The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017
The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017
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DOI：
10.1016/s2468-2667(20)30190-0
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发表时间：
2020-10-01
影响因子：
50
通讯作者：
Feigin, Valery L.
中科院分区：
文献类型：
--
作者：
Deuschl, Guenther;Beghi, Ettore;Feigin, Valery L.
神经系统疾病在全球范围内造成了巨大且不断增加的健康负担，如2016年全球疾病负担（GBD）研究所示。了解这种负担在区域和国家之间的差异对于告知公共卫生政策和预防战略非常重要。欧盟的人口比世卫组织欧洲区域（西欧、中欧和东欧）的人口年龄大，甚至比全球人口年龄大，这表明欧盟可能特别容易受到年龄相关神经系统疾病负担增加的影响。我们的目的是比较1990年至2017年欧盟与世界卫生组织欧洲地区和全球神经系统疾病的负担。方法计算2017年欧盟和世界卫生组织欧洲地区国家神经系统疾病的负担，包括发病率、患病率、死亡率、残疾调整生命年（DADs）、寿命损失年数和残疾生存年数。完全地和单独地。分析的疾病有阿尔茨海默病和其他痴呆症、癫痫、头痛（偏头痛和紧张型头痛）、多发性硬化症、帕金森病、脑癌、运动神经元疾病、神经感染性疾病和中风。数据以总数和性别、年龄、年份、地区和社会人口学背景列出，并以计数和比率显示。结果2017年，可归因于神经系统疾病的残疾人总数为2100万（95%不确定性区间18.5-23.9），在欧盟和4110万（36.7-45.9），欧盟和世卫组织欧洲区域的死亡总数分别为110万（1.09-1.14）和197万（1.95-2.01）。在欧盟，神经系统疾病排在心血管疾病和癌症之后，占总死亡人数的13.3%（10.3-17.1）和总死亡人数的19.5%（18.0-21.3）。中风、痴呆和头痛是欧盟最常见的三种原因。中风也是世卫组织欧洲区域糖尿病的主要原因。在研究期间，我们发现神经退行性疾病的所有年龄段负担大幅增加，尽管中风和感染率大幅下降。在欧洲，男性的神经系统疾病负担高于女性，在80-84岁的个体中达到峰值，并且在世卫组织欧洲区域和国家之间存在很大差异。在所有年龄段衡量标准中，所有年龄段的DALY、死亡人数和神经系统疾病患病率均有所增加，但在除三个国家（阿塞拜疆、土库曼斯坦和乌兹别克斯坦）外的所有国家中，使用年龄标准化衡量标准时，这些数字均有所下降。这一下降主要归因于过早死亡率的下降，尽管残疾人数总体上有所增加。解释神经系统疾病是欧盟残疾和过早死亡的第三大常见原因，其患病率和负担可能会随着欧洲人口的逐步老龄化而增加。卫生当局必须更加重视神经系统疾病的预防和护理。这里提供的数据表明，不同国家在卫生服务发展和资源分配方面有不同的优先事项。版权所有（c）2020作者。爱思唯尔有限公司出版
Background Neurological disorders account for a large and increasing health burden worldwide, as shown in the Global Burden of Diseases (GBD) Study 2016. Unpacking how this burden varies regionally and nationally is important to inform public health policy and prevention strategies. The population in the EU is older than that of the WHO European region (western, central, and eastern Europe) and even older than the global population, suggesting that it might be particularly vulnerable to an increasing burden of age-related neurological disorders. We aimed to compare the burden of neurological disorders in the EU between 1990 and 2017 with those of the WHO European region and worldwide.Methods The burden of neurological disorders was calculated for the year 2017 as incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability for the countries in the EU and the WHO European region, totally and, separately. Diseases analysed were Alzheimer's disease and other dementias, epilepsy, headache (migraine and tension-type headache), multiple sclerosis, Parkinson's disease, brain cancer, motor neuron diseases, neuroinfectious diseases, and stroke. Data are presented as totals and by sex, age, year, location and socio-demographic context, and shown as counts and rates.Findings In 2017, the total number of DALYs attributable to neurological disorders was 21.0 million (95% uncertainty interval 18.5-23.9) in the EU and 41.1 million (36.7-45.9) in the WHO European region, and the total number of deaths was 1.1 million (1.09-1.14) in the EU and 1.97 million (1.95-2.01) in the WHO European region. In the EU, neurological disorders ranked third after cardiovascular diseases and cancers representing 13.3% (10.3-17.1) of total DALYs and 19.5% (18.0-21.3) of total deaths. Stroke, dementias, and headache were the three commonest causes of DALYs in the EU. Stroke was also the leading cause of DALYs in the WHO European region. During the study period we found a substantial increase in the all-age burden of neurodegenerative diseases, despite a substantial decrease in the rates of stroke and infections. The burden of neurological disorders in Europe was higher in men than in women, peaked in individuals aged 80-84 years, and varied substantially with WHO European region and country. All-age DALYs, deaths, and prevalence of neurological disorders increased in all-age measures, but decreased when using age-standardised measures in all but three countries (Azerbaijan, Turkmenistan, and Uzbekistan). The decrease was mostly attributed to the reduction of premature mortality despite an overall increase in the number of DALYs.Interpretation Neurological disorders are the third most common cause of disability and premature death in the EU and their prevalence and burden will likely increase with the progressive ageing of the European population. Greater attention to neurological diseases must be paid by health authorities for prevention and care. The data presented here suggest different priorities for health service development and resource allocation in different countries. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd.