher School of EconomicsHjärt-LungfondenCentro de Investigación Biomédica en Red de Salud MentalGeneralitat ValencianaNational Taiwan UniversityDepartment of Biotechnology, Ministry of Science and Technology, IndiaUniversidad de ChileNIHR Collaboration for Leadership in Applied Health Research and Care South LondonVirginia Commonwealth UniversityUniversità di BolognaGöteborgs UniversitetTaipei Medical UniversityUniversity of South AfricaUniversity of the PhilippinesUniversität BielefeldBabol University of Medical SciencesUniversidade de São PauloHacettepe ÜniversitesiUniversitetet i OsloUniversity of New South WalesKermanshah University of Medical SciencesUniversity of Social Welfare and Rehabilitation SciencesFujita Health UniversityFundação Oswaldo CruzNationwide Children's HospitalUniversidad de Costa RicaNational and Kapodistrian University of AthensJazan UniversityGriffith UniversityAhvaz Jundishapur University of Medical SciencesUmeå UniversitetMinistry of Health and Medical EducationHaramaya UniversityInyuvesi Yakwazulu-NataliUniversity College LondonUniversiti Kebangsaan MalaysiaKuwait UniversityChinese Center for Disease Control and PreventionTampereen YliopistoUniversity of PennsylvaniaTsinghua UniversityEuropean Regional Development FundKarolinska InstitutetJordan University of Science and TechnologyGeorg-August-Universität GöttingenMinisterio de Economía y CompetitividadIlam University of Medical SciencesLunds UniversitetSistema Nacional de InvestigadoresNational Institutes of HealthNational University of SingaporeWollega UniversityBanaras Hindu UniversityKyung Hee UniversitySun Yat-sen UniversityMinistarstvo Prosvete, Nauke i Tehnološkog RazvojaMinisterio de Educación, Cultura y DeporteKing Saud UniversityMaurice Wilkins Centre for Molecular BiodiscoveryShiraz University of Medical SciencesAin Shams UniversityMedical School, University of MichiganHospital for Sick ChildrenAcademia SinicaSanjay Gandhi Postgraduate Institute of Medical SciencesNational Natural Science Foundation of ChinaWuhan UniversityDezful University of Medical SciencesHögskolan DalarnaRijksuniversiteit GroningenMinistério da EducaçãoEli Lilly and CompanyPublic Health AgencyRede de Química e TecnologiaTulane UniversityTartu ÜlikoolSanofi-Aventis DeutschlandUniversity of AucklandUniversitas Negeri SemarangCancer Society of New ZealandUniversità degli Studi di MilanoBayerPomorski Uniwersytet Medyczny W SzczecinieUniversity of OtagoNanyang Technological UniversityBall State UniversityAddis Ababa UniversityUniversità degli Studi di FirenzeUniversidad Autónoma MetropolitanaDepartment of Science and Technology, Ministry of Science and Technology, IndiaPacific Institute for Research and EvaluationQazvin University of Medical SciencesUniversitair Medisch Centrum GroningenAustralian National UniversityUniwersytet Jagielloński Collegium MedicumShiraz UniversityKing's College LondonSree Chitra Tirunal Institute for Medical Sciences and TechnologyCochrane South AfricaUniversity of TorontoHigh Blood Pressure Research Council of AustraliaPublic Health EnglandImperial College LondonJohns Hopkins UniversityUniversity of WarwickJackson State UniversityUniversity of SouthamptonNational Research FoundationNational Institute for Health and Care ResearchAbbott DiagnosticsDirectorate for Biological SciencesPolitechnika CzestochowskaBundesministerium für GesundheitSouth African Medical Research CouncilMashhad University of Medical SciencesSaint Paul's Hospital Millennium Medical CollegeAlexander von Humboldt-StiftungTribhuvan UniversityNIHR Oxford Biomedical Research CentreHorizon PharmaceuticalsUniversität UlmBournemouth UniversityLoma Linda UniversityUniversity of EmbuHealth Research Council of New ZealandUniwersytet ŁódzkiMaragheh University of Medical SciencesUniversity of DhakaUniversiteit StellenboschUniversity of TabrizEuropean CommissionAhmadu Bello UniversityUniversidade do PortoAustralian GovernmentIlam UniversityWellcome TrustKorea UniversityTrường Đại học Duy TânUniversidade Federal de Santa CatarinaUniversity of West FloridaSanofiUniversity of OxfordMcMaster UniversityAksum UniversityUniversity of HullXiamen UniversityNational Institute of Neurological Disorders and StrokeTechnische Universität MünchenUniversité de BourgogneU.S. Department of DefenseUniversity of Technology SydneyYork UniversityYale UniversityJimma UniversityHarvard UniversityDeutsches KrebsforschungszentrumHorizon PharmaIran University of Medical SciencesFudan UniversityCase Western Reserve UniversityNovo NordiskDanmarks GrundforskningsfondDurban University of TechnologyKing Fahd University of Petroleum and MineralsHamad Medical CorporationMedtronicDeakin UniversityBristol-Myers SquibbBASFHelsingin YliopistoAmgenMinistério da Educação e CiênciaBirmingham City UniversityLee Kong Chian School of Medicine, Nanyang Technological UniversitySchool of Medicine, Boston UniversityBundesministerium für Bildung und ForschungUniversitat de BarcelonaAbbVieStudent Research Committee, Tabriz University of Medical SciencesFrankfurt University of Applied SciencesLa Trobe UniversityArabian Gulf UniversityKaiser PermanenteAstellas Pharma USBrien Holden Vision InstituteAstraZenecaUniversidade Federal de Minas GeraisCelgeneUniversity of Cape TownUniversity of OttawaCurtin University of TechnologyKing Khalid UniversityIsfahan University of Medical SciencesInstituto de Salud Carlos IIISan Diego State UniversityMerck Sharp and DohmeIslamic Azad UniversityWest Virginia UniversityGlaxoSmithKlineUniversidad Nacional de ColombiaNorthwestern UniversityUniversiti Sains MalaysiaHáskólinn í ReykjavíkPfizerBill and Melinda Gates FoundationAustralian Catholic UniversityUniversitat de ValènciaBoehringer IngelheimPublic Health Agency of Canada

Mots-clés

Burden of diseaseDiseaseMedicineDisease burdenEnvironmental healthPathology

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