The Global Burden of Disease Study (GBD 2010) is a large epidemiological study by the World Health Organization that has resulted in dozens of papers over the past decade.
As a result of improvements in some areas of population health (e.g. maternal and child health, sanitation, infection control) and the aging of the population, the health priorities are now shifting from mortality to morbidity – underscoring the significant impact of neurological and psychiatric disorders on burden of disease.
The following is a brief summary of some of the key findings from GBD 2010.
While neurological and psychiatric disorders account for only 1.4% of all deaths, they represent 28% of all years of life lived with disability (YLD) (Menken et al. Arch Neurol 2000;57:418-420). It is expected that by 2020, neurological and psychiatric disorders will account for 14.7% of the global burden of disease.
In Europe, the estimated annual cost (direct and indirect) per person with a brain disorder ranges from €285 for headache to €30,000 for neuromuscular disorders (Olesen et al. Eur J Neurol 2012;19:155-162). The Top 10 most costly disorders (in billions of Euros) are: mood disorders (113.4), dementia (105.2), psychotic disorders (93.9), anxiety disorders (74.4), addiction (65.7), stroke (64.1), headache (43.5), mental retardation (43.3), sleep disorders (35.4), and traumatic brain injury (33.0). Also important are multiple sclerosis (14.6), and Parkinson’s disease (13.9).
With respect to stroke, the incidence has decreased 12% in high-income countries but has increased by 12% in lower-income countries between 1990 and 2010 (Feigin et al. Lancet 2014;383:245-254). Mortality has decreased 37% in high-income countries and by 20% in lower-income countries. However, there were significant increases over the past two decades in the absolute number of people experiencing a first stroke (68% increase), in stroke survivors (84% increase), and in stroke-related deaths (26% increase). Over 62% of new strokes and 45.5% of stroke deaths were in patients younger than 75 years.
An important contributor to ischemic heart disease morbidity and mortality is major depression (Charlson et al. BMC Med 2013;11:250; free full text at www.biomedcentral.com/content/pdf/1741-7015-11-250.pdf). Depressive disorders are the leading contributor to disability-adjusted life years (DALY), and the second-leading cause of YLD (Ferrari et al. PLoS Med 2013;10:e1001547; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3818162/pdf/pmed.1001547.pdf). The greatest burden is seen in depressive disorders, followed by anxiety disorders, illicit drug use disorders, alcohol use disorders, schizophrenia and bipolar disorder (Whiteford et al. Lancet 2013;382:1575-1586).
Also noteworthy is that in 2010, an estimated 24 million people had psychostimulant dependency (amphetamines, 17 million; cocaine, 7 million); the point prevalence was 0.1% (Degenhardt et al. Drug Alcohol Depend 2014; epublished January 27, 2014) Over one-half of amphetamine dependence was found in Asian countries, whereas almost one-half of cocaine dependence was seen in North and South America (23% in North America).
Comment
Dr. Daniel Selchen: These data should be required reading for health ministries given the persistent systemic underfunding of neurological and mental health services compared to other areas (e.g. cardiology, oncology).With population aging, even with improving treatment, the morbidity related to neurodegenerative conditions and stroke will result in dramatically escalating social and economic costs. In Canada, there does not seem to be any plan to deal with this completely predictable crisis.