Burden of Neurological Disorders across the US from 1990-2017: A Global Burden of Disease Study

Valery L. Feigin, Theo Vos, Fares Alahdab, Arianna Maever L. Amit, Till Winfried Bärnighausen, Ettore Beghi, Mahya Beheshti, Prachi P. Chavan, Michael H. Criqui, Rupak Desai, Samath Dhamminda Dharmaratne, E. Ray Dorsey, Arielle Wilder Eagan, Islam Y. Elgendy, Irina Filip, Simona Giampaoli, Giorgia Giussani, Nima Hafezi-Nejad, Michael K. Hole, Takayoshi IkedaCatherine Owens Johnson, Rizwan Kalani, Khaled Khatab, Jagdish Khubchandani, Daniel Kim, Walter J. Koroshetz, Vijay Krishnamoorthy, Rita V. Krishnamurthi, Xuefeng Liu, Warren David Lo, Giancarlo Logroscino, George A. Mensah, Ted R. Miller, Salahuddin Mohammed, Ali H. Mokdad, Maziar Moradi-Lakeh, Shane Douglas Morrison, Veeresh Kumar N. Shivamurthy, Mohsen Naghavi, Emma Nichols, Bo Norrving, Christopher M. Odell, Elisabetta Pupillo, Amir Radfar, Gregory A. Roth, Azadeh Shafieesabet, Aziz Sheikh, Sara Sheikhbahaei, Jae Il Shin, Jasvinder A. Singh, Timothy J. Steiner, Lars Jacob Stovner, Mitchell Taylor Wallin, Jordan Weiss, Chenkai Wu, Joseph Raymond Zunt, Jaimie D. Adelson, Christopher J.L. Murray

Research output: Contribution to journalArticlepeer-review

131 Citations (Scopus)


Importance: Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US. Objective: To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017. Design, Setting, and Participants: This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus. Exposures: Any of the 14 listed neurological diseases. Main Outcome and Measure: Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated. Results: The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (-29.1% [95% UI, -32.4% to -25.8%]); spinal cord injury prevalence (-38.5% [95% UI, -43.1% to -34.0%]); meningitis prevalence (-44.8% [95% UI, -47.3% to -42.3%]), deaths (-64.4% [95% UI, -67.7% to -50.3%]), and DALYs (-66.9% [95% UI, -70.1% to -55.9%]); and encephalitis DALYs (-25.8% [95% UI, -30.7% to -5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. Conclusions and Relevance: There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders..

Original languageEnglish
Pages (from-to)165-176
Number of pages12
JournalJAMA Neurology
Issue number2
Publication statusPublished - 2021 Feb

Bibliographical note

Funding Information:
Funding/Support: This study was supported by the Bill & Melinda Gates Foundation. Dr Sheikh acknowledges support from Health Data Research UK. Dr Bärnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor Award, funded by the German Federal Ministry of Education and Research.

Funding Information:
grants from Italian Ministry of Health, Italian Ministry of Health, American ALS Association, and SOBI and personal fees from Arvelle Therapeutics and Eisai, outside the submitted work. Dr Dorsey reports personal fees from American Academy of Neurology courses, American Neurological Association, University of Michigan, 23andMe, Abbott, AbbVie, American Well, Biogen, BrainNeuroBio, Clintrex, Curasen Therapeutics, DeciBio, Denali Therapeutics, GlaxoSmithKline, Grand Rounds, Karger, Lundbeck, MC10, MedAvante, Medical-Legal services, Mednick Associates, National Institute of Neurological Disorders and Stroke, Olson Research Group, Optio, Origent Data Sciences Inc, Otsuka, Prilenia, Putnam Associates, Roche, Sanofi, Shire, Spark, Sunovion Pharma, Teva, Theravance, UCB, and Voyager Therapeutics; grants from AbbVie, Acadia Pharmaceuticals, AMC Health, Biosensics, Burroughs Wellcome Fund, Davis Phinney Foundation, Duke University, Food and Drug Administration, GlaxoSmithKline, Greater Rochester Health Foundation, Huntington Study Group, Michael J. Fox Foundation, National Institutes of Health/National Institute of Neurological Disorders and Stroke, National Science Foundation, Nuredis Pharmaceuticals, Patient-Centered Outcomes Research Institute, Pfizer, Prana Biotechnology, Raptor Pharmaceuticals, Roche, Safra Foundation, Teva Pharmaceuticals, and University of California, Irvine; editorial services from Karger Publications; and an ownership interest in Grand Rounds (a second-opinion service), outside the submitted work. Dr Norrving reports personal fees from AstraZeneca and Bayer, outside the submitted work. Dr Pupillo reports grants from American Amyotrophic Lateral Sclerosis Association and other support from Revalesio Corporation outside the submitted work. Dr Sheikh reports grants from Health Data Research UK, outside the submitted work; personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio Health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, Practice Point Communications, the National Institutes of Health, the American College of Rheumatology, and Simply Speaking; ownership in stock options from Amarin Pharmaceuticals and Viking Pharmaceuticals; other support from Vaxart Pharmaceuticals; and nonfinancial support from the US Food and Drug Administration Arthritis Advisory Committee, the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, and Veterans Affairs Rheumatology Field Advisory Committee, the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside the submitted work. In addition, Dr Singh is the chair of the Veterans Affairs Rheumatology Field Advisory Committee, the editor and director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, and a former member of the following committees: the American College of Rheumatology's Annual Meeting Planning Committee and Quality of Care Committees, the Chair of the American College of Rheumatology Meet the Professor, Workshop and Study Group Subcommittee and the cochair of the American College of Rheumatology Criteria and Response Criteria subcommittee. Dr Steiner reports personal fees from Eli Lilly outside the submitted work. Dr Stovner reports grants and personal fees from Allergan, Teva, and Novartis and personal fees from Lundbeck, Lilly, and Springer Publisher, outside the submitted work. Dr Wu reports personal fees from Health Keepers and grants from Suzhou Science and Technology Bureau, Kunshan Government, and Duke Kunshan University, outside the submitted work. Dr Roth reported grants from the Bill and Melinda Gates Foundation and Cardiovascular Medical Research and Education Foundation during the conduct of the study. No other disclosures were reported.

Publisher Copyright:
© 2021 American Medical Association. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Clinical Neurology


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