Summary Background 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. Methods 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. Findings 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. Interpretation 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. Funding Bill & Melinda Gates Foundation.

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1990-2015 年全球、区域和国家神经系统疾病负担：2015 年全球疾病负担研究的系统分析

摘要 背景 关于全球和特定国家神经系统疾病负担及其趋势的可比数据对于卫生保健规划和资源分配至关重要。全球疾病、伤害和风险因素负担 (GBD) 研究提供了此类信息，但不会例行汇总神经系统疾病临床医生感兴趣的结果。在这项系统分析中，我们量化了 2015 年由神经系统疾病引起的全球疾病负担及其与国家发展水平的关系。方法 我们估计了全球和特定国家的患病率、死亡率、伤残调整生命年 (DALY)、生命损失年 (YLL)、和各种神经系统疾病的残疾寿命 (YLD)，这些神经系统疾病在 GBD 分类中以前已经分布在多个疾病组中。更具包容性的神经系统疾病组包括中风、脑膜炎、脑炎、破伤风、阿尔茨海默病和其他痴呆症、帕金森病、癫痫、多发性硬化症、运动神经元疾病、偏头痛、紧张型头痛、药物过度使用头痛、脑和神经系统癌症，以及其他神经系统疾病的残留类别。我们还分析了基于社会人口指数 (SDI) 的结果，该指数是人均收入、教育和生育率的复合衡量指标，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如何。结果 神经系统疾病是 2015 年 DALYs 的主要病因组（250·7 [95% 不确定性区间 (UI) 229·1 至 274·7] 万，占全球 DALYs 的 10·2%）和第二大病因死亡人数（9·4 [9·1 至 9·7] 百万]，占全球死亡人数的 16·8%）。最普遍的神经系统疾病是紧张型头痛（1505·9 [UI 1337·3 至 1681·6 百万例]）、偏头痛（958·8 [872·1 至 1055·6] 万例）、药物过度使用性头痛（58 ·5 [50·8 至 67·4 百万]），以及阿尔茨海默病和其他痴呆症（46·0 [40·2 至 52·7 百万]）。1990 年至 2015 年间，神经系统疾病死亡人数增加了 36·7%，DALY 人数增加了 7·4%。尽管年龄标准化死亡率和 DALYs 分别下降了 26·1% 和 29·7%，但这些增长还是发生了。中风和传染性神经系统疾病是造成这些下降的主要原因。在 SDI 低的国家，传染性神经系统疾病是造成 DALY 的最大原因。中风率在 SDI 中等水平时最高，在 SDI 最高时最低。随着发育，神经系统疾病的 DALY 率的大部分变化是由 YLL 的变化驱动的。解释 神经系统疾病是世界范围内导致残疾和死亡的重要原因。在全球范围内，尽管中风和传染性神经系统疾病的死亡率大幅下降，但由于人口数量的增加和老龄化，神经系统疾病的负担在过去 25 年中大幅增加。未来几十年，需要具有神经系统疾病专业知识的临床医生护理的患者数量将继续增加。政策制定者和卫生保健提供者应了解这些趋势，以提供足够的服务。资助比尔和梅琳达·盖茨基金会。