Non-Communicable Neurological Disorders Doubled In India In Last Two Decades

The share of non-communicable and injury-related neurological disorders to the total disease burden more than doubled in India from 1990 to 2019, whereas the contribution of communicable neurological disorders reduced during this period by three-quarters, according to a report published in The Lancet Global Health by the India State-Level Disease Burden Initiative. 

Ageing of the population is one of the main contributors to the rise in burden of non-communicable neurological disorders within the country, the report highlights. While communicable diseases contributed to the majority of total neurological disorders burden in children younger than 5 years, non-communicable neurological disorders were the highest contributor in all other age groups.

Among the known risk factors for neurological disorders, the burden is high blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index.

The first comprehensive estimates of disease burden due to neurological disorders and their trends in every state of India, reveal that stroke alone caused 699,000 deaths in India in 2019, which was 7.4% of the total deaths in the country.

The rising neurological disorders include non-communicable neurological disorders (stroke, headache disorders, epilepsy, cerebral palsy, Alzheimer’s disease and other dementias, brain and central nervous system cancer, Parkinson’s disease, multiple sclerosis, motor neuron diseases, and other neurological disorders), communicable neurological disorders (encephalitis, meningitis, and tetanus), and injury-related neurological disorders (traumatic brain injuries and spinal cord injuries.

Gagandeep Singh, Professor, Dayanand Medical College, and the first author of the paper states that the prevalence of epilepsy, a common neurological disorder in India, has increased over the past three decades. “It is gratifying to note that India has made some gains in reducing premature deaths and morbidity of people with epilepsy over this period by reducing treatment gaps. There is however a need to scale up treatment coverage of epilepsy in governmental schemes such as the Rashtriya Bal Swasthya Karyakram and Ayushman Bharat. Policies and practices focusing on safe births, preventing head injury and stroke would help in averting a substantial proportion of epilepsies,” states Singh.

The study, based on collaboration with leading neurology experts in India, provides policy-relevant insights into the trends of neurological disorders across the states.

“While the burden of infectious neurological disorders has fallen in India, this burden is higher in less developed states. On the other hand, the burden of neurological disorders related to injury is higher in more developed states. Among non-communicable neurological disorders, stroke is the third leading cause of death in India, and dementias are the fastest growing neurological disorder,” states Prof Lalit Dandona, Director of the India State-Level Disease Burden Initiative, who is also honorary distinguished scientist at ICMR and distinguished professor at PHFI, and senior author of the paper.

The burden of many neurological disorders vary substantially across the states. The state-specific findings described in this scientific paper highlight the extent of the effort needed in each state to reduce the burden of neurological disorders through state-specific health system responses aimed at increasing awareness, early identification, cost-effective treatment, and rehabilitation. The trends over about three decades reported in this research paper utilized all available data sources from India, which enabled more robust estimates of neurological disorder burden across India than those available so far.

“This scientific paper presents a comprehensive perspective of the burden of neurological disorders over the last thirty years, and systematically highlights the variations between the states. Several government policies and initiatives are in place to address the burden of neurological disorders across India, however more focused efforts are required for the planning of specific neurology services in each state,” says Prof Vinod Paul, Member NITI Aayog, in a statement.

Paul stressed on the need to address the shortage of trained neurology workforce, and strengthen early detection and cost-effective management of neurological disorders in the country to deal with their growing burden.

Pointing out that neurological disorders contribute 10% of the total disease burden in India, Prof Balram Bhargava, Secretary, Department of Health Research, Ministry of Health & Family Welfare, and Director General, ICMR, stresses, “The findings presented in this research paper are useful for health-care planning at the state level to reduce the neurological disorders burden.”

Contribution of each neurological disorder to the total neurological disease burden in India, 2019

Percentage of total neurological disorders disease burden (DALYs)

Non-communicable disorders

82.8

Stroke

37.9

Headache disorders

17.5

Migraine

16.0

Tension-type headache

1.6

Epilepsy

11.3

Idiopathic epilepsy

6.4

Secondary epilepsy

5.0

Cerebral palsy

5.7

Alzheimer's disease and other dementias

4.6

Brain and central nervous system cancer

2.2

Parkinson's disease

1.8

Multiple sclerosis

0.2

Motor neuron disease

0.1

Other neurological disorders

1.3

Communicable disorders

11.2

Encephalitis

5.3

Meningitis

4.8

Tetanus

1.1

Injuries

6.0

Traumatic brain injuries

4.1

Spinal cord injuries

1.9

DALYs are disability-adjusted life-years. This is a comprehensive measure of disease burden that is calculated by adding years of life lost due to premature deaths and years lived with disability weighted for the severity of disability for each neurological disorder.