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National Institutes of Health Research Funding Inequities of Psychiatric and Neurological Disorders: A Predictive
Eli Berglas1, Eliyahu M Kochman, Lana Krilyuk
1Author Affiliations: College of Medicine, State University of New York Downstate, Brooklyn, New York, USA (Mr Eli Berglas, Mr Kochman, Ms Krilyuk, Mr Mathew, and Mr Yomtov); College of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA (Ms Berglas); and Department of Neurosurgery, Albany Medical Center, Albany, New York, USA (Dr Adamo).
Context:
The burden of vastly different diseases has been used to predict National Institutes of Health (NIH) research funding, typically including only 1 year of data. A multi-year analysis of related diseases would provide a more accurate assessment of which diseases are funded appropriately compared to their burden, enabling targeted lobbying efforts and policy changes to ensure equitable funding.
Objectives:
Determining under- or over-funded psychiatric and neurological diseases over a 13-year period.
Design:
This ecological study utilized disability-adjusted life years (DALYs) to quantify disease burden. Quantile regression residuals and 95% CIs at several quantiles determined under- or over-funding. Joinpoint regression delineated DALY trends using average annual percent change (AAPC).
Setting:
The United States.
Participants:
Persons contributing DALYs from attention-deficit/hyperactivity disorder, autism, depressive disorders, eating disorders, schizophrenia, epilepsy, headache disorders, multiple sclerosis, Parkinson's disease, or stroke.
Intervention:
None.
Main Outcome Measure:
The difference between actual and predicted funding.
Results:
Changes in DALYs had a greater impact at higher funding levels. Eating and headache disorders were significantly underfunded at all quantiles. The severity of underfunding at the 50 th quantile decreased for eating (363% [CI: 329%, 386%] to 190% [CI: 170%, 204%]) and headache (1497% [CI: 1164%, 1665%] to 676% [CI: 514%, 759%]) disorders from 2011 to 2023. Disability-adjusted life years for eating disorders decreased (AAPC = -1.0% [CI: -1.1%, -0.9%]), whereas DALYs for headache disorders increased marginally (AAPC = 0.1% [CI: 0.1%, 0.1%]).
Conclusions:
Changes in disease burden were correlated with more significant funding changes in diseases with greater baseline funding. The 2 lowest-funded diseases, eating and headache disorders, are being drastically underfunded compared to their disease burden. While this was not correlated with significant aberrations in disease burden trends in the study period, further lobbying efforts and policy changes must be considered to ensure these diseases receive equitable funding.
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