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Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study

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GBD 2017 US Neurological Disorders Collaborators, Feigin, Valery L., Vos, Theo, Alahdab, Fares, Amit, Arianna Maever L., Bärnighausen, Till Winfried, Beghi, Ettore, Beheshti, Mahya, Chavan, Prachi P., Criqui, Michael H., Desai, Rupak, Dhamminda Dharmaratne, Samath, Dorsey, E. Ray, Wilder Eagan, Arielle, Elgendy, Islam Y., Filip, Irina, Giampaoli, Simona, Giussani, Giorgia, Hafezi-Nejad, Nima, Hole, Michael K., Ikeda, Takayoshi, Owens Johnson, Catherine, Kalani, Rizwan, Khatab, Khaled, Khubchandani, Jagdish, Kim, Daniel, Koroshetz, Walter J., Krishnamoorthy, Vijay, Krishnamurthi, Rita V., Liu, Xuefeng, Lo, Warren David, Logroscino, Giancarlo, Mensah, George A., Miller, Ted R., Mohammed, Salahuddin, Mokdad, Ali H., Moradi-Lakeh, Maziar, Morrison, Shane Douglas, Shivamurthy, Veeresh Kumar N., Naghavi, Mohsen, Nichols, Emma, Norrving, Bo, Odell, Christopher M., Pupillo, Elisabetta, Radfar, Amir, Roth, Gregory A., Shafieesabet, Azadeh, Sheikh, Aziz, Sheikhbahaei, Sara, Shin, Jae Il, Singh, Jasvinder A., Steiner, Timothy J., Stovner, Lars Jacob, Wallin, Mitchell Taylor, Weiss, Jordan, Wu, Chenkai, Zunt, Joseph Raymond, Adelson, Jaimie D., Murray, Christopher J. L.·2021·JAMA Neurology
DOI 10.1001/jamaneurol.2020.4152PMC PMC7607495
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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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Crossref · 10.1001/jamaneurol.2020.4152

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Figure 1. Temporal Trends in Aggregate US-Wide Age-Standardized Disability-Adjusted Life-Year (DALY) Rates per 100 000 Persons per Year for Neurological Disorders From 1990 to 2017
Figure 1. Temporal Trends in Aggregate US-Wide Age-Standardized Disability-Adjusted Life-Year (DALY) Rates per 100 000 Persons per Year for Neurological Disorders From 1990 to 2017CC BY · PubMed Central
Figure 2. Disability-Adjusted Life-Year Rates per 100 000 Persons for Neurological Disorders in the US States in 2017 MS indicates multiple sclerosis.
Figure 2. Disability-Adjusted Life-Year Rates per 100 000 Persons for Neurological Disorders in the US States in 2017 MS indicates multiple sclerosis.CC BY · PubMed Central
Figure 3. Disability-Adjusted Life-Year Rates per 100 000 Persons for Neurological Disorders in the US States in 2017 NS indicates nervous system.
Figure 3. Disability-Adjusted Life-Year Rates per 100 000 Persons for Neurological Disorders in the US States in 2017 NS indicates nervous system.CC BY · PubMed Central

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Research works printed but not linked: 3

  1. GBD 2016 Stroke Collaborators, 2019, Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016., Lancet Neurol, 18, 439, 10.1016/S1474-4422(19)30034-1 · DOI
  2. Flaxman, 2015, An Integrative Metaregression Framework for Descriptive Epidemiology.
  3. Stovner, 2019, Societal Impact of Headache Burden, Cost and Response, 112

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Metadata

Authors
Collaborators, G. 2. U. N. D., Feigin, V. L., Vos, T., Alahdab, F., Amit, A. M. L., Bärnighausen, T. W., Beghi, E., Beheshti, M., Chavan, P. P., Criqui, M. H., Desai, R., Dhamminda Dharmaratne, S., Dorsey, E. R., Wilder Eagan, A., Elgendy, I. Y., Filip, I., Giampaoli, S., Giussani, G., Hafezi-Nejad, N., Hole, M. K., Ikeda, T., Owens Johnson, C., Kalani, R., Khatab, K., Khubchandani, J., Kim, D., Koroshetz, W. J., Krishnamoorthy, V., Krishnamurthi, R. V., Liu, X., Lo, W. D., Logroscino, G., Mensah, G. A., Miller, T. R., Mohammed, S., Mokdad, A. H., Moradi-Lakeh, M., Morrison, S. D., Shivamurthy, V. K. N., Naghavi, M., Nichols, E., Norrving, B., Odell, C. M., Pupillo, E., Radfar, A., Roth, G. A., Shafieesabet, A., Sheikh, A., Sheikhbahaei, S., Shin, J. I., Singh, J. A., Steiner, T. J., Stovner, L. J., Wallin, M. T., Weiss, J., Wu, C., Zunt, J. R., Adelson, J. D., & Murray, C. J. L.
Affiliations
  • University of Washington (US)
  • Mayo Clinic (US)
  • Harvard University (US)
  • Mario Negri Institute for Pharmacological Research (IT)
  • New York University (US)
  • University of California San Diego (US)
  • University of Peradeniya (LK)
  • Institute for Health Metrics and Evaluation, University of Washington, Seattle
  • Tufts Medical Center (US)
  • Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts
  • Kaiser Permanente (US)
  • Johns Hopkins University (US)
  • Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
  • Auckland University of Technology (NZ)
  • Ball State University (US)
  • Northeastern University (US)
  • National Institutes of Health (US)
  • Duke University (US)
  • University of Michigan (US)
  • Nationwide Children's Hospital (US)
  • Curtin University (AU)
  • Iran University of Medical Sciences (IR)
  • Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Emory University (US)
  • Lund University (SE)
  • University of Central Florida (US)
  • United States Department of Veterans Affairs (US)
  • Norwegian University of Science and Technology (NO)
  • University of Maryland, Baltimore (US)
Corresponding author
  • GBD 2017 US Neurological Disorders Collaborators
  • Feigin, Valery L.
ORCID
Venue
JAMA Neurology
Publisher
American Medical Association (AMA)
Published
2021-02-01
Volume
78
Issue
2
Pages
165
ISSN
2168-6149 (ISSN-L)
DOI
10.1001/jamaneurol.2020.4152
PMC
PMC7607495
OpenAlex
W3095385778
Cited by
622
References
31
Citations by year
2026: 67 · 2025: 142 · 2024: 142 · 2023: 118 · 2022: 101 · 2021: 52
FWCI
10.37
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Neurology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
  • Tuwhera (Auckland University of Technology) (submittedVersion, cc-by)
  • YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
  • Lund University Publications (Lund University) (submittedVersion)
  • Greater South Information System
Funders
  • U.S. Department of Veterans Affairs
  • Alexander von Humboldt-Stiftung
  • Massachusetts General Hospital
  • Kaiser Permanente
  • Ohio State University
  • Emory University
  • Tufts Medical Center
  • George Washington University
  • Harvard University
  • Nationwide Children's Hospital
  • University of Washington
  • Johns Hopkins University
  • University of Central Florida
  • Auckland University of Technology, New Zealand
  • Ball State University
  • University of Alabama at Birmingham
  • Norges Teknisk-Naturvitenskapelige Universitet
  • Sheffield Hallam University
  • University of Alabama
  • Iran University of Medical Sciences
  • A.T. Still University
  • Istituto di Ricerche Farmacologiche Mario Negri - IRCCS
  • Imperial College London
  • Department of Social Services, Australian Government
  • Curtin University of Technology
  • Yonsei University
  • Lunds Universitet
  • Istituto Superiore di Sanità
  • Tehran University of Medical Sciences and Health Services
  • Universita degli Studi di Bari Aldo Moro
  • University of Cape Town
  • Duke Kunshan University
  • Center for Stroke Research Berlin
  • National Institutes of Health
  • Duke Global Health Institute, Duke University
  • Yonsei University College of Medicine
  • National Institute on Aging (T32AG000247)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Epidemiology
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
neurological disorders, disease burden, disability-adjusted life years, stroke, Parkinson's disease, epilepsy, multiple sclerosis, migraine, traumatic brain injury, spinal cord injury, meningitis, encephalitis, tetanus, nervous system cancer, incidence, prevalence, mortality, population aging, United States, age and sex differences, healthcare resource allocation
MeSH terms
Global Burden of Disease, Disability-Adjusted Life Years, Humans, Nervous System Diseases, United States, Global Health, Cost of Illness

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