Presentation on theme: "Epidemiology of Neurological Disorders Dr. Yeşim YASİN Fall-2013."— Presentation transcript:
Epidemiology of Neurological Disorders Dr. Yeşim YASİN Fall-2013
Outline: Global burden of neurological disorders National burden of neurological disorders Most commonly seen neurological disorders: a public health approach Prevention
Global burden of disesase Neurological diseases are becoming increasingly important in terms of public health throughout the world and in Turkey.
Global burden of disesase The Global Burden of Disease report drew the attention of the international health community to the fact that the burden of mental and neurological disorders had been seriously underestimated by traditional epidemiological methods that took into account only mortality, not disability rates.
Global burden of disease The Global Burden of Disease report specifically showed that while mental and neurological disorders are responsible for about 1% of deaths, they account for almost 11% of disease burden worldwide
Many conditions including neuropsychiatric disorders and injuries cause considerable ill-health but no or few direct deaths. Separate measures of survival and of health status among survivors needed to be combined to provide a single, holistic measure of overall population hea lth.
Many conditions including neuropsychiatric disorders and injuries cause considerable ill-health but no or few direct deaths.
To assess the burden of disease; measures both premature mortality (years of life lost because of premature mortality or YLL) disability (years of healthy life lost as a result of disability or YLD, weighted by the severity of the disability).
The sum of these two components, disability-adjusted life years (DALYs), provides a measure of the future stream of healthy life (years expected to be lived in full health) lost as a result of the incidence of specific diseases and injuries
Neuropsychiatric disorders and injuries in particular were major causes of lost years of healthy life as measured by DALYs, were significantly underestimated when measured by mortality alone
The cause categories used in the GBD study is divided into three broad groups of causes: Group I consists of communicable diseases, maternal causes, conditions arising in the perinatal period and nutritional deficiencies; Group II encompasses the noncommunicable diseases (including neuropsychiatric conditions); and Group III comprises intentional and unintentional injuries.
Common neurological disorders Stroke Dementia Epilepsy parkinsonS disease Headeache disorders Multiple sclerosis Neuroinfections Neurological disorders associated with malnutrition Pain associated with neurological disorders Traumatic brain disorder
Estimates of disability adjusted life years (DALYs)
Table 1. Number of DALYs for neurological disorders and as percentage of global DALYs projected for 2015 and 2030 neuropsychiatric category 2% 4.3%
Percentage of total DALYs for selected diseases a and neurological disorders b Neurological disoerders constitute slightly over 6% of total burden,
DALYs for individual neurological disorders as percentage of total neurological disorders
Neurological disorders as percentage of total DALYs for 2005, 2015 and 2030 across income category Neurological disorders contribute to 10.9%, 6.7%, 8.7% and 4.5% of the global burden of disease in high, upper middle, lower middle and low income countries, respectively, in 2005.
Deaths attributable to neurological disorders as percentage of total deaths, 2005, 2015, 2030
Deaths from selected neurological disorders as percentage of total neurological disorders
Deaths DALYs Deaths and DALYs from selected neurological disorders as percentage of total neurological disordres
Neurological disorders as percentage of total deaths for 2005, 2015 and 2030 across World Bank income category Neurological disorders constitute 16.8% of the total deaths in lower middle income countries compared with 13.2% of the total deaths in high income countries.
Estimates of years of healthy life lost as a result of disability (YLDs)
YLDs per 100 000 population associated with neurological disorders and other diseases and injuries with neurological sequelae and as percentage of total YLDs projected for 2015 and 2030 The number of YLDs per 100 000 population associated with neurological disorders and other diseases and injuries with neurological sequelae is projected to decline from 1264 in 2005 to 1109 in 2030
YLDs per 100 000 population associated with neurological disorders and other diseases and injuries with neurological sequelae and as percentage of total YLDs projected for 2015 and 2030 YLDs associated with Alzheimer and other dementias, however, are projected to increase by 38%.
Top five causes of YLDs among neurological disorders, by income category YLDs per 100 000 population for neuroinfections, and the nutritional deficiencies and neuropathies category are highest for low income countries neurological injuries, epilepsy and migraine, they are highest in upper middle income countries For Alzheimer and other dementias they are highest for high income countries
YLDs associated with neurological disorders by income category almost half of the burden in terms of YLDs attributable to neurological disorders is in low income countries followed by lower middle income countries
BURDEN ATTRIBUTABLE TO SEVEN BASIC RISK FACTORS Alcohol use Insufficient consumption of fruits and vegetables Physical inactivity High colesterol Smoking High body mass index High blood pressure
Hypertension as a common risk factor number of deaths attributed to hypertension, which refers to the fact that they could be prevented by keeping hypertension under control is 39.731 for cerebrovascular diseases
alcohol consumption- attributed deaths are mostly the consequences ischemic heart diseases and hemorragic stroke. 2088 deaths caused by hemorrhagic stroke could be prevented by prevention of alcohol consumption
11109 deaths caused by ischemic stroke could be prevented by prevention of obesity
high cholesterol is among major risk factors of ischemic heart diseases and ischemic stroke. Prevention of high cholesterol could prevent 7.802 deaths caused by ischemic stroke
Sufficient amount of physical activity could prevent 10.269 deaths caused by ischemic stroke. As for burden of disease which is preventable, physical activity could prevent 101.578 DALY in ischemic stroke.
Primary prevention High risk approach (individual approach) Population based approach
Prevention- high risk strategy Elimination of the major risk factors. Controlling high blood pressure Lowering the level of blood cholesterol Quitting tobacco use Controlling diabetes Maintaining a healthy weight, body mass index Diet Exercising regularly Prevention and treatment of coronary hearth diseases
Prevention- population based strategy Raising awareness of health personnel about treatment and prevention of neurological diseases A comprehensive national strategy; community-based health promotion and access to treatment can substantially decrease the burden associated with cerebrovascular diseases (stroke)
Health promotion programmes to prevent risk factors. Smoke free air space Diabet control programmes Promoting and creating built or natural environments that encourage and support physical activity. Prevention-population based strategy
immunization programme for the prevention of neuroinfections (poliomyelitis, neurological consequences of infections) Road safety – prevention of traumatic brain injury Traumatic brain injury is the leading cause of death and disability in children and young adults
Tertiary prevention Using medication Rehabilitation ASPIRIN In cases of acute stroke, aspirin is given as soon as CT or MRI has excluded intracranial haemorrhage. Immediate aspirin treatment slightly lowers the risk of early recurrent stroke and increases the chances of survival free of disability about one fewer patient dies or is left dependent per 100 treated. However, because aspirin is applicable to so many stroke patients, it has the potential to have a substantial public health effect.
WHO recommendations Gain commitment from decision-makers Increase public and professional awareness Minimize stigma and eradicate discrimination Strengthen neurological care within the existing health systems Incorporate rehabilitation into the key strategies Establish links to other sectors Define priorities for research
Conclusions Estimating the burden of diseases is difficult due to imperfect medical registration, variations in structure of patient referral and influence of secondary diagnoses. Taking into account the current aging of the population, the prevalence of some neurological diseases, such as CVA, Parkinson's disease and dementia will rise. Priority setting for care and treatment is hampered by differences in burden of illness on the individual and on the community level