The Epidemiological Transition of Neurodegenerative Diseases in China: A Multi-Layered Deconstruction Using Global Burden of Disease Study 2023

Neurodegenerative diseases (NDDs), including Alzheimer's disease and other dementias (ADOD), Parkinson's disease (PD), and motor neuron disease (MND), represent a mounting public health challenge in China amid rapid population aging. A systematic deconstruction of their epidemiological transition using the most recent data remains lacking.

Data from the Global Burden of Disease Study 2023 were utilized to examine temporal trends (1990-2023) for ADOD, PD, and MND in China. Age-standardized rates of incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life-years (ASDR) were analyzed. Joinpoint regression was used to identify significant inflection points. Decomposition analysis quantified the contributions of population aging, population growth, and epidemiological change. And bayesian age-period-cohort models projected trends to 2035.

From 1990 to 2023, the ASIR for ADOD (EAPC 0.41; 95% CI 0.33 to 0.49) and PD (EAPC 0.84; 95% CI 0.76 to 0.92) rose significantly. Between 2019 and 2023, multiple indicators across the three diseases demonstrated a consistently synchronous upward trend. This acceleration coincided with the COVID-19 pandemic. Decomposition demonstrated that population aging was the dominant driver. Sex-specific disparities were pronounced. Females bore a higher ADOD burden, whereas males predominated in PD. ASIR and ASPR are expected to rise, while ASMR and ASDR are projected to decline for ADOD and PD. For MND, only the ASPR indicated a brief, peaked rise in the predicted trends.

In the field of neurodegenerative diseases, China is projected to undergo an epidemiological transition characterized by chronicization. This trend calls for systematic adjustments in healthcare services, long-term care systems, and social support structures. Sex and gender differences further underscore the need for gender-sensitive prevention, clinical management, and care strategies to prevent the further widening of inequalities. Population aging remains a critical factor that cannot be overlooked. Therefore, there is an urgent need to establish a proactive, gender-sensitive framework for system-wide restructuring that incorporates long-term monitoring and oversight.