Neuroepidemiology最新文献

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.

Instruction: Traumatic spinal cord injury (TSCI) can cause severe health loss because of premature mortality and long-term disabilities. This study estimated the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of TSCI using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.

Methods: DisMod-MR2.1 was utilized to derive case number and age-standardized rate (ASR) with 95% uncertainty intervals (95% UIs) for the incidence (ASIR), prevalence (ASPR), and YLDs (ASYRs) for SCI from 1990 to 2021 for the whole world, 21 GBD regions, and 204 countries. Estimated annual percentage change was determined using a linear regression mode. Spearman rank order correlation was performed to identify the correlations between sociodemographic index (SDI) and the burden of TSCI.

Results: Globally, there were 574,502 (95% UI 440,219-757,445) incident cases, 15,400,682 (95% UI, 17,075,106-14,009,114) prevalent cases, and 1,305,142 (95% UI, 1,726,419-917,167) YLDs of total TSCI in 2021. From 1990, the number of incidences, prevalence, and YLDs cases showed an upward trend, while the ASIR, ASPR, and ASYR showed a downward trend. Males had higher ASIR, ASPR, and ASYR, and the ASIR, ASPR, and ASYR increased with age. Cervical SCI had higher ASIR and ASYR than SCI below neck level. It showed positive correlations between SDI and ASIR (rho = 0.4670, p < 0.01), ASPR (rho = 0.4035, p < 0.01), and ASYR (rho = 0.2727, p = 0.003) in 2021.

Conclusion: The absolute counts of incidence, prevalence, and burden of TSCI substantially increased from 1990 to 2021, despite the decrease in corresponding ASRs. TSCI happened in the most active periods of individuals globally, which were shifting toward older age-groups over time. TSCI had larger effects on the elderly and males than younger populations and females.

Introduction: This study explored the association between the frequency of individual outdoor activity and the risk of incident dementia in an elderly population in China. We aimed to provide scientific evidence to support non-pharmaceutical strategies for preventing or delaying the onset of dementia.

Methods: A total of 8,758 participants (median age: 85 years) from the Chinese Longitudinal Healthy Longevity Survey were included in the analyses. We assessed the association between the frequency of individual outdoor activity and the risk of incident dementia using the Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses were performed, stratified by age, sex, and residence. Additionally, a sensitivity analysis was conducted to evaluate the robustness of the findings after excluding participants who, at baseline, had a Mini-Mental State Examination (MMSE) score <18 or had been diagnosed with stroke, other cerebrovascular diseases, diabetes mellitus, cancer, or Parkinson's disease.

Results: Over a median follow-up period of 4.33 years, 637 participants (7.27%) developed dementia. Compared with those who almost never engaged in outdoor activities, participants who engaged almost daily had a reduced risk of incident dementia by approximately 25% (HR: 0.75, 95% CI: 0.62-0.92). Subgroup analyses showed significant associations in females and participants living in cities and towns, whereas no significant differences were observed between age groups. The sensitivity analysis yielded results consistent with the primary analysis.

Conclusion: Frequent participation in individual outdoor activity may be associated with a reduced risk of dementia among the elderly in China. These findings support outdoor activity as a potential non-pharmaceutical strategy to delay cognitive decline and prevent dementia.

Introduction: Adolescent neurological disorders remain a leading cause of the global disease burden. This study aimed to provide an updated assessment and insights into the burden trends from 1990 to 2021.

Methods: We calculated the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for common 10 prevalent neurological diseases in adolescents and young adults globally from 1990 to 2021. Data were presented by total numbers, sex, age, year, location, risk factors, Socio-Demographic Index (SDI), and expressed in counts and rates.

Results: In 2021, migraine (592.8 million, 95% UI 47.6-1,445.1), idiopathic epilepsy (204.8 million, 95% UI 152.8-279.5), and stroke (116.1 million, 95% UI 104.2-126.9) ranked as the top three neurological disorders globally in terms of DALYs. From 1990 to 2021, the absolute number of DALYs and deaths due to common neurological disorders significantly increased, although the age-standardized mortality rate slightly declined. Most disease burden increased with age, with a higher prevalence in females than in males. Furthermore, significant variations were observed between different diseases and regions, and the age-standardized DALY rates for most neurological disorders showed a significant positive correlation with the country's SDI value.

Conclusion: Neurological disorders ranked second in global adolescent and young adults' DALYs and remained a key mortality driver. Persistent absolute burden despite declining age-standardized rates urges prioritized prevention policies and care strategies amid population growth.

Introduction: Stroke is a leading cause of morbidity and mortality, particularly in older adults. Identifying lifestyle factors, such as physical activity (PA), that mitigate stroke risk is critical for stroke prevention, especially in postmenopausal women. We sought to determine the association between levels and types of recreational PA and risk of total, ischemic, and hemorrhagic stroke in postmenopausal women.

Methods: We performed a prospective cohort study conducted within the Women's Health Initiative from 1993 to 1998 with a mean follow-up of 8.5 years. We studied a total of 139,871 postmenopausal women aged 50-79 years without prior cardiovascular disease or stroke at enrollment. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Recreational PA was assessed via questionnaire, including total, light, moderate, and vigorous activities and walking. Incident total, ischemic, and hemorrhagic strokes were recored. HRs and 95% CIs were adjusted for sociodemographic, lifestyle, and clinical factors.

Results: During follow-up, 4,642 stroke occurred (3,496 ischemic and 728 hemorrhagic). Higher levels of total PA (per 1 SD MET-hr/wk: HR = 0.90, 95% CI: 0.87-0.93), walking (HR = 0.93, 95% CI: 0.90-0.96), and moderate PA (HR = 0.91, 95% CI: 0.88-0.94) were associated with reduced total stroke risk. Similar inverse associations were found for ischemic stroke. Vigorous PA demonstrated a J-shaped association with ischemic stroke, while light PA was not significantly associated with stroke risk. Total (HR = 0.90, 95% CI: 0.83-0.97) and vigorous PA (HR = 0.88, 95% CI: 0.81-0.96) were inversely associated with hemorrhagic stroke. Associations were consistent across subgroups defined by age, race/ethnicity, blood pressure, hormone therapy use, BMI, and dietary intake.

Conclusion: Increased recreational PA, particularly moderate, with cautious interpretation of vigorous activity due to its J-shaped association and potential risks, is associated with reduced risks of total and ischemic stroke in postmenopausal women. Our findings support promoting PA as a key strategy for stroke prevention in this population.