@article{3106051,
    title = "Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016",
    author = "Feigin, V.L. and Nichols, E. and Alam, T. and Bannick, M.S. and Beghi, E. and Blake, N. and Culpepper, W.J. and Dorsey, E.R. and Elbaz, A. and Ellenbogen, R.G. and Fisher, J.L. and Fitzmaurice, C. and Giussani, G. and Glennie, L. and James, S.L. and Johnson, C.O. and Kassebaum, N.J. and Logroscino, G. and Marin, B. and Mountjoy-Venning, W.C. and Nguyen, M. and Ofori-Asenso, R. and Patel, A.P. and Piccininni, M. and Roth, G.A. and Steiner, T.J. and Stovner, L.J. and Szoeke, C.E.I. and Theadom, A. and Vollset, S.E. and Wallin, M.T. and Wright, C. and Zunt, J.R. and Abbasi, N. and Abd-Allah, F. and Abdelalim, A. and Abdollahpour, I. and Aboyans, V. and Abraha, H.N. and Acharya, D. and Adamu, A.A. and Adebayo, O.M. and Adeoye, A.M. and Adsuar, J.C. and Afarideh, M. and Agrawal, S. and Ahmadi, A. and Ahmed, M.B. and Aichour, A.N. and Aichour, I. and Aichour, M.T.E. and Akinyemi, R.O. and Akseer, N. and Al-Eyadhy, A. and Al-Shahi Salman, R. and Alahdab, F. and Alene, K.A. and Aljunid, S.M. and Altirkawi, K. and Alvis-Guzman, N. and Anber, N.H. and Antonio, C.A.T. and Arabloo, J. and Aremu, O. and Ärnlöv, J. and Asayesh, H. and Asghar, R.J. and Atalay, H.T. and Awasthi, A. and Ayala Quintanilla, B.P. and Ayuk, T.B. and Badawi, A. and Banach, M. and Banoub, J.A.M. and Barboza, M.A. and Barker-Collo, S.L. and Bärnighausen, T.W. and Baune, B.T. and Bedi, N. and Behzadifar, M. and Behzadifar, M. and Béjot, Y. and Bekele, B.B. and Belachew, A.B. and Bennett, D.A. and Bensenor, I.M. and Berhane, A. and Beuran, M. and Bhattacharyya, K. and Bhutta, Z.A. and Biadgo, B. and Bijani, A. and Bililign, N. and Bin Sayeed, M.S. and Blazes, C.K. and Brayne, C. and Butt, Z.A. and Campos-Nonato, I.R. and Cantu-Brito, C. and Car, M. and Cárdenas, R. and Carrero, J.J. and Carvalho, F. and Castañeda-Orjuela, C.A. and Castro, F. and Catalá-López, F. and Cerin, E. and Chaiah, Y. and Chang, J.-C. and Chatziralli, I. and Chiang, P.P.-C. and Christensen, H. and Christopher, D.J. and Cooper, C. and Cortesi, P.A. and Costa, V.M. and Criqui, M.H. and Crowe, C.S. and Damasceno, A.A.M. and Daryani, A. and De la Cruz-Góngora, V. and De La Hoz, F.P. and De Leo, D. and Degefa, M.G. and Demoz, G.T. and Deribe, K. and Dharmaratne, S.D. and Diaz, D. and Dinberu, M.T. and Djalalinia, S. and Doku, D.T. and Dubey, M. and Dubljanin, E. and Duken, E.E. and Edvardsson, D. and El-Khatib, Z. and Endres, M. and Endries, A.Y. and Eskandarieh, S. and Esteghamati, A. and Esteghamati, S. and Farhadi, F. and Faro, A. and Farzadfar, F. and Farzaei, M.H. and Fatima, B. and Fereshtehnejad, S.-M. and Fernandes, E. and Feyissa, G.T. and Filip, I. and Fischer, F. and Fukumoto, T. and Ganji, M. and Gankpe, F.G. and Garcia-Gordillo, M.A. and Gebre, A.K. and Gebremichael, T.G. and Gelaw, B.K. and Geleijnse, J.M. and Geremew, D. and Gezae, K.E. and Ghasemi-Kasman, M. and Gidey, M.Y. and Gill, P.S. and Gill, T.K. and Gnedovskaya, E.V. and Goulart, A.C. and Grada, A. and Grosso, G. and Guo, Y. and Gupta, R. and Gupta, R. and Haagsma, J.A. and Hagos, T.B. and Haj-Mirzaian, A. and Haj-Mirzaian, A. and Hamadeh, R.R. and Hamidi, S. and Hankey, G.J. and Hao, Y. and Haro, J.M. and Hassankhani, H. and Hassen, H.Y. and Havmoeller, R. and Hay, S.I. and Hegazy, M.I. and Heidari, B. and Henok, A. and Heydarpour, F. and Hoang, C.L. and Hole, M.K. and Homaie Rad, E. and Hosseini, S.M. and Hu, G. and Igumbor, E.U. and Ilesanmi, O.S. and Irvani, S.S.N. and Islam, S.M.S. and Jakovljevic, M. and Javanbakht, M. and Jha, R.P. and Jobanputra, Y.B. and Jonas, J.B. and Józwiak, J.J. and Jürisson, M. and Kahsay, A. and Kalani, R. and Kalkonde, Y. and Kamil, T.A. and Kanchan, T. and Karami, M. and Karch, A. and Karimi, N. and Kasaeian, A. and Kassa, T.D. and Kassa, Z.Y. and Kaul, A. and Kefale, A.T. and Keiyoro, P.N. and Khader, Y.S. and Khafaie, M.A. and Khalil, I.A. and Khan, E.A. and Khang, Y.-H. and Khazaie, H. and Kiadaliri, A.A. and Kiirithio, D.N. and Kim, A.S. and Kim, D. and Kim, Y.-E. and Kim, Y.J. and Kisa, A. and Kokubo, Y. and Koyanagi, A. and Krishnamurthi, R.V. and Kuate Defo, B. and Kucuk Bicer, B. and Kumar, M. and Lacey, B. and Lafranconi, A. and Lansingh, V.C. and Latifi, A. and Leshargie, C.T. and Li, S. and Liao, Y. and Linn, S. and Lo, W.D. and Lopez, J.C.F. and Lorkowski, S. and Lotufo, P.A. and Lucas, R.M. and Lunevicius, R. and Mackay, M.T. and Mahotra, N.B. and Majdan, M. and Majdzadeh, R. and Majeed, A. and Malekzadeh, R. and Malta, D.C. and Manafi, N. and Mansournia, M.A. and Mantovani, L.G. and März, W. and Mashamba-Thompson, T.P. and Massenburg, B.B. and Mate, K.K.V. and McAlinden, C. and McGrath, J.J. and Mehta, V. and Meier, T. and Meles, H.G. and Melese, A. and Memiah, P.T.N. and Memish, Z.A. and Mendoza, W. and Mengistu, D.T. and Mengistu, G. and Meretoja, A. and Meretoja, T.J. and Mestrovic, T. and Miazgowski, B. and Miazgowski, T. and Miller, T.R. and Mini, G.K. and Mirrakhimov, E.M. and Moazen, B. and Mohajer, B. and Mohammad Gholi Mezerji, N. and Mohammadi, M. and Mohammadi-Khanaposhtani, M. and Mohammadibakhsh, R. and Mohammadnia-Afrouzi, M. and Mohammed, S. and Mohebi, F. and Mokdad, A.H. and Monasta, L. and Mondello, S. and Moodley, Y. and Moosazadeh, M. and Moradi, G. and Moradi-Lakeh, M. and Moradinazar, M. and Moraga, P. and Moreno Velásquez, I. and Morrison, S.D. and Mousavi, S.M. and Muhammed, O.S. and Muruet, W. and Musa, K.I. and Mustafa, G. and Naderi, M. and Nagel, G. and Naheed, A. and Naik, G. and Najafi, F. and Nangia, V. and Negoi, I. and Negoi, R.I. and Newton, C.R.J. and Ngunjiri, J.W. and Nguyen, C.T. and Nguyen, L.H. and Ningrum, D.N.A. and Nirayo, Y.L. and Nixon, M.R. and Norrving, B. and Noubiap, J.J. and Nourollahpour Shiadeh, M. and Nyasulu, P.S. and Ogbo, F.A. and Oh, I.-H. and Olagunju, A.T. and Olagunju, T.O. and Olivares, P.R. and Onwujekwe, O.E. and Oren, E. and Owolabi, M.O. and A, M.P. and Pakpour, A.H. and Pan, W.-H. and Panda-Jonas, S. and Pandian, J.D. and Patel, S.K. and Pereira, D.M. and Petzold, M. and Pillay, J.D. and Piradov, M.A. and Polanczyk, G.V. and Polinder, S. and Postma, M.J. and Poulton, R. and Poustchi, H. and Prakash, S. and Prakash, V. and Qorbani, M. and Radfar, A. and Rafay, A. and Rafiei, A. and Rahim, F. and Rahimi-Movaghar, V. and Rahman, M. and Rahman, M.H.U. and Rahman, M.A. and Rajati, F. and Ram, U. and Ranta, A. and Rawaf, D.L. and Rawaf, S. and Reinig, N. and Reis, C. and Renzaho, A.M.N. and Resnikoff, S. and Rezaeian, S. and Rezai, M.S. and Rios González, C.M. and Roberts, N.L.S. and Roever, L. and Ronfani, L. and Roro, E.M. and Roshandel, G. and Rostami, A. and Sabbagh, P. and Sacco, R.L. and Sachdev, P.S. and Saddik, B. and Safari, H. and Safari-Faramani, R. and Safi, S. and Safiri, S. and Sagar, R. and Sahathevan, R. and Sahebkar, A. and Sahraian, M.A. and Salamati, P. and Salehi Zahabi, S. and Salimi, Y. and Samy, A.M. and Sanabria, J. and Santos, I.S. and Santric Milicevic, M.M. and Sarrafzadegan, N. and Sartorius, B. and Sarvi, S. and Sathian, B. and Satpathy, M. and Sawant, A.R. and Sawhney, M. and Schneider, I.J.C. and Schöttker, B. and Schwebel, D.C. and Seedat, S. and Sepanlou, S.G. and Shabaninejad, H. and Shafieesabet, A. and Shaikh, M.A. and Shakir, R.A. and Shams-Beyranvand, M. and Shamsizadeh, M. and Sharif, M. and Sharif-Alhoseini, M. and She, J. and Sheikh, A. and Sheth, K.N. and Shigematsu, M. and Shiri, R. and Shirkoohi, R. and Shiue, I. and Siabani, S. and Siddiqi, T.J. and Sigfusdottir, I.D. and Sigurvinsdottir, R. and Silberberg, D.H. and Silva, J.P. and Silveira, D.G.A. and Singh, J.A. and Sinha, D.N. and Skiadaresi, E. and Smith, M. and Sobaih, B.H. and Sobhani, S. and Soofi, M. and Soyiri, I.N. and Sposato, L.A. and Stein, D.J. and Stein, M.B. and Stokes, M.A. and Sufiyan, M.B. and Sykes, B.L. and Sylaja, P. and Tabarés-Seisdedos, R. and Te Ao, B.J. and Tehrani-Banihashemi, A. and Temsah, M.-H. and Temsah, O. and Thakur, J.S. and Thrift, A.G. and Topor-Madry, R. and Tortajada-Girbés, M. and Tovani-Palone, M.R. and Tran, B.X. and Tran, K.B. and Truelsen, T.C. and Tsadik, A.G. and Tudor Car, L. and Ukwaja, K.N. and Ullah, I. and Usman, M.S. and Uthman, O.A. and Valdez, P.R. and Vasankari, T.J. and Vasanthan, R. and Veisani, Y. and Venketasubramanian, N. and Violante, F.S. and Vlassov, V. and Vosoughi, K. and Vu, G.T. and Vujcic, I.S. and Wagnew, F.S. and Waheed, Y. and Wang, Y.-P. and Weiderpass, E. and Weiss, J. and Whiteford, H.A. and Wijeratne, T. and Winkler, A.S. and Wiysonge, C.S. and Wolfe, C.D.A. and Xu, G. and Yadollahpour, A. and Yamada, T. and Yano, Y. and Yaseri, M. and Yatsuya, H. and Yimer, E.M. and Yip, P. and Yisma, E. and Yonemoto, N. and Yousefifard, M. and Yu, C. and Zaidi, Z. and Zaman, S.B. and Zamani, M. and Zandian, H. and Zare, Z. and Zhang, Y. and Zodpey, S. and Naghavi, M. and Murray, C.J.L. and Vos, T. and GBD 2016 Neurology Collaborators",
    journal = "The Lancet Neurology",
    year = "2019",
    volume = "18",
    number = "5",
    pages = "459-480",
    publisher = "The Lancet Publishing Group",
    doi = "10.1016/S1474-4422(18)30499-X",
    keywords = "Alzheimer disease;  Article;  cause of death;  cerebrovascular accident;  dementia;  disability-adjusted life year;  encephalitis;  generalized epilepsy;  global disease burden;  human;  incidence;  meningitis;  migraine;  mortality rate;  multiple sclerosis;  neurologic disease;  prevalence;  priority journal;  sex difference;  tension headache;  tetanus;  adult;  age;  aged;  dementia;  disability;  economics;  female;  global disease burden;  male;  middle aged;  mortality;  neurologic disease;  quality adjusted life year;  risk factor;  sex factor;  socioeconomics;  very elderly, Adult;  Age Factors;  Aged;  Aged, 80 and over;  Cause of Death;  Dementia;  Disability Evaluation;  Female;  Global Burden of Disease;  Humans;  Incidence;  Male;  Middle Aged;  Nervous System Diseases;  Prevalence;  Quality-Adjusted Life Years;  Risk Factors;  Sex Factors;  Socioeconomic Factors",
    abstract = "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. © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license"
}