Neuroepidemiology最新文献

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 US are approximately 25 years old, this work aimed to provide updated estimates on the incidence and prevalence of CIDP in the US 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% 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 US. 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 co-morbidities 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. This Registry comprises data on all 2725 (1903 females and 822 males) PwMS in the Belgrade region. For study purposes, Registry was searched, and 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.

Background: Childhood idiopathic epilepsy poses a major public health issue in Asia. This study aimed to characterize the burden of idiopathic epilepsy among children aged 0-14 years across Asia between 1990 and 2021, using data from the Global Burden of Disease (GBD) Study 2021.

Methods: Data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for children idiopathic epilepsy in Asia were extracted from the GBD 2021. The analyses involved evaluating trends by calculating age-standardized rates (ASRs) and the estimated annual percentage change (EAPC). Stratification was conducted by region, sex, age, and Socio-demographic Index (SDI). Temporal trends were assessed using joinpoint regression analysis, which calculated the average annual percentage change (AAPC). Future trends through 2035 were projected with an Autoregressive Integrated Moving Average (ARIMA) model.

Results: From 1990 to 2021, the age-standardized incidence rate (ASIR) exhibited a slight upward trend (EAPC = 0.17, 95% CI: 0.10 to 0.25). In contrast, significant declines were observed in the age-standardized prevalence rate (ASPR; EAPC = -0.16, 95% CI: -0.25 to -0.07), mortality rate (ASMR; EAPC = -1.81, 95% CI: -1.93 to -1.69), and DALY rate (ASDR; EAPC = -1.32, 95% CI: -1.40 to -1.24). All four metrics were consistently higher in males than females across all age groups. The age group <5 years carried the highest burden for incidence, mortality, and DALYs, while prevalence was highest in the 10-14 years age group. Projections to 2035 indicate a continuing upward trend in incidence and prevalence but a decline in mortality.

Conclusion: Despite overall ASPR, ASMR, ASDR declines, slight ASIR rise as well as regional, age, and sex disparities highlights that childhood idiopathic epilepsy remains a persistent health issue in Asia. Future public health efforts should prioritize strengthening healthcare system development and enhancing enhanced early intervention, particularly in resource - limited regions.

Background: Behavioral risks contribute to the burden of neurological diseases, but changes from 1990 to 2021 remain unclear.

Methods: Using the 2021 Global Burden of Disease database, we analyzed changes in age-standardized mortality (ASMR) and disability-adjusted life years (ASDR) for neurological diseases attributable to behavioral risks from 1990 to 2021, globally and regionally, including gender differences. The Joinpoint regression model estimated the annual percentage change of ASMR and ASDR. An age-period-cohort model separated the effects of age, period, and cohort, while a Bayesian model predicted changes from 2022 to 2035. Finally, cross-national inequality analysis evaluated the impact of socio-economic disparities on disease burden.

Results: From 1990 to 2021, neurological diseases' burden increased, with stroke contributing most, followed by Alzheimer's disease and other dementias (ADOD), idiopathic epilepsy (IE), and multiple sclerosis (MS). ASMR and ASDR for ADOD, MS, and stroke declined. But ASMR for IE attributable to high alcohol use increased (Net drift= 0.28%), particularly among individuals aged 65-69 years (Local drift= 0.33%) and older, whereas stroke mortality associated with alcohol remained stable in the 20-30-year age group. By 2035, IE burden is projected to remain similar to 2021 levels. The disease burden was higher in males than females. Stroke burden varied by SDI level: tobacco and high alcohol use were more prominent in high SDI regions, while tobacco and dietary risks were significant in other SDI regions. Regional health inequalities were pronounced, with ADOD and MS burden concentrated in high-income groups, while stroke burden was concentrated in low-income groups.

Conclusion: Tobacco remains the primary risk for neurological diseases. Alcohol significantly affects IE in adults 65+ and stroke in those aged 20-30. Dietary risks contribute greatly to stroke in non-high SDI regions. Future efforts should strengthen behavioral risk control in males and reduce the increasingly concentrated stroke burden in low-income populations.

Background: Understanding the global burden of neuroblastoma and related tumors requires further research. This study aimed to provide global, regional, and national estimates of the incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) associated with neuroblastoma and other peripheral nervous cell tumors from 1990 to 2021.

Methods: Data on the absolute counts and age-standardized rates (ASRs) of incidence, prevalence, deaths, and DALYs for neuroblastoma and other peripheral nervous cell tumors were extracted from the Global Burden of Disease (GBD) database covering 204 countries and territories. Decomposition analysis was employed to identify key contributors to changes in disease burden. Bayesian Age-Period-Cohort (BAPC) modeling was utilized to project disease trends over the next 25 years.

Results: In 2021, the highest number of incidence, prevalence, deaths, and DALYs were observed in children under five years of age, followed by a sharp decline with increasing age. ASRs for incidence, prevalence, deaths, and DALYs were highest in countries within the high socio-demographic index (SDI) quintile, whereas the middle SDI quintile exhibited the highest absolute case counts for incidence, deaths, and DALYs. Between 1990 and 2021, the global burden of neuroblastoma and other peripheral nervous cell tumors increased substantially. Incident cases rose from 5,854 (95% uncertainty interval [UI], 4,517-7,643) in 1990 to 10,867 (95% UI, 8,279-13,557) in 2021. Deaths increased from 2,675 (95% UI, 2,298-3,138) to 5,194 (95% UI, 4,295-5,932), while DALYs surged from 185,391 (95% UI, 158,570-219,544) to 285,479 (95% UI, 227,709-341,110). BAPC modeling projected a continued increase in both absolute numbers and ASRs for incidence, prevalence, deaths, and DALYs across both sexes from 2022 to 2046.

Conclusions: Over the past three decades, the global incidence, prevalence, deaths, and DALYs associated with neuroblastoma and other peripheral nervous cell tumors have increased substantially. These findings underscore the urgent need for effective healthcare policies and targeted cancer control strategies to mitigate the growing disease burden.

Background: Spinal cord injury (SCI) attributable to falls and road injuries imposes a significant burden on working-age individuals; however, its temporal and geographic patterns in this demographic remain underexplored. This study aimed to evaluate the global, regional, and national burden of SCI attributable to falls (SCIFs) and road injuries (SCIR) among working-age individuals (aged 15-64 years) from 1990 to 2021 and project trends through 2040.

Methods: Using Global Burden of Disease (GBD) 2021 data, global, regional, and national age-standardized incidence rates (ASIR), prevalence rates (ASPR), and years lived with disability rates (ASYR) were assessed according to global parameters and sociodemographic stratification. Trends were quantified by the average annual percentage change (AAPC) and future burdens projected using Bayesian age-period-cohort (BAPC) models.

Results: From 1990 to 2021, global ASIR, ASPR, and ASYR for SCIR declined markedly (AAPC -1.54 [95% confidence interval -1.54 to -1.53], -1.88 [-1.89 to -1.87], and -2.03 [-2.05 to -2.01]), whereas SCIF showed modest or stagnant reductions with regional increases (AAPC -0.24 [-0.27 to -0.22], -0.39 [-0.41 to -0.36], and -0.67 [-0.69 to -0.65]). Males exhibited higher burdens than females, with SCIF increasing with age and peaking at 60-64 years, whereas SCIR shifted toward older groups. High-sociodemographic index (SDI) regions experienced declines in both, whereas middle-SDI areas saw SCIF increases, despite SCIR decreases; low-SDI regions showed slight SCIF rises. Regionally, Western Europe displayed steady reductions, whereas Central Asia experienced an increase in SCIF and Sub-Saharan Africa showed stable or slightly increasing SCIF indicators. National variations were pronounced, with burdens often exceeding SDI expectations in rapidly developing countries. Projections to 2040 indicate a modest rise in SCIF burden (predicted ASIR 3.72 [95% uncertainty interval 1.82-5.63] per 100,000) but a decrease in SCIR (predicted ASIR 1.22 [0.73-1.72] per 100,000).

Conclusions: Although the burden of SCIR has declined substantially from 1990 to 2021 and is projected to continue decreasing, persistent or rising SCIF trends - expected to modestly increase by 2040 - alongside male predominance, age shifts, and socioeconomic disparities emphasize the urgency for tailored prevention: enhanced road-safety measures and occupational reforms targeting falls in high-risk groups to reduce inequities and socioeconomic costs.