Abstract
SummaryBackgroundA systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India.MethodsUsing all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates.FindingsThe contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2–5·0) in 1990 to 8·2% (6·6–10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2–0·3) to 0·6% (0·5–0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5–4·8) to 1·1% (0·9–1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9–46·1]), headache disorders (17·5% [3·6–32·5]), epilepsy (11·3% [9·0–14·3]), cerebral palsy (5·7% [4·2–7·7]), and encephalitis (5·3% [3·7–8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution.InterpretationThe increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation.FundingBill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Highlights
With an ageing population globally, the burden of neurological disorders is rapidly increasing, posing a challenge to the sustainability of health systems, including in low-income and middle-income countries.1–9 The burden of neurological disorders is expected to increase in India due to the rapid demographic and epidemiological transition occurring in the country.10 Evidence regarding the incidence, prevalence, and disease burden associated with neurological disorders in India is scarce
We present a detailed account of the prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) of neurological disorders for the states of India from 1990 to 2019, and the risk factors associated with these disorders
Estimation of prevalence, incidence, and years lived with disability (YLDs) The definitions of neurological disorders and their subtypes in this study are based on various standard clinical diagnostic criteria, details of which are provided in the appendix
Summary
With an ageing population globally, the burden of neurological disorders is rapidly increasing, posing a challenge to the sustainability of health systems, including in low-income and middle-income countries. The burden of neurological disorders is expected to increase in India due to the rapid demographic and epidemiological transition occurring in the country. Evidence regarding the incidence, prevalence, and disease burden associated with neurological disorders in India is scarce. With an ageing population globally, the burden of neurological disorders is rapidly increasing, posing a challenge to the sustainability of health systems, including in low-income and middle-income countries.. The burden of neurological disorders is expected to increase in India due to the rapid demographic and epidemiological transition occurring in the country.. Prevalence, and disease burden associated with neurological disorders in India is scarce. A few local studies have reported disease burden for some neurological disorders.. We found several studies describing the incidence, prevalence, and disease burden of various neurological disorders in different parts of India. No systematic compilation was available on trends in the incidence, prevalence, and disability-adjusted life-years (DALYs) for the major neurological disorders across the states of India over a long period, which is needed to inform neurological health policies and programmes in the country
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