Long-term trends in selected neurological disorders in Italy (1990-2023): analysis of the global burden of disease (GBD) 2023 data.

Abstract

Background: Neurological disorders are major contributors to disability and premature mortality. We examined long-term trends in selected neurological, cerebrovascular, central nervous system (CNS) infectious, headache, and brain and CNS cancer causes in Italy from 1990 to 2023.

Methods: Age-standardized disability-adjusted life year (DALY), years of life lost (YLL), and years lived with disability (YLD) rates were obtained from the GBD 2023 Results Tool. Causes were grouped into clinically coherent clusters. EAPCs were estimated using log-linear models with Newey-West HAC standard errors (lag 1), and Joinpoint regression characterized non-linear patterns. Sex-specific trends, descriptive uncertainty widths, and YLL/YLD ratios were evaluated.

Results: Overall DALY rates declined (EAPC - 1.01%, 95% CI -1.13 to -0.89). Cerebrovascular and CNS infectious causes showed the largest reductions, whereas multiple sclerosis, Parkinson's disease, idiopathic epilepsy, and motor neuron disease increased. Joinpoint regression identified multi-phase patterns. Migraine, multiple sclerosis, and dementia showed higher female burden, whereas stroke, Parkinson's disease, and brain and CNS cancer showed higher male burden. Uncertainty widths varied across causes; cluster summaries represent mean constituent-cause widths, not uncertainty intervals for aggregated cluster rates. YLL/YLD ratios showed marked heterogeneity between fatal and disability-driven conditions.

Conclusions: Italy experienced substantial declines in age-standardized DALY rates across several selected causes from 1990 to 2023, driven predominantly by reductions in cerebrovascular causes, alongside increasing burdens from several chronic neurological conditions. The relative contributions of premature mortality and non-fatal disability varied markedly across individual causes and clusters.