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Epidemiology of Neurological Disorders
Dr. Yeşim YASİN Fall-2013
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Outline:
• Global burden of neurological disorders
• National burden of neurological disorders
• Most commonly seen neurological disorders: a
public health approach
• Prevention
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Global burden of disesase
•Neurological diseases are becoming
increasingly important in terms of
public health throughout the world
and in Turkey.
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Global burden of disesase
• The Global Burden of Disease report drew the
attention of the international health
community to the fact that the burden of
mental and neurological disorders had been
seriously underestimated by traditional
epidemiological methods that took into
account only mortality, not disability rates.
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Global burden of disease
• The Global Burden of Disease report specifically
showed that while mental and neurological
disorders are responsible for about 1% of deaths,
they account for almost 11% of disease burden
worldwide
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• Many conditions including neuropsychiatric disorders
and injuries cause considerable ill-health but no or
few direct deaths.
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• Neuropsychiatric disorders and injuries in
particular were major causes of lost years of
healthy life as measured by DALYs,
• were significantly underestimated when measured
by mortality alone
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Common neurological disorders
• Stroke
• Dementia
• Epilepsy
• parkinsonS disease
• Headeache disorders
• Multiple sclerosis
• Neuroinfections
• Neurological disorders
associated with
malnutrition
• Pain associated with
neurological disorders
• Traumatic brain disorder
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Estimates of disability adjusted life years (DALYs)
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Table 1. Number of DALYs for neurological disorders and as percentage of global DALYs projected for 2015 and 2030
neur
opsy
chia
tric
cat
egor
y
2%
4.3%
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Percentage of total DALYs for selected
diseasesa and neurological disordersb
Neurological disoerders constitute slightly over 6% of total burden,
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DALYs for individual neurological disorders as percentage of
total neurological disorders
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Neurological disorders as percentage of total DALYs for 2005,
2015 and 2030 across income category
Neurological disorders contribute to 10.9%, 6.7%, 8.7% and 4.5% of the global burden of disease in high, upper middle, lower middle and low income countries, respectively, in 2005.
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Estimates of deaths
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Deaths attributable to neurological disorders as percentage of
total deaths, 2005, 2015, 2030
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Deaths from selected neurological disorders as percentage of
total neurological disorders
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Deaths
DALYs
Deaths and DALYs from
selected neurological
disorders as percentage
of total neurological
disordres
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Neurological disorders as percentage of total deaths for 2005,
2015 and 2030 across World Bank income category
Neurological disorders constitute 16.8% of the total deaths in lower middle income
countries compared with 13.2% of the total deaths in high income countries.
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Estimates of years of healthy life lost as a resultof disability (YLDs)
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YLDs per 100 000 population associated with neurological disorders and other diseases and injuries with neurological sequelae and as percentage of total YLDs projected for 2015 and 2030
The number of YLDs per 100 000 population
associated with neurological disorders and other diseases and injuries with neurological sequelae
is projected to decline from 1264 in 2005 to 1109
in 2030
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YLDs per 100 000 population associated with neurological disorders and other diseases and injuries with neurological sequelae and as percentage of total YLDs projected for 2015 and 2030
YLDs associated with Alzheimer and other dementias, however, are projected to increase by 38%.
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Top five causes of YLDs among neurological disorders, by income
category YLDs per 100 000 population for neuroinfections, and the nutritional deficiencies and neuropathies category are highest for low income countries
neurological injuries, epilepsy and migraine, they are highest in upper middle income countries
For Alzheimer and other dementias they are highest for high income countries
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YLDs associated with neurologicaldisorders by incomecategory
almost half of the burden in terms of YLDs attributable to neurological disorders is in low income countries followed by lower middle income countries
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Turkey, Burden of Disease
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Turkey, Burden of disease
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BURDEN ATTRIBUTABLE TO SEVEN BASIC RISK FACTORS
• Alcohol use
• Insufficient
consumption of fruits
and vegetables
• Physical inactivity
• High colesterol
• Smoking
• High body mass
index
• High blood
pressure
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Hypertension as a common risk factor
number of deaths attributed to hypertension, which refers to the fact that they could be prevented by keeping hypertension under control is 39.731 for cerebrovascular diseases
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alcohol consumption-attributed deaths are mostly the consequences ischemic heartdiseases and hemorragic stroke. 2088 deaths caused by hemorrhagic stroke could be prevented by prevention of alcohol consumption
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11109 deaths caused by ischemic stroke could be prevented by prevention of obesity
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high cholesterol is among major risk factors of ischemic heart
diseases and ischemic stroke.
Prevention of high cholesterol could prevent 7.802 deaths
caused by ischemic stroke
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Sufficient amount of physical activity could prevent 10.269 deaths caused by
ischemic stroke.
As for burden of disease which is preventable, physical activity could
prevent 101.578 DALY in ischemic stroke.
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Prevention
•Many neurological disorders can be prevented!
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Prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention
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Primary prevention
• High risk approach (individual approach)
• Population based approach
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Prevention- high risk strategy • Elimination of the major risk factors.
• Controlling high blood pressure
• Lowering the level of blood cholesterol
• Quitting tobacco use
• Controlling diabetes
• Maintaining a healthy weight, body mass index
• Diet
• Exercising regularly
•Prevention and treatment of coronary hearth diseases
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Prevention- population based strategy
• Raising awareness of health personnel about treatment and
prevention of neurological diseases
A comprehensivenational strategy; community-based health promotion and access to treatment can substantially decrease the burden associated with cerebrovascular diseases (stroke)
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• Health promotion programmes to prevent risk factors.
• Smoke free air space
• Diabet control programmes
• Promoting and creating built or natural environments that encourage
and support physical activity.
Prevention-population based strategy
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Prevention- population based strategy
• immunization programme for the prevention of
neuroinfections (poliomyelitis, neurological consequences of
infections)
• Road safety – prevention of traumatic brain injury
Traumatic brain injury is the leading cause ofdeath and disability in children and young adults
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Tertiary prevention
• Using medication
• Rehabilitation
ASPIRIN In cases of acute stroke, aspirin is given as soon as CT or
MRI has excluded intracranial
haemorrhage.
Immediate aspirin treatment slightly
lowers the risk of early recurrent stroke and
increases the chances of survival free of
disability
about one fewer patient dies or is left dependent per
100 treated. However, because aspirin is applicable to so many stroke patients,
it has the potential to have a substantial public health
effect.
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WHO recommendations
• Gain commitment from decision-makers • Increase public and professional awareness• Minimize stigma and eradicate discrimination• Strengthen neurological care within the existing
health systems • Incorporate rehabilitation into the key strategies • Establish links to other sectors• Define priorities for research
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Conclusions
• Estimating the burden of diseases is difficult due to
• imperfect medical registration,
• variations in structure of patient referral and influence of
secondary diagnoses.
• Taking into account the current aging of the population, the
prevalence of some neurological diseases, such as CVA, Parkinson's
disease and dementia will rise.
• Priority setting for care and treatment is hampered by differences in
burden of illness on the individual and on the community level
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THANK YOU!
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