Abstract
OBJECTIVES: To multi-dimensional analyze global trends and inequalities in the burden of neurological disorders (NDs) and subcategories from 1990 to 2021, and provide clues for policymakers to formulate relevant prevention and control strategies. METHODS: Using data from the Global Burden of Disease Study 2021, we assessed trends in incidence and disability-adjusted life years (DALYs) and estimated the annual percentage change (EAPC) for NDs and their eight subcategories. Cross-country inequalities and decomposition were quantified for DALYs. Analyses were stratified by Socio-Demographic Index (SDI), age, sex, and region. RESULTS: Globally, age-standardized incidence (ASIR) and DALY rates (ASDR) remained stable, but marked heterogeneity existed across subcategories. Tension-type headache (ASIR: 87%) and migraine (ASDR: 40%) dominated burdens in 2021. Parkinson's disease and migraine exhibited rising trends (ASIR-EAPC: 1.09% and 0.07%; ASDR-EAPC: 0.32% and 0.05%, respectively). Females bore higher burdens for migraine, multiple sclerosis, and Alzheimer's disease and other dementias, with disparities widening in older age groups. Middle SDI regions, particularly East Asia (EAPC: 0.22%) and China (0.23%), saw accelerating ASIR. ASDR grew fastest in Western Sub-Saharan Africa (0.22%) and Zambia (0.62%). Cross-country inequality indices revealed worsening disparities, concentrating burden in high SDI countries, while idiopathic epilepsy persistently clustered in low SDI populations. Population growth (64.21%) and aging (35.33%) drove DALYs increase, with aging disproportionately impacting high- and high-middle SDI regions. CONCLUSIONS: The burden of NDs demonstrates significant age, sex, and socioeconomic heterogeneity. Prioritizing resource equity and tailored policies is critical to achieving targets. High SDI regions require aging-focused interventions, while low/middle SDI regions need population-level strategies.