Global Burden of Neurological Diseases Attributable to Behavioral Risks, 1990-2021

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

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.

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.

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.