Neuroepidemiology最新文献

Background: Existing studies have focused on neurological disorders' morbidity and mortality, yet their economic consequences remain unquantified. We estimated the macroeconomic impact of neurological disorders and subcategories at the global, super-regional, and national levels in 2019 and 2021, and described sex and age distribution.

Methods: We obtained mortality and morbidity data, reflecting long-run and short-run disease burden respectively, from the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease 2021 study. Purchasing power parity (PPP)-adjusted gross domestic product (GDP) data were sourced from the World Bank. Economic burden was estimated using the value of lost welfare (VLW) framework, which rests on the value of a statistical life (VSL) and covers non-market losses. All monetary values are expressed in 2021 international dollars adjusted for PPP.

Results: In 2021, the global VLW of neurological disorders was $10,710.51 billion, equal to 7.23% of global gross domestic product (GDP), and the short-run economic burden predominates over the long-run component. By subcategories, headache disorders accounted for 44.7%, and Alzheimer's disease and other dementias for 35.7%. From 2019 to 2021, global VLW changed little, while VLW/GDP (%) declined slightly due to rising nominal GDP.

Conclusions: Neurological disorders impose substantial economic burden globally, particularly in High-income super-region and older populations. Policy emphasis should reflect regional burden profiles. High-income settings prioritize earlier dementia detection, life-course risk-factor control, and caregiver support., while low- and middle-income settings scale primary-care chronic management and effective acute headache therapies.

Objective: This study evaluates the use of infarct growth rate (IGR) from CT perfusion (CTP) imaging to predict poor prognosis in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT).

Methods: We analyzed data from a prospective clinical database of patients admitted with anterior circulation large vessel occlusive stroke from January 2022 to December 2024. IGR was defined as the ischemic core volume on CTP imaging divided by the time from stroke onset to imaging. O.662utcomes were assessed at 90 days using the modified Rankin scale (mRS). Multivariate logistic regression and restricted cubic spline (RCS) analyses were employed to assess the independent and combined effects of IGR and NIHSS score on the clinical prognosis of AIS patients after thrombectomy. Receiver operating characteristic (ROC) curve analysis was further utilized to evaluate the predictive performance of these associations.

Results: A total of 232 patients satisfied the inclusion criteria. Among them, 83 patients (35.8% of the study cohort) exhibited a poor prognosis. After adjustment for potential confounders, an increased IGR was independently associated with a higher risk of poor prognosis (adjusted odds ratio: 1.17; 95% CI: 1.10-1.24; P<0.001), a relationship which was further characterized as nonlinear (P for nonlinearity < 0.0001). The AUC for the combination of NIHSS score and IGR was 0.90 (95% CI: 0.86-0.94).

Conclusions: An elevated IGR was identified as an independent predictor of poor prognosis in patients with AIS who underwent EVT.

Background: Mental disorders among school-age children represent a significant global health issue and substantially contribute to the global disease burden. This study aims to examine the patterns and trends of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and conduct disorder (CD), which are commonly observed in school-age children, from 1990 to 2021, offering valuable insights for health policy formulation, medical resource allocation, and optimization of patient management strategies.

Methods: We analyzed data from the Global Burden of Disease (GBD) 2021 study for 21 regions and 204 countries, focusing on prevalence, disability-adjusted life years (DALYs), gender, and different time periods to gain a deeper understanding of the health burden. We assessed correlations with the Socio-demographic Index (SDI) and employed autoregressive integrated moving average modeling to forecast developments up to 2040, enabling us to better comprehend the burden and trends of these mental disorders.

Results: In 2021, the prevalence rates of ADHD, ASD, and CD per 100,000 population among children aged 5-14 years were 2374.8, 847.13, and 2146.48, respectively; DALYs rates were 29.17, 162.85, and 262.53, respectively. Compared to 1990, prevalence and DALYs rates exhibited changes of -0.06, 0.03, and 0.04, respectively. Australia, Japan, and the United Kingdom exhibited particularly notable burdens, with the United Kingdom continuing to show rapid growth in ASD, while ADHD and CD increased rapidly in China and India, respectively. Gender and age analyses revealed a higher burden among males. Regions with high SDI displayed higher epidemiological indicators. For the 2040 forecast, the indicators for ADHD in terms of prevalence and DALYs are projected to be 3796.65 and 44.33 for males, and 1343.18 and 16.23 for females. For ASD, they are projected to be 1103.04 and 215.23 for males, and 552.01 and 106.40 for females. For CD, they are projected to be 2650.69 and 325.64 for males, and 1593.57 and 200.41 for females.

Conclusion: This study underscores the complex epidemiological landscape of ADHD, ASD, and CD, revealing variations in burden across gender and geographical regions. It emphasizes the urgent need for healthcare professionals and policymakers to devise innovative prevention and healthcare strategies based on the current and evolving burden of these mental disorders, with the aim of alleviating the global disease burden.

Introduction: ALS is a neurodegenerative disorder with an unknown etiology for 90%-95% of cases. Several environmental and occupational exposures have been investigated although a prospective study examining the association of "ever living/working on a farm" (farming exposure) and insecticide exposure with risk of ALS mortality in women is lacking.

Methods: Within the Women's Health Initiative (WHI), a nested case-control study was conducted among 93,676 women (n=151 ALS death cases, n=1496 matched controls) from the WHI Observational Study. This included a questionnaire about farming and insecticide exposure history one year after baseline. Conditional logistic regression models adjusted for education, smoking, and physical activity estimated risk of ALS death.

Results: One-third of cases and 21% of controls reported farming exposure. Cases had higher odds of farming exposure than controls (adjusted odds ratio [aOR]=1.59, 95% CI: 1.09-2.31) and was highest at durations of 15-19 (aOR=1.81, 95% CI: 1.02-3.21) and ≥20 years (aOR=2.32, 95% CI: 1.10-4.87) compared to no exposure. Tests for interaction revealed that women with farming and smoking exposure had higher odds of ALS death (aOR=2.10, 95% CI: 1.26-3.51, p=0.0045). Little evidence was noted for increased insecticide exposure and ALS mortality risk, although power was limited.

Conclusion: Among post-menopausal women with 25+ years follow-up, a significant association was noted between farming exposure and risk of ALS death. This increased risk was highest among those who ever smoked. Future studies should include biomarkers of exposure and large cohorts of men and women with occupational and residential histories.

Introduction: As the number of people with mild cognitive impairment (MCI) increases, modifiable risk factors, such as stress and an unhealthy lifestyle, and preventative measures are gaining interest. However, evidence for an association between potential biomarkers of such risk factors and MCI is limited. The study aimed to investigate the association between the salivary testosterone concentration and MCI in Japanese community-dwelling older adults.

Methods: This cross-sectional study involved 359 participants (159 men and 200 women) aged 60 years and over. MCI was evaluated using the Japanese version of the Montreal Cognitive Assessment; a score <26 was deemed indicative of MCI. A saliva sample was collected after the patient chewed sugar-free gum for 5 min in the morning, and the salivary testosterone concentrations were assayed. A modified Poisson regression model was used to examine the association between the salivary testosterone concentration and MCI after adjusting for age, body mass index, hypertension, diabetes mellitus, alcohol intake, smoking status, physical activity, sleep hours and age at menopause (women only).

Results: For women, the multivariable-adjusted prevalence ratio (PR; 95% confidence interval [CI]) of MCI for the highest-quartile group of salivary testosterone concentrations compared with the lowest-quartile group was 0.52 (0.26, 1.04), and the multivariable-adjusted PR (95% CI) for 1-standard deviation increments of log-transformed salivary testosterone concentrations was 0.74 (0.61, 0.89). A similar trend was found in men, but it was not statistically significant.

Conclusion: This study of Japanese individuals aged 60 years or older provides important evidence that a higher salivary testosterone concentration is associated with lower prevalence of MCI and higher cognitive function in women.

Introduction: The influence of pre-stroke long-term fasting blood glucose (FBG) and its variability on post-stroke all-cause mortality in ischemic stroke (IS) patients without diabetes remains unclear. This study aimed to investigate their independent and joint effects on all-cause mortality in this specific population.

Methods: We included 193,705 non-diabetic IS patients from the Northwest China Real-world and Population-based Tianshan Cohort 2019 to 2023. Cox proportional hazards regression models assessed the associations of impaired fasting glucose (IFG; 6.1-6.9 mmol/L) and high FBG variability with post-stroke all-cause mortality risk. Additive and multiplicative interactions between the two exposures were evaluated using the delta method and likelihood ratio tests, respectively.

Results: 14,481 patients (7.5%) died during a median follow-up of 0.87 years. IFG showed no significant association with mortality risk. Higher FBG variability (LogVIM Q5 vs Q1) significantly raised mortality risk (HR 1.56, 95% CI: 1.48-1.64; Ptrend < 0.001). A significant interaction between IFG and high FBG variability was observed on both additive (RERI 0.30 95% CI 0.13-0.49, P = 0.006) and multiplicative scales (HR 1.34, 95% CI 1.13-1.58; P = 0.001).

Conclusions: Long-term pre-stroke FBG variability is an independent predictor of post-stroke all-cause mortality among non-diabetic IS patients, while IFG is not. However, IFG amplifies the effect of FBG variability. Their combination shows synergistic risk elevation.

Background: While many Western countries have reported a declining trend in dementia incidence, epidemiological data on the dementia burden in Chinese populations remain scarce. We aimed to examine trends in incidence, prevalence, and mortality of dementia in the older Hong Kong Chinese population from 2005 to 2019.

Methods: Using the territory-wide electronic health record database, we identified all public healthcare service users aged ≥60 years in Hong Kong between 2005 and 2019. Annual incidence and prevalence of dementia were estimated, and time trends were analyzed using joinpoint regression. We matched each dementia case with up to 10 dementia-free controls and compared their 1-year and 5-year mortality risk across the study period using Cox models, adjusted for age, sex, and comorbidities.

Results: Among 2,224,854 individuals, 151,511 developed incident dementia during the study period. Age-standardized incidence per 1,000 person-years increased from 7.4 in 2005 to 9.4 in 2010 (annual percent change [APC]: 5.5%; 95% CI: 2.6-10.8) but subsequently declined to 6.3 in 2019 (APC: -3.6%; 95% CI: -5.1 to -2.5), with the most pronounced decrease observed in oldest-old adults aged ≥80 years. The overall prevalence of dementia increased from 3.9% in 2005 to 4.8% in 2019. Individuals with dementia had significantly higher 1-year (hazard ratio [HR]: 2.92; 95% CI: 2.88-2.96) and 5-year mortality risks (HR: 2.07; 2.06-2.09); these associations remained consistent throughout the study period.

Conclusions: Dementia incidence has declined substantially after 2010 among older Hong Kong Chinese, particularly in the oldest-old. However, dementia prevalence remains high and is strongly associated with increased mortality risk, highlighting the need for continued public health efforts to address its burden.

Introduction: Encephalitis represents a significant and evolving global health threat. We aimed to estimate the spatiotemporal patterns of the encephalitis burden and its attributable risk factors at national, regional, and global levels, and to project future trends to guide targeted prevention and treatment programs.

Methods: This study analyzed incidence, mortality, and disability-adjusted life years (DALYs) utilizing data from the Global Burden of Disease (GBD) Study 2021. Joinpoint regression modeling was employed to identify significant turning points in age-standardized rates (ASRs). A decomposition analysis was conducted to dissect the contributions of aging, population growth, and epidemiological changes to the overall burden. Furthermore, the Bayesian age-period-cohort (BAPC) model was applied to project the global trend of encephalitis from 2021 to 2045.

Results: Although the global burden of encephalitis has generally declined over the past three decades, the reduction in ASRs ceased between 2012 and 2015. Projections indicate that ASRs will stabilize rather than continue to decline from 2021 to 2045. The disease burden remains disproportionately high in regions with a low-medium Socio-demographic Index (SDI). Demographic analysis identifies children and the elderly as high-risk populations, with low birth weight identified as a prominent risk factor for neonatal encephalitis burden.

Conclusions: The decline in encephalitis ASRs reached an inflection point during 2012-2015, potentially driven by epidemiological shifts such as emerging infectious or autoimmune etiologies. The concentration of burden in low-medium SDI regions suggests a link to tropical distributions and healthcare disparities. Targeted interventions, including promoting vaccination, enhancing prenatal care, and creating smoke-free environments, are essential to mitigate the future burden of encephalitis.

Background: The "birth cohort" effect (BCE) is the impact of the external environment on the health status of individuals born at a given time in relation to events that occurred during that timeframe. Cohort studies are used to identify the etiology of diseases and links between their risk factors. We undertook the first study to delineate the BCE in Israeli PD patients based upon big data.

Methods: We applied the US National Institutes of Health data analytic tool to perform a cohort analysis of PD data collected in the largest Israeli health services provider (Clalit Health Services) from 2002 to 2021. PD patients were divided into twelve five-year age groups (40-44…95-99) for four five-year periods (2002-2006, 2007-2011, 2012-2016, and 2017-2021). The BCE was evaluated by counting the number of diagnosed patients and using cohort rate ratios (RR) separately for male and female PD patients born between 1905-1909 and 1975-1979. The significance of the BCE was assessed by the Wald χ2 test.

Results: There was a peak in diagnosed PD cases between 1919 and 1949, followed by a steady decline in PD incidence rates (RRs), beginning with the 1905-09 cohorts and continuing through the 1975-79 cohorts in both sexes. The cohort RRs decreased from 12.94 (CI: 7.76-21.55) for females and 10.83 (CI: 7.52-15.59) for males in the 1905-09 cohorts to 0.35 (CI: 0.15-0.83) and 0.45 (CI: 0.28-0.74), respectively, in the 1975-79 cohorts. A five-year lag in BCE was found in females compared to males.

Conclusion: The BCE was characterized by a reduction in the incidence of Israeli PD patients, possibly reflecting epidemiological and sociodemographic changes that occurred in Israel.

Introduction: Neonatal seizures affect 1-3 per 1000 live term newborns and are most often acute provoked. Seizure verification with electroencephalogram (EEG) or amplitude-integrated EEG (aEEG) is of major importance for correct diagnosis. The aim of this study was to investigate the risks of developmental delay (DD), intellectual disability (ID), autism, attention-deficit hyperactivity disorder (ADHD), and cerebral palsy (CP) after EEG/aEEG-verified neonatal seizures of any cause in a Swedish population-based cohort.

Methods: Data from five national health care registers was used. Infants with EEG/aEEG-verified seizures, born from January 1, 2009, to December 31, 2020, were matched with controls, negative for neonatal seizure diagnosis. Follow-up time was from January 1, 2009, to December 31, 2021. Cumulative incidences, unadjusted and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) from Cox regression analysis of each outcome, were explored. In infants with neonatal seizures, the occurrence of pre-specified etiologies was investigated.

Results: In total, 1062 infants with neonatal seizures were matched with 5310 controls. Overall, the cumulative incidences were greater in infants with neonatal seizures compared to controls, and CP presented with the highest incidence of 21.9% (95% CI: 19.4-24.6%) in children with neonatal seizures at 10 years of age and 0.42% (95% CI: 0.27-0.64%) in controls. The greatest aHR of 42.6 (95% CI: 26.3-69.1) was found for CP, followed by an aHR of 18.9 (95% CI: 11.8-30.4) for ID when children with neonatal seizures were compared with controls. In children with neonatal seizures, 57.1% (n=606) were registered with any of the pre-specified etiologies.

Conclusion: Neonatal seizures were associated with overall increased risks of DD, ID, autism, ADHD, and CP. The findings emphasize the risks of adverse developmental trajectories in the exposed children and the importance of standardized follow-up programs to initiate clinical interventions when needed.