Burden of neurological disorders in China and its provinces, 1990–2021: Findings from the global burden of disease study 2021

Background: The burden of neurological disorders in China has not been systematically analyzed. We aim to provide a comprehensive estimation of the national and subnational neurological burden across China from the Global Burden of Disease Study (GBD) 2021. Methods: We assessed burden estimates for 16 neurological disorders by age, sex, and province from 1990 to 2021, with prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We performed decomposition analysis to determine contributing factors for DALYs and used the socio-demographic index (SDI) to assess relations with development level. Findings: In 2021, there were 468.29 million prevalent cases of neurological disorders in China, corresponding to 78.10 million DALYs. Intracerebral hemorrhage was the leading cause of DALYs, followed by ischemic stroke, dementias, and migraine. DALYs of neurological disorders were higher in males than females, peaking at 70–74 years. From 1990 to 2021, the number and age-standardized rate of DALYs significantly decreased for idiopathic epilepsy and subarachnoid hemorrhage, primarily attributed to the reduction in YLLs, while the number of DALYs disproportionately increased for dementias, Parkinson's disease, and ischemic stroke contributed by population aging. The age-standardized DALY rates of seven neurological disorders had more than 5-fold variation between western and eastern provinces, despite reduced burdens with rising SDI. Conclusions: Neurological disorders pose a large and growing burden on public health, primarily driven by population aging. Our findings could inform priority setting and targeted strategies to optimize neurological service delivery.