Neuroepidemiology最新文献

Introduction: The Coronavirus 2019 (COVID-19) pandemic disrupted medical care delivery for cerebrovascular disease. Little is known about the long-term changes in health care utilization and mortality among people who suffered cerebrovascular events.

Methods: We used 2018-2022 data to identify all Medicare fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries with a diagnosis code for an acute cerebrovascular event (stroke, transient ischemic attack, hemorrhage). We used Poisson-lognormal regression models with an offset term (beneficiary years) to model incident rate ratios (IRR) for late-COVID (2021-2022) versus pre-COVID (2018-2019) for outpatient visits, emergency department (ED) visits, hospitalizations, and mortality in the year following the index event, adjusting for age, sex, and race. We examined patterns overall and by rurality (urban, micropolitan, rural) and quartile (q) of social vulnerability index (SVI).

Results: We identified 7,071,072 and 7,065,171 unique beneficiaries in the pre-COVID and late-COVID periods, respectively, with an acute cerebrovascular event. Our cohort was predominantly non-Hispanic White (73%), female (54%), and urban (83%). Compared to pre-COVID, outpatient care utilization in the year following the acute event was higher in 2021-2022 (IRR=1.14, 95% confidence interval [CI]: 1.13-1.14), while ED visits (IRR=0.92, 95% CI: 0.91-0.92) and inpatient hospitalizations (IRR=0.94, 95% CI: 0.94-0.95) were lower. Mortality was higher during the late-COVID versus pre-COVID period (IRR=1.24, 95% CI: 1.23-1.25). The mortality differences were similar across rural strata, but higher in more socially disadvantaged areas (IRR 1.20, 1.22, 1.24, 1.27 for q1 [reference], p-interaction= q2=0.12, q3=0.01, and q4<0.001).

Conclusions: Medicare beneficiaries who sustained acute cerebrovascular events had marked differences over the subsequent year in healthcare utilization patterns and increased mortality in the late-COVID period compared with their utilization and outcomes pre-COVID. The differences in mortality were the most pronounced for beneficiaries in socially disadvantaged areas.

Objectives: To investigate the causal effects of body mass index (BMI) at different life stages (childhood and adulthood) on migraine and its subtypes.

Background: While previous studies suggest BMI is a risk factor for migraine, it is unclear whether BMI influences migraine differently throughout the life course. The causal effect of childhood BMI may have obscured the association between adult BMI and migraine, making it difficult to determine the independent role of adult adiposity.

Methods: We conducted a life-course Mendelian randomization (MR) study. Two-sample and conventional multivariable MR analyses were performed initially. Subsequently, FLOW-MR-a newly-developed three-sample multivariable MR method-was applied to estimate the direct, indirect, and total effects of BMI at childhood or adulthood on migraine. All estimates were scaled per 1-SD increase in BMI (SDs: 1.35 kg/m² at age 1; 1.78 kg/m² at age 8; 4.76 kg/m² in adulthood).

Results: The causal effect of BMI on migraine is strictly dependent on the timing of exposure. First, we found no evidence that adult BMI influences the risk of either migraine subtype. Second, higher BMI at age 8 exerted a direct protective effect against migraine with aura (OR = 0.522). Third, BMI at age 1 exhibited a dual role: its direct risk-increasing effect (OR = 1.983) was offset by an indirect protective effect mediated through 8-year-old BMI (OR = 0.511), resulting in a null total effect on migraine with aura. Migraine without aura was unaffected by BMI at any life stage.

Conclusion: The causal effect of BMI on migraine is dependent on developmental timing, challenging the conventional view of BMI as a uniform risk factor. We emphasize that the observed protective role of childhood BMI is a model-estimated association from genetic data, which does not constitute a recommendation to increase body weight in children.

Introduction: Non-traumatic intracerebral hemorrhage (ICH) is a major cause of mortality and disability in Asia, yet comprehensive assessments remain limited. We quantified the ICH burden across Asia during 1990-2021 and projected trends to 2050.

Methods: Using Global Burden of Disease 2021 data, we analyzed age-standardized rates (ASRs) of prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (ASDR) by age, sex, and region. We examined correlations with the Socio-demographic Index (SDI) and Universal Health Coverage Index (UHCI), and forecast trends with Bayesian age-period-cohort modeling.

Results: From 1990 to 2021, absolute burden increased: prevalent cases 7.23→11.44 million, incident cases 1.59→2.56 million, deaths 1.64→2.56 million, and DALYs 44.20→60.54 million. ASRs declined: ASPR 295.05→221.51 per 100,000 (EAPC -1.07), ASIR 82.35→52.35 (-1.79), ASMR 92.02→53.26 (-1.86), and ASDR 2,094.51→1,194.11 (-1.89). Males consistently had higher burdens; all ASRs increased with age. High systolic blood pressure was the leading risk factor. ASIR, ASMR, and ASDR were inversely correlated with SDI and UHCI (p<0.001), whereas ASPR showed no association. Projections indicate continued declines in ASPR, ASIR, and ASMR through 2050.

Conclusion: Despite broad declines in ASRs linked to healthcare advances, population aging is driving rising absolute burden. Region-specific preventive strategies are urgently needed to curb future ICH impact across diverse Asian settings.

Background Spinal cord injury (SCI) is a debilitating condition that imposes profound and persistent socioeconomic burdens. Despite its relatively low prevalence, SCI results in lifelong disability, reduced productivity, and sustained healthcare costs, particularly among working-age populations. While clinical aspects of SCI have been extensively studied, its broader macroeconomic burden remains underexplored. Methods We developed a dynamic macroeconomic model to estimate the long-term economic burden of SCI across 191 countries and territories from 2020 to 2050. The model integrated epidemiological data from the Global Burden of Disease (GBD) 2019 study with macroeconomic indicators to assess the impact of SCI on labor supply and physical capital accumulation. A counterfactual scenario, assuming the absence of SCI-related disability and healthcare costs, was used to estimate the economic burden. Sensitivity analyses were performed using Monte Carlo simulations and varying social discount rates. Findings Globally, the cumulative macroeconomic burden of SCI between 2020 and 2050 is estimated at INT$5.58 trillion. The highest absolute burdens were observed in China, the USA, and India, while the highest relative burdens as a share of GDP occurred in Iraq (0.26%), Burundi (0.20%), and Sri Lanka (0.17%). High-income countries (HICs) bore the greatest total cost (INT$2.84 trillion), driven by intensive care utilization and prolonged survival. However, low-income countries experienced the highest burden relative to income per capita, highlighting fiscal vulnerability. The burden of SCI was primarily driven by reduced labor force participation and long-term healthcare expenditures, significantly constraining national savings and investment. Interpretation SCI imposes a substantial and uneven macroeconomic burden, with profound implications for national productivity and fiscal resilience. Economic consequences are shaped not only by disease prevalence but also by institutional capacity and health system responsiveness. Investments in SCI prevention, rehabilitation, and social protection are urgently needed, particularly in LMICs, to mitigate long-term economic burden. Our findings offer empirical evidence to inform global health financing and disability policy.

Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune-mediated neuropathy typically presenting as symmetrical motor weakness and/or sensory impairment. As the most recent data describing the epidemiology of CIDP in the USA are approximately 25 years old, this work aimed to provide updated estimates on the incidence and prevalence of CIDP in the USA and information on patient characteristics and treatment patterns.

Methods: This retrospective claims-based cohort study utilized Inovalon closed claims data from 2016 through 2023. Identified patients with CIDP were those with ≥2 claims containing ICD-10 codes for CIDP (G61.81) separated by ≥30 days. The incident cohort was defined as patients with CIDP and continuous enrollment for all of 2022 and 2023, with no diagnosis of CIDP prior to 2023. The prevalent cohort was defined as patients with CIDP and continuous enrollment in 2023. Incidence and prevalence rates were determined for the study population, then adjusted for age and sex and extrapolated to the total US population.

Results: The incident and prevalent cohorts included 913 and 8,697 patients, respectively. The median ages for males and females, respectively, were 59 and 53 years in the incident cohort and 60 and 56 years in the prevalent cohort. The most common comorbidity was diabetes mellitus. Among patients who received treatment in 2023, a majority in both cohorts received steroids, followed by immunoglobulin. Patients in both cohorts were most frequently seen by neurology specialists, and these specialists were the most frequent prescribers of immunoglobulin. Adjusted incidence and prevalence rates for CIDP in 2023 were 2.8 (95% confidence interval [CI] 2.7-2.9) and 23.3 (95% CI 23.1-23.5), respectively, per 100,000 persons, yielding an estimate of 77,058 total individuals with CIDP currently living in the USA. Incidence and prevalence rates in patients aged ≥55 years were generally higher in males compared with females.

Conclusion: This study reports increased epidemiologic rates for CIDP and provides insights into patient characteristics and current treatment patterns. These updated estimates can inform strategic healthcare resource planning, although they may be limited by the potential misclassification of CIDP diagnoses in the claims data.

Introduction: Amyotrophic lateral sclerosis (ALS) is a fatal motor neurons disease with multifactorial etiology. The epidemiology of ALS in France is mainly documented through the Limousin regional registry (FRALim). We aimed to determine the incidence and clinical characteristics of ALS cases over a 20-year period in another French region, the Pays de la Loire, served by a single centralized diagnostic center.

Methods: All patients diagnosed with ALS at the Angers University Hospital reference center between 2003 and 2023 were retrospectively included. Demographic and clinical data were extracted from medical records, and incidence rates were calculated using annual population estimates from the National Institute of Statistics and Economic Studies. Spatial analyses were performed to identify over-incidence areas and potential environmental or occupational determinants.

Results: A total of 1,316 patients were diagnosed with ALS during the study period, corresponding to a crude incidence rate of 1.88 cases per 100,000 person-years (95% CI: 1.78-1.98), with no significant variation over time. The standardized incidence rate was 1.73 (95% CI: 1.63-1.83). The mean age at symptom onset was 63.6 ± 11.2 years, 58.7% of patients were male. The mean disease duration was 3.7 ± 3.5 years. ALS onset was spinal in 70.3%, bulbar in 27.9%, and respiratory in 1.7% of cases. Familial or genetic forms accounted for 6% of patients. Four geographical over-incidence areas were identified, with no correlation found with pesticide use, air pollution, or other environmental indicators. One occupational cluster was observed among farmers in a specific commune, prompting a dedicated investigation.

Conclusion: This 20-year retrospective study provides the first epidemiological data on ALS in western France. The incidence and clinical features are consistent with national and European data. The identification of spatial and occupational clusters underlines the importance of continued regional surveillance and of prospective, registry-based studies to clarify environmental and occupational risk factors for ALS.

Global increases in multiple sclerosis (MS) prevalence and incidence have been observed, yet Japan's longitudinal trends and future burden remain understudied. This study analyzed MS incidence, mortality, and disability-adjusted life years (DALYs) in Japan from 1990 to 2021, and projected burden to 2050 using age-period-cohort modeling and Bayesian meta-regression. Results showed a 50.2% rise in age-standardized prevalence rates (from 7.622 to 11.452 per 100,000), mainly driven by a 59.2% increase among females (from 10.853 to 17.282 per 100,000). Projections indicate an increase to 10.12 per 100,000 by 2050, with females remaining disproportionately affected (female-to-male ratio: 2.18:1). Disability accounted for 71.2% of total DALYs in 2021, especially among women aged ≥80 years, who experienced a 446% increase in years lived with disability. Regional disparities persisted, with northern prefectures showing higher prevalence and DALYs. Incidence peaks shifted to older ages, and female incidence remained 1.5-2.0 times higher than males after 2000. Although Japan remains a low-incidence country, the MS burden is rising due to increasing disability, female predominance, and regional disparities, highlighting the need for targeted screening, resource allocation to high-risk areas, and elderly-focused care.

Introduction: Multimorbidity was defined as having at least two comorbidities in addition to the confirmed index diagnosis. The aim of the present study was to determine multimorbidity patterns in patients with multiple sclerosis (PwMS) from the Belgrade region, using population-based MS Registry data. Additionally, comparison of the prevalence of multimorbidity in PwMS and in the general population of Serbia was also performed.

Methods: The source for this study was Belgrade population-based MS Registry, established and maintained at the Clinic of Neurology, University Clinical Center of Serbia, in Belgrade. This Registry comprises data on all 2,725 (1,903 females and 822 males) PwMS in the Belgrade region. For study purposes, Registry was searched, data on all PwMS with multimorbidity were extracted, and the new database was created. In order to compare the prevalence of multimorbidity between PwMS and the general population of Serbia, we used already published prevalence data, which examined patterns of multimorbidity in the Serbian general population.

Results: Multimorbidity was present in 552 PwMS (prevalence = 20.3%, 95% CI: 18.8-21.8), out of which 130 (23.6%) were males and 421 (76.4%) females. Average number of comorbidities per patient in our cohort was 2.6. Majority of them had two chronic conditions (341, 61.8%), and the maximum number was eight. PwMS with multimorbidity had shorter disease duration (p < 0.001), higher level of EDSS (p = 0.001), and higher PI (p = 0.003), in comparison with those without multimorbidity. Overall prevalence was significantly higher in the general population than in PwMS (26.9% in the general population vs. 20.3% in the PwMS population, p < 0.001). However, in the youngest age group (20-44 years) males with MS had twice as high prevalence as in the general population (11.6% vs. 5.3%) and in females, in this age group, the difference was even more pronounced (28.3% vs. 6.4%).

Conclusion: Our study indicated lower overall prevalence of multimorbidity in the Belgrade MS population, compared to the general population. However, PwMS reach the peak prevalence of multimorbidity in earlier life than persons in the general population (20-44 years vs. 65 and more years). PwMS with multimorbidity experienced faster disease progression, expressed via PI, in comparison to PwMS without multimorbidity.

Introduction: Cannabis use has been increasing in the United States (U.S.), yet its potential long-term effects on neurocognitive outcomes remain unknown. We aimed to examine the association of the history of cannabis smoking with subjective cognitive complaints (SCC) in older women.

Methods: This prospective cohort analysis included 15,378 older women (age ≥ 65 years) of the U.S. National Institute of Environmental Health Sciences' Sister Study. Participants reported their history of cannabis smoking at enrollment (2003-2009) and completed the Eight-item Interview to Differentiate Aging and Dementia (AD8) as an SCC screener at the cohort's 2nd (2011-2014), 3rd (2014-2016), and 4th (2017-2019) follow-ups. We used multivariable joint models to assess the association.

Results: 3,973 (25.8%) women reported ever smoking cannabis, mostly in their early adulthood. Compared with never cannabis smokers, the multivariable odds ratios (ORs) for ever smokers were 1.27 (95% confidence interval (CI): 1.13, 1.43) at the 2nd follow-up, 1.28 (95% CI: 1.14, 1.44) at the 3rd follow-up, and 1.30 (95% CI: 1.11, 1.52) at the 4th follow-up. Associations were stronger for regular than occasional cannabis smokers. For example, at the 2nd follow-up, the OR was 1.61 (95% CI: 1.31, 1.98) for regular smokers and 1.19 (95% CI: 1.04, 1.35) for occasional smokers. Results were overall consistent in subgroup and sensitivity analyses.

Conclusions: This study suggests a potential association between a history of cannabis smoking and SCC in older women, calling for further research on cannabis use and cognitive outcomes in the context of aging.