Neuroepidemiology最新文献

Introduction: This study aims to quantify the global, regional, and national incidence, mortality, and disability-adjusted life years (DALYs) of intracerebral hemorrhage (ICH) among youth (15-49 years) from 1990 to 2021 and to evaluate the contributions of major attributable risk factors using the Global Burden of Disease (GBD) 2021 framework. The findings are intended to provide an updated descriptive overview that may inform future research and offer reference points for public health planning.

Methods: Data were obtained from the GBD study conducted in 2021. Time trends in the incidence, mortality, and DALYs among youth with ICH were assessed using estimated annual percentage changes. Risk factors associated with ICH were selected, including six environmental/occupational factors, eight behavioral risks, and four metabolic factors. Age-standardized rates and the percentages of DALYs attributable to these risk factors were calculated.

Results: In 2021, there were 610,000 cases, 260,000 deaths, and 13.79 million DALYs due to ICH globally. Between 1990 and 2021, age-standardized rates of incidence, mortality, and DALYs decreased, while the absolute numbers of incidence, deaths, and DALYs increased. Globally, approximately 79.68% of the age-standardized DALY rates for ICH among individuals aged 15-49 years was attributable to the risk factors listed in the GBD 2021 dataset. In 2021, the primary risk factors for ICH among youth were high systolic blood pressure (46.59%), smoking (21.37%), ambient particulate matter pollution (14.92%), household air pollution from solid fuels (14.64%), and diet low in fruits (13.53%). Among them, a high body mass index (BMI) had the greatest increase in impact on ICH.

Conclusion: The burden of ICH remains substantial among young individuals, with metabolic risk factors identified as the primary contributors. These findings provide updated comparative evidence that may inform future research and offer reference points for public health planning.

Background/objective: Cranial (i.e., head and voice) tremors are highly prevalent in essential tremor (ET). They may be disabling, and they often drive treatment. Furthermore, their appearance may provide insights into disease severity and staging. Several features of these tremors make self-report data complex. There are no data on the validity of self-reported information on cranial tremors in ET. We evaluated the validity of self-reported cranial tremor in ET.

Methods: ET cases, enrolled in a prospective evaluation, were queried about the presence of head and voice tremors. A detailed neurological examination was performed, and the presence of head or voice tremor was assessed by an experienced movement disorders neurologist.

Results: There were 185 ET cases. The prevalence of voice tremor on examination was 50.8%, and of head tremor was 49.7%. Cases underreported voice and head tremors (sensitivity = 13.8%-59.3%); however, the positive predictive value of self-reported voice and head tremor was moderate (61.9%-84.2%). Overall, the validity of self-reported data was lower for voice tremor than for head tremor. Self-reported voice tremor was the least valid when that tremor was mild.

Conclusions: We provide the only data we are aware of on the validity of self-reported cranial tremors in ET. Self-reports were a poor screen to ascertain cranial tremors; however, if a case did report these tremors, the information was likely to be valid. These data emphasize the importance of a thorough neurological examination. Although this requires a greater investment of time/resources, it reduces the number of false negatives.

Background: Spontaneous intracerebral hemorrhage (ICH) is a leading cause of disability and death worldwide. Understanding temporal trends in the burden of the disease is critical to evaluate the effectiveness of preventive strategies and identify targets for action. This study aimed to assess long-term temporal trends in incidence, attack rates, and early case fatality of ICH.

Methods: All cases of ICH among residents of Dijon, France, were prospectively recorded between 1985 and 2022 using a population-based registry. Annual incidence and attack rates were assessed, and temporal trends were analyzed by calculating incidence rate ratio (IRR) and attack rate ratio (ARR). Case fatality was measured at 30 days.

Results: A total of 1,015 ICH cases (mean age 73.5 ± 16.4 years old, 52.7% women) were recorded including 815 patients with a first-ever ICH and 200 cases of ICH as stroke recurrences. Age-standardized incidence increased progressively from 12.6/100,000/year in 1985-1991 to 20.8/100,000/year in 2011-2016 (IRR: 1.96, p < 0.001). A slight decrease was observed during period 2017-2022 (18.9/100,000/year, IRR: 0.81; 95% CI: 0.61-1.06, p = 0.11). A similar trend was noted in attack rates, with a peak during 2011-2016 (27.9/100,000/year; ARR: 1.79; 95% CI: 1.47-2.20, p < 0.001) and a decrease in the most recent period (23.2/100,000/year; ARR: 0.83; 95% CI: 0.69-0.99, p = 0.04). In men, a significant increase in incidence and attack rates was observed from 1985-1991 to 2011-2016, followed by a slight decline. In contrast, women showed a delayed increase in rates, with no decline in the most recent period. The 30-day case fatality rate declined between 1985 and 2010 (from 40.3% to 26.3%), followed by an increase thereafter, reaching 38.8% during the last study period.

Conclusion: Our study revealed an overall increase in incidence and attack rates of ICH followed by a slight decline in recent years. Sex differences in trends warrant further investigation into the contributing factors and emphasize the continued need for prevention strategies to further reduce the burden of ICH. The recent increase in early case fatality rates highlights the need for specific acute-phase treatments of ICH.

Background: This investigation utilized cross-sectional NHANES data to explore the relationship between the A Body Shape Index (ABSI) and stroke, with a focus on age differences.

Methods: A total of 40,213 participants from four NHANES cycles (2003-2018) were included in the analysis. Stroke status was determined via self-report, and ABSI was calculated using waist circumference, height, and weight measurements. To investigate the relationship between ABSI and stroke risk, we employed multivariate logistic regression models adjusted for potential confounders and used restricted cubic spline analysis to explore nonlinear associations. Additionally, subgroup analyses were conducted based on gender, age, race, and BMI.

Results: Elevated ABSI was associated with higher odds of stroke (OR = 1.19, 95% CI: 1.07-1.87, p = 0.002). When divided into quartiles, participants in the highest quartile (Q4) had a notably increased stroke risk compared to those in the lowest (Q1) (OR = 1.33, 95% CI: 1.05-1.76, p = 0.005). Subgroup analyses revealed this association was especially pronounced across different genders, races and in individuals aged 40-59 (OR = 1.38, 95% CI: 1.00-1.72, p = 0.04) and 60+ (OR = 1.48, 95% CI: 1.01-1.61, p = 0.004). Restricted cubic spline analysis showed a nonlinear association between ABSI and the odds of stroke, with the odds increasing when ABSI exceeded 0.08.

Conclusion: Higher ABSI was associated with higher stroke prevalence, especially in the highest quartile and among individuals aged 40 and over, with a nonlinear increase observed when ABSI exceeded 0.08. Further longitudinal studies are needed to confirm the predictive value of ABSI.

Background: Neonatal encephalopathy due to birth asphyxia and trauma (NEBAT) constitutes a significant component of neonatal mortality, with survivors often suffering from long-term and severe cognitive, behavioral, and developmental impairments. Nevertheless, in-depth research on the global trends and key risk factors of NEBAT remains scarce.

Methods: This study analyzed data from the GBD 2021 database. The prevalence, deaths, and corresponding crude rates were quantified globally and across 204 countries and territories from 1990 to 2021. The burden was analyzed by region and sociodemographic index (SDI), with trends examined using the estimated annual percentage change (EAPC). In addition, we used the Spearman rank test to determine associations between EAPC, NEBAT-related prevalence and death burden, and SDI. Risk factors contributing to the burden of NEBAT-related death were analyzed.

Results: From 1990 to 2021, the global prevalence cases of NEBAT increased from 446,841 to 508,909, with the crude prevalence rate rising from 445.1 per 100,000 population to 522.2 per 100,000 population. However, the deaths significantly declined by 31.0%, from 823,812 to 568,255, with the crude mortality rate dropping from 8,205.7 per 100,000 population to 5,831.1 per 100,000 population. Low SDI regions experienced a substantial 112.9% increase in NEBAT cases, while high-middle SDI regions witnessed a significant 34.8% decrease. Although mortality rates declined across all SDI regions, the low SDI region had the smallest decline. More than half of the GBD regions experienced a reduction in NEBAT cases, but Western sub-Saharan Africa saw a dramatic 151.7% increase. Globally, NEBAT-related mortality cases and rates declined in most countries, while a few countries like Ethiopia saw a significant rise in both. Regions with lower SDI were associated with higher trends of NEBAT prevalence and mortality growth. Low birth weight and short gestation were the primary risk factors for neonatal encephalopathy deaths globally, with notable regional variations. In the past 3 decades, the attributable proportions of low birth weight and short gestation have slightly increased, while those of household air pollution from solid fuels decreased, and ambient particulate matter pollution increased.

Conclusions: NEBAT remains a significant public health concern, particularly in LMICs, where disparities in NEBAT burden are evident. This study highlights the need for targeted interventions to address key risk factors and reduce the NEBAT burden, with a focus on improving the healthcare access and quality in LMICs.

Introduction: As a prevalent chronic neurological condition, idiopathic epilepsy poses particular challenges for women of childbearing age (WCBA) due to distinctive biological and social characteristics. Nevertheless, global evaluations of its burden in this demographic are still limited.

Methods: Based on data from the Global Burden of Disease Study 2021, we examined the prevalence, incidence, and disability-adjusted life years (DALYs) associated with idiopathic epilepsy in WCBA from 1990 to 2021, covering global, regional, and national scales. Temporal patterns were evaluated using estimated annual percentage change (EAPC), Joinpoint regression, and age-period-cohort (APC) models. Frontier and decomposition analyses were conducted to examine disparities and driving factors, and associations with sociodemographic index (SDI) were explored. A Bayesian APC model was also employed to forecast the burden through 2036.

Results: From 1990 to 2021, the number of WCBA with idiopathic epilepsy increased from 3.54 to 5.38 million, incident cases increased from 0.44 to 0.69 million, and DALYs increased from 2.40 to 3.02 million. Age-standardized prevalence rate (ASPR) remained relatively constant (EAPC = -0.06) with a recent uptick; age-standardized incidence rate (ASIR) experienced a mild increase (EAPC = 0.16); and age-standardized DALYs (ASR-DALYs) declined (EAPC = -0.59). High-SDI areas exhibited relatively stable burden, while low- and middle-SDI regions experienced marked increases. Frontier analysis revealed a substantial gap between actual and achievable burden levels in many countries. Population growth was the main contributor to the rising burden, whereas high-SDI countries benefited more from epidemiological advances. Projections estimate that by 2036, the number of WCBA with epilepsy will reach approximately 7.13 million, with upward trends in ASPR, ASIR, and ASR-DALYs. The APC model indicated highest epilepsy risk during adolescence and divergent burden trends across SDI regions.

Conclusion: Despite favorable trends in ASR-DALYs, idiopathic epilepsy still exerts a rising burden on WCBA, with significant variation across regions. There is an urgent need for region-specific and population-focused prevention strategies.

Background: An inverse association between dementia and cancer has been consistently reported and often attributed to opposing biological mechanisms. However, methodological biases such as collider stratification and surveillance bias may underlie this finding.

Methods: We examined the association between dementia and subsequent cancer diagnoses among 4,532 participants of the population-based Rotterdam Study. Individuals with incident dementia were matched to up to two participants without dementia by age and sex; importantly, we also aligned the start of follow-up between these groups to reduce immortal time bias and ensure comparable observation windows. Cancer outcomes included both pathology-confirmed and non-pathology-confirmed (NPC) diagnoses to address potential surveillance bias. We applied cause-specific Cox proportional hazards models and Fine and Gray subdistribution hazard models to estimate cancer risk, accounting for the competing risk of death.

Results: An initial analysis of the full cohort, assessing the association between ever having dementia and ever having cancer, replicated the previously reported inverse association (hazard ratio [HR] 0.58; 95% CI: 0.50-0.68). However, after matching and aligning follow-up periods, Kaplan-Meier curves indicated a lower probability of remaining cancer-free among individuals with dementia compared to those without dementia - particularly when including NPC diagnoses, which were more frequent among participants with dementia. In these analyses, the direction of the association reversed (HR 5.23; 95% CI: 3.65-7.48), suggesting a higher cancer risk among individuals with dementia. This elevated risk persisted in competing risks analysis (subdistribution HR 2.54; 95% CI: 1.80-3.58), suggesting that the elevated cancer risk was not solely attributable to differential mortality.

Conclusions: The frequently reported inverse association between dementia and cancer may reflect methodological artefacts rather than biological antagonism. Accounting for collider stratification and surveillance bias revealed a potential positive association, underscoring the importance of bias-aware epidemiological methods in research on comorbidities of ageing.

Introduction: Sustainable and low-cost data systems for national and global surveillance of stroke are urgently needed to address the growing burden of stroke. Routinely collected health data (including registries and administrative data) are proliferating at a rapid pace, offering promise for systematic and enduring global stroke surveillance. However, several challenges exist in utilising these routinely collected data from across the globe for global stroke surveillance, such as non-standardised definitions and coding, missingness of data, and lack of transparent or reproducible methods. We aim to describe the vision and methods for a new global collaboration to leverage and harmonise population-level health data for global stroke surveillance.

Methods: The International Network for Standardised Population Insights and Real-world Evidence for STROKE (INSPIRE-STROKE) was established in October 2023 and currently includes 39 collaborators from 16 countries. The vision of INSPIRE-STROKE is to develop new methods that will harmonise and combine health databases across the world to facilitate reliable and robust multi-country stroke surveillance. Through this scientific community, we are initially collaborating to: (1) summarise existing methods for calculating and reporting measures of post-stroke outcomes using routinely collected health data; (2) develop consensus-based standards for analysing routinely collected health data on post-stroke outcomes; and (3) conduct proof-of-concept studies to align variables/definitions in routinely collected health data and create standardised statistical code to measure post-stroke outcomes (e.g., medication adherence, readmissions, and mortality) according to consensus-based definitions.

Conclusion: INSPIRE-STROKE will support more reliable investigations into country-level trends in stroke incidence and outcomes, by leveraging routinely collected health data at a global scale. The large and diverse data compiled for INSPIRE-STROKE could facilitate exploration of rare stroke outcomes, particularly among under-represented groups (e.g., pregnant women, children). INSPIRE-STROKE will strengthen health policy and resource planning by providing high-quality evidence to improve access to stroke care and maximise patient outcomes.

Objective: There is currently no clear consensus on the optimal treatment strategy for multiple intracranial aneurysms (MIAs). This study aimed to systematically compare the clinical outcomes of one-stage treatment of all aneurysms versus treatment of only the responsible aneurysm in patients with ruptured MIAs.

Methods: We included patients with ruptured MIAs who underwent surgical treatment in the Chinese Multicenter Cerebral Aneurysm Database (CMAD). 1:1 propensity score matching (PSM) was applied to balance baseline differences between groups and to compare outcomes and complications between one-stage treatment of all aneurysms and treatment of the responsible aneurysm only. The association between treatment modality and inhospital complications was assessed using a generalized estimating equation model. Survival was analyzed using Kaplan-Meier curves, and Cox proportional hazards models were used to identify risk factors for mortality in patients with ruptured MIAs.

Results: A total of 811 patients with ruptured MIAs were initially enrolled in this study. After PSM, 316 patients who underwent one-stage treatment were matched with 316 patients who received treatment for the responsible aneurysm only, resulting in 632 patients included in the final analysis. Although no statistically significant difference in mortality was observed between the groups, the survival curve trend favored one-stage treatment, with a lower 2-year mortality rate (11.2% vs. 16.2%; HR 1.368, 95% CI: 0.920-2.032, p = 0.121). No significant differences were found between the groups in terms of functional outcomes or inhospital complications. Multivariable Cox proportional hazards analysis identified age, previous stroke, and Hunt-Hess grade IV-V as independent risk factors for mortality. Endovascular treatment (EVT) was found to be a protective factor.

Conclusion: In this cohort, one-stage treatment of ruptured MIAs appeared feasible and showed no evident excess risk compared with treating only the responsible aneurysm. Patient selection remains critical, and the identified mortality risk factors may provide useful guidance for clinical risk assessment and preventive strategies.

Introduction: Cardiovascular disease (CVD) is associated with disability, highlighting the need for prevention strategies that assess and mitigate CVD risk. This study aimed to examine the relationship between participation in lifestyle activities and incident disability among older individuals at high risk of CVD.

Methods: This prospective cohort study included 3,217 older adults (mean age 70.7 years, standard deviation ± 6.8; 1,843 women [57.3%]). Absolute CVD risk was estimated using the revised World Health Organization charts, categorizing individuals' risk levels as either low (<10%) or high (≥10%). The incidence of disability was monitored for 60 months. Baseline assessments included the frequency of participation in 36 lifestyle activities spanning physical, cognitive, and social domains, measured by annual participation frequency. A total score was calculated and categorized into three tertiles based on the frequency of participation (low, moderate, and high groups). An adjusted Cox proportional hazard analysis assessed disability risk based on baseline participation in lifestyle activities stratified by CVD risk level.

Results: Over 60 months, 326 (10.2%) participants experienced disability. Older adults who were highly active in cognitive and social activities had a lower risk of disability than those who were less active. Stratified analysis based on CVD risk level showed that engagement in lifestyle activities was linked to disability risk among older adults at high risk of CVD, whereas no such association was observed in those at low risk.

Conclusion: Among older adults at high CVD risk, greater engagement in lifestyle activities was associated with a reduced risk of disability after 60 months.