Global trends in epilepsy and the Chinese experience: Epidemiological transitions, underlying mechanisms, and...

Epilepsy represents a global public health challenge, with its burden distribution profoundly illuminating patterns of health inequality. Based on the Global Burden of Disease Study 2021 (GBD 2021) data, this review constructs a three-dimensional analytical framework encompassing biological determinants, health system performance, and social determinants of health. Over the past three decades, although the absolute number of individuals with epilepsy worldwide has continued to increase, age-standardized mortality rates have declined substantially. However, 87.9% of the associated disability-adjusted life years (DALYs) are concentrated in low- and lower-middle-income countries (LMICs). China, with approximately 9-10 million people living with epilepsy, confronts a triple disparity encompassing regional disparities, urban-rural gaps, and health system hierarchy barriers: mortality rates in western provinces are approximately nine times higher than those in eastern regions; the treatment gap in rural areas reaches 60%-90%; and primary care capacity deficits within the tiered diagnosis and treatment system create bottlenecks in case identification and referral. Concurrently, the disease spectrum is undergoing a profound transition, with an increasing burden of post-stroke epilepsy in older adults, while special populations, including children and women, continue to face persistent challenges. Despite China's notable achievements in reducing mortality and establishing a tertiary epilepsy center network, multiple interacting factors perpetuate a vicious cycle of poverty, disease, and stigma among affected individuals. Future efforts require alignment with the World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP) to develop precision prevention and control strategies, thereby contributing the Chinese experience to global epilepsy governance.