Neurological Disorders Now Top Cause of Illness Disability. (Part 1)

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Read our follow up blog (Part 2): How can I lower my blood pressure and reduce my risk of Neurological Disease?

Article: Medscape Medical News © 2024 WebMD, LLC

Cite this: Neurologic Disorders Now Top Global Cause of Illness, Disability - Medscape - March 14, 2024.

Stroke, Alzheimer’s Disease (AD), and other neurologic conditions are now the leading cause of health loss and disability around the world, affecting nearly half of the world's population, a new comprehensive analysis showed.

In 2021, neurologic conditions were responsible for 443 million years of healthy life lost due to illness, disability, and premature death — a measurement known as disability-adjusted life years (DALY) — making them the top contributor to the global disease burden, ahead of cardiovascular diseases.

Some 3.4 billion people — 43% of the entire global population — had a neurologic illness in 2021, the report noted.

"As the world's leading cause of overall disease burden, and with case numbers rising 59% globally since 1990, nervous system conditions must be addressed through effective, culturally acceptable, and affordable prevention, treatment, rehabilitation, and long-term care strategies," lead author Jaimie Steinmetz, PhD, from the Institute of Health Metrics and Evaluation (IHME), University of Washington, Seattle, said in a news release. 

The findings, from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021, "have important health service and policy implications and serve as evidence that global neurological heath loss has been under-recognized and is increasing and unevenly distributed geographically and socioeconomically," the authors noted.

The study was published online on March 14, 2024, in Lancet Neurology.

The top 10 contributors to neurologic health loss in 2021 were:

·        Stroke

·       Neonatal encephalopathy

·       Migraine

·       Alzheimer’s Disease

·       Diabetic Neuropathy

·       Meningitis

·       Epilepsy

·       Neurological complications from preterm birth

·       Autism spectrum disorder

·       Nervous system cancers

Neurologic consequences of COVID-19 ranked 20th out of 37 unique conditions assessed.

In 2021, there were more than 23 million global cases of COVID-19 with long-term cognitive symptoms or Guillain-Barre Syndrome, accounting for 57% of all infectious neurologic disease cases and contributing to 2.48 million years of healthy life lost, the study found.

The most prevalent neurologic disorders were tension-type headache (about 2 billion cases) and migraine (about 1.1 billion cases), while diabetic neuropathy is the fastest-growing of all neurologic conditions.

"The number of people with diabetic neuropathy has more than tripled globally since 1990, rising to 206 million in 2021. This is in line with the increase in the global prevalence of diabetes," co-senior author Liane Ong, PhD, from IHME, said in the release.

The data showed striking differences in the burden of neurologic conditions between world regions and national income levels, with over 80% of neurologic deaths and health loss occurring in low- and middle-income countries. Regions with the highest burden of neurologic conditions were central and western sub-Saharan Africa, while high-income Asia Pacific and Australasia had the lowest burden.

"Nervous system health loss disproportionately impacts many of the poorest countries partly due to the higher prevalence of conditions affecting neonates and children under 5, especially birth-related complications and infections," co-senior author Tarun Dua, MD, with the World Health Organization (WHO) brain health unit, noted in the release. "Improved infant survival has led to an increase in long-term disability, while limited access to treatment and rehabilitation services is contributing to the much higher proportion of deaths in these countries," Dua said.

Prioritize Prevention

The analysis also provides estimates of the proportion of neurologic conditions that are potentially preventable by eliminating known risk factors for stroke, dementia, multiple sclerosis, Parkinson's disease, encephalitis, meningitis, and intellectual disability.

It shows that modifying 18 risk factors over a person's lifetime — most importantly high systolic blood pressure — could prevent 84% of global DALYs from stroke. Controlling lead exposure could lower intellectual disability cases by 63% and reducing high fasting plasma glucose to normal levels could cut dementia by roughly 15%.

"Because many neurological conditions lack cures, and access to medical care is often limited, understanding modifiable risk factors and the potentially avoidable neurological condition burden is essential to help curb this global health crisis," co-lead author Katrin Seeher, PhD, mental health specialist with WHO's brain health unit, said in the release.

It's important to note that nervous system conditions include infectious and vector-borne diseases and injuries as well as noncommunicable diseases and injuries, Steinmetz said, "demanding different strategies for prevention and treatment throughout life."

"We hope that our findings can help policymakers more comprehensively understand the impact of neurological conditions on both adults and children to inform more targeted interventions in individual countries, as well as guide ongoing awareness and advocacy efforts around the world," Steinmetz added.

In an accompanying editorial, Wolfgang Grisold, president of the World Federation of Neurology, London, United Kingdom, noted that the study builds on previous findings and expands the number of neurologic conditions studied from 15-37.

"This important new GBD report highlights that the burden of neurological conditions is greater than previously thought," wrote Grisold, who was not a part of the study. "In the next iteration, more attention should be given to neuromuscular diseases, the effects of cancer in the nervous system, and neuropathic pain. Comparing the disability caused by conditions with episodic occurrence versus those that cause permanent and progressive disease will remain challenging because the effects on the individuals vary substantially."

The study was funded by the Bill and Melinda Gates Foundation. Full disclosures are included in the original article.

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