Stroke, Headache, Epilepsy Lead in India's Disease Burden: Lancet

The proportion of non-communicable neurological disorders including stroke and epilepsy in the total disease burden in India has doubled from 1990 to 2019 finds a new published in the medical journal, the Lancet Global Health.

The landmark study is the collaborative effort of neurology experts in India, the Indian Council of Medical Research (ICMR), Public Health Foundation of India, and the Institute for Health Metrics and Evaluation.

"This is the first time something like this has been done," Dr Gagandeep Singh, the first author of the paper tells FIT.

“This research paper provides the first consolidated estimates on the burden of most neurological disorders for every state of India from 1990 to 2019. The findings presented in this research paper are useful for health-care planning at the state level to reduce the neurological disorders burden.”

Dr Balram Bhargava, Director-General, ICMR in a statement

About the Study

Speaking to FIT, Prof Lalit Dandona, Research Professor, the Public Health Foundation of India and one of the researchers who worked on this study says,

"The major contribution of the study is that it is the first comprehensive systemic compilation of the estimates of all major neurological disorders in each state pf the country. In fact, this paper is part of a larger series of papers by the India State-Level Disease Burden Initiative."

Prof Lalit Dandona, Research Professor, the Public Health Foundation of India

Here are some key points to know about the study.

• The study highlights the contribution of non-communicable neurological disorders to the total disease burden has more than doubled from 1990 (4 percent) to 2019 (8.2 percent).

• Of these, the highest disease burden comes from stroke (37·9 percent), headache disorders (17·5 percent) and epilepsy (11·3 percent).

Stroke caused 699,000 deaths in India in 2019, which was 7.4% of the total deaths in the country. In fact, stroke is the third leading cause of death in India.

The study compares the burden of communicable neurological disorders (encephalitis, meningitis, and tetanus) and injury related neurological damage, to that of non-communicable neurological disorders including stroke, headache disorders, epilepsy, cerebral palsy, Alzheimer’s disease and other dementias, Parkinson’s disease, multiple sclerosis, motor neuron diseases, and other neurological disorders.

• The contribution of communicable diseases went down from 4·1 percent in 1990 to 1.1 percent in 2019.

• 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.

• Migraine and multiple sclerosis were more prevalent among females than males.

"Migraine is one of the leading non-communicable neurological disorders, yet a systemic approach to the management of migraine is lacking in the country."

Prof Lalit Dandona, Research Professor, the Public Health Foundation of India

• Traumatic brain injuries were more common among males than females in 2019

• Over 300 leading scientists and experts from 100 institutions across India are engaged with this study.

Why is the Burden of Neurological Disorders so High?

The main reasons that the researchers point to are the ageing population of India, on top of other external risk factors.

High blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index are some leading contributors listed by the study.

"Stroke is more preventable than most other neurological disorders as the risk factors are clearer," says Prof Dandona.

"In the case of other disorders, the risk factors are not fully understood, so prevention can be difficult. However, bolstering management of these disorders can help bring down fatalities and morbidity."

Speaking to FIT, Dr Gagandeep Singh, explains the two significant findings of the study.

First, he explains is the time trends, and the second is the statewise trends.

The study also shows the marked variation in the burden of diseases between the different states.

"Health is a state concern so each state knowing the disease that has the highest burden in that particular state can help make more streamlined health policies," says Dr Singh.

"The main purpose of the study is to highlight the variations between different states in India when it comes to disease burden from neurological disorders," says Prof Dandona.

"The study points to differences in trends among the states. For instance, less developed states still have a higher burden of communicable neurological disorders while injury-related disorders are higher in more developed states."

Prof Lalit Dandona, Research Professor, the Public Health Foundation of India

He also adds, "it is interesting to note that the increase in non-communicable neurological diseases does not follow any particular pattern when it comes to more or less developed states."

Why is the Study Important?

What could be the real world impact of the study and its findings?

"The study's findings are extremely important for the government and policymakers, so they can decide which conditions to prioritise in terms of making policies," says Dr Singh.

For instance, knowing that stroke is one of the highest burdens to healthcare from neurological disorders means the health department would have to ensure a higher availability of specialised treatment for stroke, Dr Singh Explains.

Furthermore, with the state-specific study results, the researchers hope to propel state health system responses that address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation.

"There is a 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.”

Dr V. K. Paul, Member (Health), NITI Aayog, in a statement