Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
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DOI：
10.1016/s1474-4422(17)30299-5
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发表时间：
2017-11
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通讯作者：
GBD 2015 Neurological Disorders Collaborator Group
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作者：
GBD 2015 Neurological Disorders Collaborator Group
全球及各国神经系统疾病负担及其趋势的可比数据对于医疗保健规划和资源分配至关重要。全球疾病负担、伤害及危险因素（GBD）研究提供了此类信息，但并未常规汇总对神经科临床医生有意义的结果。在这项系统分析中，我们量化了2015年神经系统疾病导致的全球疾病负担及其与国家发展水平的关系。
我们估算了全球及各国多种神经系统疾病的患病率、死亡率、伤残调整生命年（DALYs）、因过早死亡损失的寿命年（YLLs）和伤残所致生命年（YLDs），这些疾病在GBD分类中此前分散在多个疾病类别中。涵盖更广泛的神经系统疾病类别包括卒中、脑膜炎、脑炎、破伤风、阿尔茨海默病及其他痴呆、帕金森病、癫痫、多发性硬化症、运动神经元病、偏头痛、紧张型头痛、药物过度使用性头痛、脑和神经系统癌症以及其他神经系统疾病这一剩余类别。我们还根据社会人口学指数（SDI，一种人均收入、教育和生育率的综合衡量指标）分析了结果，以确定与发展相关的模式以及各国相对于其发展水平的预期结果的表现情况。
2015年，神经系统疾病是DALYs的首要病因类别（2.507亿[95%不确定区间（UI）为2.291亿 - 2.747亿]，占全球DALYs的10.2%），是死亡的第二大病因类别（940万[910万 - 970万]，占全球死亡人数的16.8%）。最常见的神经系统疾病是紧张型头痛（15.059亿[UI为13.373亿 - 16.816亿例]）、偏头痛（9.588亿[8.721亿 - 10.556亿]）、药物过度使用性头痛（5850万[5080万 - 6740万]）以及阿尔茨海默病及其他痴呆（4600万[4020万 - 5270万]）。1990年至2015年期间，神经系统疾病导致的死亡人数增加了36.7%，DALYs增加了7.4%。尽管年龄标准化死亡率和DALYs率分别下降了26.1%和29.7%，但这些数字仍在增加；卒中以及传染性神经系统疾病是这些下降的主要原因。在社会人口学指数较低的国家，传染性神经系统疾病是DALYs的最大病因。卒中发病率在社会人口学指数中等水平时最高，在最高水平时最低。神经系统疾病DALY率随发展的大部分变化是由YLLs的变化驱动的。
神经系统疾病是全球残疾和死亡的重要原因。在全球范围内，尽管卒中及传染性神经系统疾病的死亡率大幅下降，但由于人口数量增加和老龄化，过去25年神经系统疾病的负担大幅增加。未来几十年，需要神经科专业临床医生护理的患者数量将继续增加。政策制定者和医疗服务提供者应了解这些趋势，以提供充足的服务。
比尔及梅琳达·盖茨基金会
Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions. In this systematic analysis, we quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level. We estimated global and country-specific prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for various neurological disorders that in the GBD classification have been previously spread across multiple disease groupings. The more inclusive grouping of neurological disorders included stroke, meningitis, encephalitis, tetanus, Alzheimer's disease and other dementias, Parkinson's disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, medication overuse headache, brain and nervous system cancers, and a residual category of other neurological disorders. We also analysed results based on the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility, to identify patterns associated with development and how countries fare against expected outcomes relative to their level of development. Neurological disorders ranked as the leading cause group of DALYs in 2015 (250·7 [95% uncertainty interval (UI) 229·1 to 274·7] million, comprising 10·2% of global DALYs) and the second-leading cause group of deaths (9·4 [9·1 to 9·7] million], comprising 16·8% of global deaths). The most prevalent neurological disorders were tension-type headache (1505·9 [UI 1337·3 to 1681·6 million cases]), migraine (958·8 [872·1 to 1055·6] million), medication overuse headache (58·5 [50·8 to 67·4 million]), and Alzheimer's disease and other dementias (46·0 [40·2 to 52·7 million]). Between 1990 and 2015, the number of deaths from neurological disorders increased by 36·7%, and the number of DALYs by 7·4%. These increases occurred despite decreases in age-standardised rates of death and DALYs of 26·1% and 29·7%, respectively; stroke and communicable neurological disorders were responsible for most of these decreases. Communicable neurological disorders were the largest cause of DALYs in countries with low SDI. Stroke rates were highest at middle levels of SDI and lowest at the highest SDI. Most of the changes in DALY rates of neurological disorders with development were driven by changes in YLLs. Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, despite substantial decreases in mortality rates from stroke and communicable neurological disorders. The number of patients who will need care by clinicians with expertise in neurological conditions will continue to grow in coming decades. Policy makers and health-care providers should be aware of these trends to provide adequate services. Bill & Melinda Gates Foundation.