L. FEIGIN, Valery, VOS, Theo, ALAHDAB, Fares, KHATAB, Khaled, MAEVER, Arianna and J. L. MURRAY, Christopher (2020). Burden of Neurological Disorders Across the US From 1990-2017. JAMA Neurology. [Article]
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Abstract
IMPORTANCE Accurate and up-to-date estimates on incidence, prevalence, mortality, and
disability-adjusted life-years (burden) of neurological disorders are the backbone of
evidence-based health care planning and resource allocation for these disorders. It appears
that no such estimates have been reported at the state level for the US.
OBJECTIVE To present burden estimates of major neurological disorders in the US states by
age and sex from 1990 to 2017.
DESIGN, SETTING, AND PARTICIPANTS This is a systematic analysis of the Global Burden of
Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted
life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of
the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were
analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy,
multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain
injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis,
and tetanus.
EXPOSURES Any of the 14 listed neurological diseases.
MAIN OUTCOME AND MEASURE Absolute numbers in detail by age and sex and
age-standardized rates (with 95% uncertainty intervals) were calculated.
RESULTS The 3 most burdensome neurological disorders in the US in terms of absolute
number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs),
Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and
migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological
disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as
DALYs) increased from 1990 to 2017, largely because of the aging of the population.
Exceptions for this trend included traumatic brain injury incidence (−29.1% [95% UI, −32.4%
to −25.8%]); spinal cord injury prevalence (−38.5% [95% UI, −43.1% to −34.0%]); meningitis
prevalence (−44.8% [95% UI, −47.3% to −42.3%]), deaths (−64.4% [95% UI, −67.7% to
−50.3%]), and DALYs (−66.9% [95% UI, −70.1% to −55.9%]); and encephalitis DALYs
(−25.8% [95% UI, −30.7% to −5.8%]). The different metrics of age-standardized rates varied
between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for
tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while
northern states had a relatively higher burden of multiple sclerosis and eastern states had
higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache,
and meningitis, encephalitis, and tetanus.
CONCLUSIONS AND RELEVANCE There is a large and increasing burden of noncommunicable
neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in
particular neurological disorders across the US states. The information reported in this article
can be used by health care professionals and policy makers at the national and state levels to
advance their health care planning and resource allocation to prevent and reduce the burden
of neurological disorders.
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