Summary 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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1990-2016 年全球、区域和国家神经系统疾病负担：2016 年全球疾病负担研究的系统分析


摘要 背景 神经系统疾病越来越被认为是全世界死亡和残疾的主要原因。 2016 年全球疾病、伤害和风险因素负担研究 (GBD) 分析的目的是提供对全球、区域和国家神经系统疾病负担的最全面和最新的估计。方法 我们按年龄和性别估算了 15 种神经系统疾病类别（破伤风、脑膜炎、脑炎、中风、脑部及其他中枢神经系统癌症、脑外伤、脊髓损伤、阿尔茨海默病及其他痴呆症、帕金森病、多发性硬化症、运动神经元疾病、特发性癫痫、偏头痛、紧张型头痛及残留类1990年至2016年期间，195个国家发生了其他不太常见的神经系统疾病。DisMod-MR 2.1（一种贝叶斯元回归工具）是估计患病率和发病率的主要方法，并使用了死因集成模型（CODEm）用于死亡率估计。我们使用 GBD 比较风险评估方法量化了 84 种风险和风险组合对 15 种神经系统疾病类别的疾病估计的贡献。研究结果 在全球范围内，2016 年，神经系统疾病是 DALY 的主要原因（2.76 亿 [95% UI 247–308]），也是第二大死亡原因（9·0 百万 [8·8–9·4]）。所有神经系统疾病导致的死亡和伤残调整生命年的绝对人数增加（死亡增加 39% [34–44]，伤残调整生命年增加 15% [9–21]），而年龄标准化比率下降（死亡增加 28% [26–30]） ] 和伤残调整生命年 (DALY) 在 1990 年至 2016 年间增加了 27% [24–31])。 死亡率和伤残调整生命年绝对数下降的唯一神经系统疾病是破伤风、脑膜炎和脑炎。神经系统 DALY 的四个最大贡献者是中风 (42·2% [38·6–46·1])、偏头痛 (16·3% [11·7–20·8])、阿尔茨海默病和其他痴呆症 (10·4) % [9·0–12·1]) 和脑膜炎 (7·9% [6·6–10·4])。对于复合神经系统疾病，男性的年龄标准化 DALY 率显着高于女性（男女比例 1·12 [1·05–1·20]），但偏头痛、多发性硬化症和紧张型头痛以女性更为常见，造成的负担也更大，男女比例小于0·7。 GBD 中量化的 84 种风险只能解释不到 10% 的神经系统疾病 DALY 负担（中风除外），其中 88·8% (86·5–90·9) 的 DALY 归因于风险因素，而阿尔茨海默病的程度较小和其他痴呆（DALY 的 22·3% [11·8–35·1] 属于风险归因）和特发性癫痫（DALY 的 14·1% [10·8–17·5] 属于风险归因）。解读 在全球范围内，神经系统疾病的负担（以伤残调整生命年的绝对数衡量）持续增加。随着人口增长和老龄化，以及主要致残性神经系统疾病的患病率随着年龄的增长而急剧增加，政府将面临对神经系统疾病的治疗、康复和支持服务日益增长的需求。对于大多数神经系统负担而言，缺乏既定的可改变风险，这表明需要新的知识来制定有效的预防和治疗策略。资助比尔及梅琳达·盖茨基金会。