In 2021, neurological diseases affected 3.40 billion individuals worldwide, corresponding to 43.1% of the global population. In China, rapid demographic shifts and lifestyle changes have contributed to a continued rise in the burden of stroke, dementia, and Parkinson's disease—a trend expected to persist. However, previous studies have largely focused on individual diseases, leaving gaps in understanding the comparative burden across conditions and populations.
A research team led by Professor Yamei Tang from Sun Yat-sen Memorial Hospital, Sun Yat-sen University, analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study examined the prevalence and burden of 12 neurological disorders in the Chinese mainland from 1990 to 2021, including subgroup analyses by age, sex, region, and modifiable risk factors. The findings were recently published in the Chinese Medical Journal on April 1, 2026.
In 2021, the most prevalent neurological diseases were tension-type headache (19,948.3 per 100,000), migraine (12,985.6 per 100,000), and ischemic stroke (1,462.2 per 100,000). The leading causes of death were intracerebral hemorrhage (ICH) (93.0 per 100,000), ischemic stroke (82.7 per 100,000), and dementia (34.6 per 100,000). In terms of disability-adjusted life years (DALYs), ICH (1,930.3 per 100,000), ischemic stroke (1,646.8 per 100,000), and dementia (708.0 per 100,000) ranked highest.
Between 1990 and 2021, prevalence increased for most disorders except idiopathic epilepsy. Parkinson's disease showed the fastest growth (544.1%), followed by dementia (249.1%) and ischemic stroke (161.5%). Based on DALY rates, dementia increased most rapidly (208.2%), followed by Parkinson's disease (160.7%) and ischemic stroke (95.2%). Notably, between 2019 and 2021, several neurological disorders—including dementia, idiopathic epilepsy, multiple sclerosis, and tension-type headache—showed sharp increases in prevalence. Joinpoint analysis identified a significant turning point in age-standardized prevalence rates during this period, coinciding with the COVID-19 pandemic.
Disease burden varied significantly by age. In children under 10 years, idiopathic epilepsy and central nervous system cancers were the leading contributors. Migraines were most prevalent among individuals aged 10–39 years. Among those aged 40–74 years, ICH and ischemic stroke were dominant. After age 75, ischemic stroke and dementia surpassed ICH, and in those over 90 years, dementia became the largest contributor. Women showed higher prevalence rates of dementia and migraine, although DALY rates were similar between sexes. Regionally, ischemic stroke had the highest DALY rates in northern and northeastern China, while ICH ranked highest in other regions, especially southwestern and northwestern China.
Among modifiable risk factors, high systolic blood pressure was the leading contributor. Behavioral risk factors differed by sex: secondhand smoke and low physical activity contributed more to disease burden in women, while alcohol use, smoking, and high-sodium diets had a greater impact on men.
"Our study reveals a profound transition in China's neurological disease burden—from predominantly fatal to predominantly disabling," said Prof. Tang. With population aging, neurodegenerative diseases such as dementia and Parkinson's disease are becoming more prominent, while fatal cerebrovascular conditions like ICH are declining. This shift places increasing demands on rehabilitation and long-term care systems.
The increase in neurological disease burden during 2019–2021 warrants attention. Although causation cannot be confirmed, emerging evidence suggests possible links to COVID-19. Persistent cognitive impairment after SARS-CoV-2 infection may resemble early Alzheimer's disease, and post-COVID headaches may mimic migraines or tension-type headaches. Additionally, disruptions in healthcare access may have affected disease management. Further longitudinal research is needed.
In conclusion, neurological disease burden in China continues to rise and remains unevenly distributed. Addressing this challenge requires coordinated national strategies spanning prevention, treatment, rehabilitation, and long-term care, tailored to demographic and regional needs.
Reference
DOI: http://doi.org/10.1097/CM9.0000000000004051
About Yamei Tang from Sun Yat-sen University
Professor Yamei Tang is the Vice President of Sun Yat-sen Memorial Hospital and Lead Principal Investigator of the Sun Yat-sen Memorial Hospital Brain Research Center. She is the recipient of the National Science Fund for Distinguished Young Scholars and has published over 80 high-impact papers as the last corresponding author in journals including JAMA, J Clin Oncol, and Neuron. She specializes in cerebrovascular diseases, radiation‑induced brain injury, and neurological critical care. She has led nine projects funded by the National Natural Science Foundation of China (including two key projects) and serves on multiple national and provincial neurology societies.
