Neurological diseases constitute a heterogeneous group of conditions that, at the population level, are widespread and disabling. Some of them have their onset after the age of 60-65, and considering the aging of the Italian population, it is highly likely that there will be an increasing trend in the prevalence of these diseases in our country.
In this study, we used estimates on Italy for the years 1990 and 2019 to assess the incidence (i.e., the number of new cases per year), prevalence (i.e., the number of cases with that specific disease), and disability (measured by “years lived with disability”) associated with neurological diseases, viz: Alzheimer’s disease and other dementias, brain and central nervous system tumors, epilepsy, motor neuron disease, multiple sclerosis, Parkinson’s disease, stroke, migraine and muscle tension headache; meningitis, encephalitis and tetanus; head injury and spinal cord injury. For each of these we evaluated the numbers in absolute terms and the rates/100,000 on an annual basis, as well as the percentage change between 1990 and 2019; secondly, we compared diseases with onset in young adulthood (epilepsies, multiple sclerosis, migraine and muscle-tensive headache) with those with onset in older ages (dementias, brain tumors, motor neuron disease, Parkinson’s disease and stroke), with communicable diseases (meningitis, encephalitis and tetanus) and finally with those of traumatic origin (head injury and spinal cord injury).
The most prevalent diseases are muscle tension headaches, migraine and dementia, and those associated with the most disability in the population are migraine, dementia and head injury. In absolute terms, between 1990 and 2019, the prevalence of neurological diseases increased by 13% (5.9% in rate/100,000). This increase is mainly due to a growth in diseases with onset in young-adult age: diseases with onset in old age increased considerably in absolute terms (+53%) but decreased significantly in terms of rates/100,000 (-14.3%), which can be interpreted as an increase due to population growth and aging. A similar trend can be observed for disability: it increased with reference to diseases with onset in youth-adult age, while in diseases with onset in old age it increased considerably in absolute terms (+57.4%) but decreased significantly in terms of rates/100,000 (-13.7%).
The results of this study return a description of the trend of neurological diseases in Italy, which overall shows an increase in total cases and disability associated with these diseases. This increase, in absolute terms, is very strong for diseases with onset in old age. However, it should be noted that between 1990 and 2019, Italy’s population increased (from about 55 to about 61 million). Above all, the population has aged: for example, in 1990 there were about 1,300,000 Italians over the age of 80, while in 2019 there were about 3,200,000; in contrast, there were about 8,800,000 young people under the age of 25 in 1990 and there were about 6,800,000 in 2019; in the middle range, there has been a rise from about 45 to about 51 million people aged 25 to 75. This demographic variation explains the reason for this increase, which is, however, different depending on the type of disease: those with onset in old age increased mainly because there are more people of advanced age.
This increase has led to a growth in the disability of the population as a whole, and neurological diseases have shown a significant increase with respect to this parameter. It will be increasingly important to put in place actions that are able to mitigate the outcomes of neurological disorders in different aspects: early diagnosis, appropriate treatments, dedicated care pathways, and labor policy interventions that will reduce disability in the adult group, especially work-related disability.
Raggi, A., Monasta, L., Beghi, E., Caso, V., Castelpietra, G., Mondello, S., Giussani, G., Logroscino, G., Magnani, F. G., Piccininni, M., Pupillo, E., Ricci, S., Ronfani, L., Santalucia, P., Sattin, D., Schiavolin, S., Toppo, C., Traini, E., Steinmetz, J., Nichols, E., … Leonardi, M. (2021). Incidence, prevalence and disability associated with neurological disorders in Italy between 1990 and 2019: an analysis based on the Global Burden of Disease Study 2019. Journal of neurology, 10.1007/s00415-021-10774-5. Advance online publication. https://doi.org/10.1007/s00415-021-10774-5