Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Evaluating the evolution of ECMWF precipitation products using observational data for Iran:from ERA40 to ERA5

Abstract European Center for Medium-Range Weather Forecasts Reanalysis (ERA), one of the most widely used precipitation products, has evolved from ERA-40 to ERA-20CM, ERA-20C, ERA-Interim, and ERA5. Studies evaluating the performance of individual ERA products cannot adequately assess the evolution of the products. We compared the performance of all ERA precipitation products at daily, monthly, and annual data (1980–2018) using more than 2100 Iran precipitation gauges. Results indicated that ERA-40 performed worst, followed by ERA-20CM, which showed only minor improvements over ERA-40. ERA-20C considerably outperformed its predecessors, benefiting from the assimilation of observational data. Although several previous studies have reported full superiority of ERA5 over ERA-Interim, our results revealed several shortcomings in ERA5 compared with the ERA-Interim estimates. Both ERA-Interim and ERA5 performed best overall, with ERA-Interim showing better statistical and categorical skill scores, and ERA5 performing better in estimating extreme precipitations. These results suggest that the accuracy of ERA precipitation products has improved from ERA-40 to ERA-Interim, but not consistently from ERA-Interim to ERA5. This study employed a grid-grid comparison approach by first creating a gridded reference data set through the spatial aggregation of point source observations, however, the results from a point-grid approach showed no change in the overall ranking of products (despite the slight changes in the error index values). These findings are useful for model development at a global scale and for hydrological applications in Iran