Bayesian age-period-cohort analysis and trend prediction of epilepsy disease burden in China, 1990-2021

This study analyzes the trends, age-period-cohort effects, and influencing factors of epilepsy burden in China from 1990 to 2021, and predicts future burden to support prevention strategies.

Data were sourced from the Global Burden of Disease Study (GBD) 2021 study. Joinpoint regression analyzed trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs). The BAPC (Bayesian Age-Period-Cohort) model evaluated age, period, and cohort effects, and an ARIMA (Autoregressive Integrated Moving Average) model projected burden to 2036.

In 2021, epilepsy cases reached 3.086 million (a 41.67% increase since 1990), while DALYs fell to 1.375 million person-years (a 35.60% decrease). Age-standardized incidence and prevalence increased (average annual percent change [AAPC] = 0.78% and 0.42%, respectively), whereas mortality and DALY rates declined (AAPC = -2.65% and -1.79%). After 2019, incidence and prevalence rose sharply, accompanied by a short-term increase in DALY rates indicating a risk of rebound. Age-specific burden shifted from a unimodal (0-25 years) to a bimodal distribution (0-14 and 30-34 years), with the highest burden now among working-age adults. The DALY rate decreased slowest in youths (20-24 years) and fastest in middle-aged groups (45-55 years). Projections indicate continued declines in mortality but stable yet fluctuating incidence through 2036.

Despite improved mortality and DALY rates, epilepsy incidence and prevalence have increased, and although the overall DALY rate has declined, a recent uptick since 2019 signals the need for continued vigilance and targeted intervention. The shifting burden toward working-age populations underscores the need for differentiated prevention strategies focusing on young adults and the elderly, emphasizing early intervention and long-term management.