Neuroepidemiology最新文献

Introduction: The study uniquely focuses on the global incidence, mortality, and temporal trends of brain and central nervous system (CNS) cancer from 1992 to 2021. It explores the association between the disease burden and factors such as age, period, and birth cohorts, and provides forecasts for future incidence and mortality.

Methods: Leveraging the Global Burden of Disease 2021 data from 1992 to 2021, we calculated incidence, and deaths and their age-standardized rates (ASRs) and assessed temporal trends using the average annual percent change derived from joinpoint regression analysis. To explore the impacts of age, period, and birth cohort in greater depth, we applied an age-period-cohort model. Additionally, a Nordpred age-period-cohort analysis was conducted to forecast the global epidemiological trends from 2022 to 2031.

Results: The global incidence of brain and CNS cancer has increased from 2,831,075 in 1992 to 3,420,786 in 2021, and the number of mortalities has risen by 80.62%. The incidence ASR was highest in high sociodemographic index (SDI) regions and showed an increasing trend. Conversely, the mortality ASR displayed downward trends in high-middle and high SDI regions. Notably, the age-period-cohort model suggests a recent increase in incidence risk and a decline in mortality. From 2022 to 2031, the global mortality ASR was predicted to decrease whereas the incidence ASR increases slowly.

Conclusion: The global trends in brain and CNS cancer incidence and mortality generally showed an increasing trend with considerable heterogeneity. Furtherly, high SDI regions were displayed where healthcare systems could conduct earlier and better medical interventions with better outcome for brain and CNS cancer.

Background: Encephalitis can lead to significant disability among survivors. Up-to-date estimates of encephalitis incidence and the risk of postencephalitic epilepsy (PE) are crucial for informing health policy.

Methods: We used the National Taiwan Insurance Research Database to estimate the standardized incidence of encephalitis for each year from 2003 to 2017. We analyzed PE among these cases.

Results: From 2003 to 2017, the age- and sex-standardized incidence of encephalitis increased from 5.95 (95% confidence interval [CI]: 5.61-6.28) to 10.46 (95% CI: 10.04-10.87) per 100,000 person-years, with an annual percentage change of 1.6% (1.1-2.2, p < 0.05). However, yearly variation was observed. The incidence was consistently higher in patients under 18 years than in those aged ≥ 18 years throughout the study period. In 2017, the highest annual incidence was seen in adults aged ≥ 70 years and in children aged 1-4 years. Approximately 20% of the survivors developed PE within 5 years, with the highest risk observed in infants under 1 year of age.

Conclusion: The overall incidence of encephalitis in Taiwan increased from 2003 to 2017. Pediatric patients, particularly those under 1 year of age, are more vulnerable to encephalitis and its long-term complications, including PE, compared to adults, except for those aged ≥ 70 years.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with varying epidemiological trends across regions and demographics. Updated global assessments are needed to inform prevention and care strategies.

Materials and methods: Data on the age-standardized prevalence, incidence, and years lived with disability (YLDs) of TBI and its leading causes were retrieved from the Global Burden of Disease (GBD) 2021 project for 204 countries and territories, between 1990 and 2021. The counts and rates per 100,000 population, along with 95% uncertainty intervals (UIs), were presented for each estimate.

Results: In 2021, 37.92 million (37,928,494) prevalent cases of TBI were reported globally, with TBI accounting for 20.83 million (20,837,466) incident cases and 5.48 million (5,480,354) YLDs cases. The global age-standardized point prevalence, incidence, and YLD rates for TBI were 448 (95% UIs: 429.3-469.7), 259 (225.5-296.2), and 64.8 (45.7-86.7) per 100,000 population, which were 16.5%, 20.2%, 16.2% lower than in 1990, respectively. In 2021, the Kingdom of Saudi Arabia (1,218.2) had the highest age-standardized point prevalence of TBI (per 100,000). Kingdom of Saudi Arabia (680.7) had the highest age-standardized incidence of TBI (per 100,000). Syrian Arab Republic (83.5%) showed the largest increases in age-standardized point prevalence across the study period. Kingdom of Saudi Arabia (177.8) and the Republic of Madagascar (25.8) had the highest and lowest age-standardized YLD rates per 100,000, respectively. Among men, the global YLD rate of TBI increased up to age 80-84 years and then decreased with advancing age, whereas for women the rate increased up to age 90-94 years and then decreased with advancing age. Causes at the global level contributing most to the YLD rates for TBI were road injuries (21.4%), other transport injuries (13.2%), and interpersonal violence (11.4%).

Conclusion: Despite some evidence pointing to the decreasing burden of TBI, this injury remains a serious public health and social problem concerning peace and war, especially in countries of Eastern Europe and Central Europe with high-medium sociodemographic index. Our findings highlight road injuries as a key target for prevention and underscore the importance of fall prevention strategies - particularly for older adults and other vulnerable groups. Preventive strategies should concentrate on enhancing public awareness of road safety, improving laws and regulations on road traffic safety management, stabilizing impetuous and restless social emotions, stopping the war, and defending world peace to reduce the burden of TBI further.

Introduction: Acute ischemic stroke (AIS) is the most prevalent type of stroke, associated with a significant burden of functional impairments. About 94.2% of AIS patients present with multiple comorbidities, but how they affect AIS prognosis remains largely unknown. This study aimed to comprehensively assess the associations of a wide range of AIS-related comorbidities, their patterns, with functional impairments in AIS patients.

Methods: This study utilized data from the China National Stroke Registry 3 (CNSR3), a prospective registry encompassing 201 Chinese hospitals from August 2015 to March 2018. A total of 10,508 AIS patients were included, with a median age of 62.0 years (IQR: 54.0-70.0), and 65% were female. Eighteen AIS-related comorbidities were considered in the analysis and frequent pattern mining was employed to identify potential comorbidity patterns among AIS patients. Functional outcomes at 1 year after an AIS event were assessed using the modified Rankin Scale. Logistic regression models were utilized to evaluate associations of comorbidities, their patterns with AIS prognosis. Furthermore, association rule mining was applied to explore the hidden comorbidity combinations and their relationship with functional outcomes based on the identified patterns.

Results: Comorbidity was observed in 88.9% of AIS patients. The majority of AIS patients exhibited one to 3 comorbidities. Eight patterns of main comorbidities among AIS patients were identified. The pattern of common metabolic disorders, coronary heart disease, and atrial fibrillation demonstrated the strongest association (OR = 2.49, 1.59-3.89) with the development of poor functional outcomes. The further combination of heart failure and arthritis significantly increases the probability of poor functional outcomes, with lifts of 3.11 and 5.52, respectively.

Conclusions: Our study revealed that comorbidity is highly prevalent among AIS patients in China, encompassing diverse patterns. Specific comorbidities and comorbidity patterns are closely associated with poor functional outcomes. Our findings emphasized the importance of prioritizing comprehensive management of AIS and AIS-related comorbidities to reduce the risk of disability among AIS patients.

Background: Intracerebral hemorrhage represents a critical subtype of stroke, imposing substantial social and economic challenges. Considering the considerable impact of intracerebral hemorrhage in Asia and the absence of studies detailing its epidemiological features, the aim of this study was to elucidate the temporal trends and distribution characteristics of intracerebral hemorrhage in Asia from 1990 to 2021, as well as to forecast the future burden.

Methods: The data derived from Global Disease Burden Study 2021 were used to investigate the age-standardized rates and absolute numbers of incident intracerebral hemorrhage cases and related deaths in Asia across genders, age groups, and geographical locations. An estimated annual percentage change was estimated to represent temporal trends, and an autoregressive integrated moving average model was used to forecast the future burden.

Results: In Asia, the age-standardized incidence and mortality rates of intracerebral hemorrhage per 100,000 population have declined from 1990 to 2021, despite a continuous increase in the absolute numbers, which exhibit significant heterogeneity across different geographical locations. In terms of gender, males experience a greater burden of intracerebral hemorrhage compared to females, and the impact of risk factors on disability-adjusted life years of intracerebral hemorrhage varies. In comparison to the figures observed in 2021, our forecasts indicate a rise in the burden of intracerebral hemorrhage in Asia.

Conclusions: The study offers an extensive depiction of the epidemiological features of intracerebral hemorrhage in Asia spanning from 1990 to 2021 while also outlining the diverse trajectories of the impending burden of this condition in the region. Comprehending the expected increase in disease burden can aid in formulating tailored strategies to tackle upcoming challenges.

Background: Prospective data show an increased risk of mortality in essential tremor (ET). Understanding the contributors to this increased mortality is of value.

Methods: A total of 347 cases were enrolled in a prospective study of cognition in elders with ET (M baseline age = 79.6 years, M follow-up length = 2.7 years). At each visit, cases completed clinical assessments, a cognitive test battery, and were assigned a Clinical Dementia Rating (CDR). Cox proportional hazards regression equations identified predictors of cases' relative risk of mortality.

Results: 41 (11.8%) of 347 cases died during follow-up. Deceased cases were older at baseline, had fewer years of education, used more medication, had more severe tremor, had more gait impairment, and reported more falls, less physical activity, and more depressive symptoms than did living cases. In univariate analyses, a CDR score of 1 or 2 (dementia) was associated with a six-fold increased risk of mortality (hazard ratio [HR] = 6.33). Moderate rather than milder levels of dementia (CDR 2 rather than 1) were driving this effect, with multivariate models demonstrating HRs in excess of 7.5 (p < 0.001). Gait impairment and falls were also associated with significant increased risk of mortality in multivariate models.

Conclusion: We identified several factors that may be used to risk-stratify ET patients with respect to mortality. The information from these analyses can be of value in identifying subgroups of ET patients who demonstrate risk for early death; such subgroups can then be targeted for interventions as well as preventive measures.

Background: Management of ruptured intracranial aneurysms (RIAs) in elderly patients remains a major challenge in the treatment of cerebrovascular diseases. This study aims to provide a comprehensive analysis of the impact of microsurgical treatment (MST) and endovascular treatment (EVT) on the outcomes of elderly patients with RIAs in northern China.

Methods: We consecutively enrolled elderly patients with RIAs who underwent surgery in the Chinese Multicenter Cerebral Aneurysm Database (CMAD) from January 2017 to December 2020. In this study, in-hospital complications, survival, and functional outcomes were compared between MST and EVT after 1:1 propensity score matching (PSM). Kaplan-Meier survival analyses and Cox proportional hazards modeling identified factors associated with mortality in both groups. Logistic regression analyses identified 2-year survival-dependent risk factors, and subgroup analyses were conducted for key strata.

Results: 744 elderly patients with RIAs were enrolled in the study. 219 patients with MST after PSM were matched with 219 patients with EVT. Compared to EVT, MST had a higher 2-year mortality rate (32.8% vs. 20.5%, p = 0.002), higher incidence of adverse discharge outcomes (48.4% vs. 32.4%, p = 0.001), longer length of stay (LOS) (16 [12-24] vs. 15 [10-23], p = 0.049), pneumonia (MST: 31.1%; EVT: 21.9%, p = 0.030), and intracranial infection (9.6% vs. 2.7%, p = 0.005). However, there was no difference in the 2-year survival-dependent outcome (22.7% vs. 23.2%, p = 0.924). Differences in risk factors for mortality and 2-year survival-dependent outcomes were observed between the MST and EVT groups in the elderly population. The negative association of EVT with risk of mortality was consistent across specific subgroups.

Conclusion: Elderly patients with RIAs who underwent EVT were significantly better than the MST group in terms of short-term functional outcomes, in-hospital complications, long-term survival, and LOS. However, there were no differences in the 2-year survival-dependent outcomes.

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

Methods: We analyzed global and regional changes in age-standardized mortality rates (ASMRs) and disability-adjusted life years (ASDR) for neurological diseases attributable to behavioral risks from 1990 to 2021, considering sex differences. Joinpoint regression estimated annual changes, while age-period-cohort and Bayesian models assessed temporal patterns and projected trends to 2035. Cross-national analysis evaluated the impact of socioeconomic disparities.

Results: From 1990 to 2021, the absolute burden of neurological diseases increased, with stroke contributing the most, followed by Alzheimer's disease and other dementias (ADODs), idiopathic epilepsy (IE), and multiple sclerosis (MS). ASMR and ASDR declined for ADOD, MS, and stroke, whereas IE mortality attributable to alcohol rose (net drift = 0.28%), particularly among adults aged ≥65 years (local drift = 0.33%). Stroke mortality linked to alcohol remained stable among those aged 20-30 years. Males had a higher burden than females. By 2035, little reduction in the IE burden is expected. Stroke burden varied across sociodemographic index (SDI) levels: tobacco and alcohol were dominant in high-SDI regions, while tobacco and diet were prominent elsewhere. Regional inequalities persisted, with ADOD and MS concentrated in high-income regions and stroke in low-income regions.

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 greatly contribute to stroke in non-high-SDI regions. Future efforts should strengthen risk control in males and reduce 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 5 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 3 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.