Global Burden of Parkinson’s Disease from 1990 to 2021: A Population-Based Study

doi:10.21203/rs.3.rs-4904959/v1

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Global Burden of Parkinson’s Disease from 1990 to 2021: A Population-Based Study

https://doi.org/10.21203/rs.3.rs-4904959/v1

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Background

Parkinson’s disease (PD) has become a public health concern with global aging.With a focus on PD, this study sought to project its burden and trends at the national, regional, and worldwide levels between 1990 and 2021.

Methods

The Global Burden of Disease 2021 provided the PD burden data. The age-standardized rate (ASR) and annual percentage change (EAPC) were used to estimate trends in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of PD from 1990 to 2021. ASR was used to calculate the EAPCs using a linear regression model.A Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2046.

Results

Globally, the overall ASR of the incidence, prevalence,DALYs and mortality of PD increased from 1990 to 2021, and their EAPCs were 1.09 (95% confidence interval [CI]: 1.07–1.11), 1.52(95CI:1.49–1.54),0.32 (95% CI: 0.28–0.36) and 0.18(95% CI: 0.13–0.23).The incidence, prevalence, mortality, DALYs, of PD in 2021 were all higher in men than in women.From 1990 to 2021, the burden in males consistently surpassed that in females, with the gender difference widening as age.The prevalence,incidence,DALYs and mortality rates of PD increased with age before declining, peaking in the 80–84 age group for prevalence and incidence ,while in the 90–94 age group for mortality. peaked in the 85–89 age group for DALY rates. The ASR of incidence and prevalence both increased pronouncedly in Norway (EAPC = 3.39,95% CI: 3.15–3.64),(EAPC = 5.04,95%CI: 4.65–5.43).Lesotho was the nation with the most rise in age-standardized DALYs for PD (EAPC = 1.67, 95%CI༚1.41–1.93).United Arab Emirates had the fastest increase in age-standardized mortality for PD (EAPC = 1.98,95%:1.24–2.71).The global ASPR of PD was projected to show a continuous upward trend.

Conclusions

From 1990 to 2019, there were rising trends in the prevalence and burden of PD in most areas and nations worldwide. Our research indicated that PD control and management needed to be improved, particularly in light of the population's propensity to age.

Health sciences/Diseases

Health sciences/Health care

Health sciences/Medical research

Health sciences/Neurology

Parkinson’s disease

Gobal burden of disease

Incidence

Prevalence

Mortality

disability-adjusted life years

Parkinson's disease (PD) is the second most prevalent neurodegenerative illness. It is characterized by low dopamine levels because the substansia nigra loses dopaminergic neurons [1]. Among neurological diseases, PD has shown the fastest increase in frequency and impairment in recent times, making it one of the primary causes of disability globally [2]. Furthermore, there was a 155.5% global increase in the prevalence of PD between 1990 and 2019 [3].Additionally, there was a significant increase in the PD-attributable disability-adjusted life years (DALYs) rates,along with increases in the socio-demographic index (SDI) [4]. It was discovered that PD was more common in men and that its frequency rose with age, culminating in the 85–89 and 90–94 age ranges for men and women, respectively [4].

Nevertheless, no study has looked at changes in mortality, disability, and prevalence during the previous generation globally and in each nation in 2021.Our goal was to investigate the variations in counts and age-standardized rates (ASR) of PD between 1990 and 2021 in terms of incidence, prevalence, disability, and mortality.

Study design and data sources

A consistent and comparable methodology was employed in GBD 2021 to obtain a comprehensive estimate of population, fertility, morbidity, and mortality for 204 nations and territories.In-depth details on this research are available in GBD 2021[5]. The Global Burden of Disease research found that there were notable differences in the cause-of-death and prevalence data for PD, in contrast to most other disorders. In order to increase estimation accuracy,the GBD research team worked collaboratively to replicate Parkinson's disease mortality and morbidity estimates. Additional information is available in the literature[5, 6, 7].

From 1990 to 2021, we have retrieved demographic data and PD data for 204 countries and territories. Each estimate was given as a rate per 100,000 people and as counts per thousand. Using an ordered set of 1000 drawings, the 2.5th and 97.5th percentiles were used to calculate the 95% uncertainty interval (UI). The GBD world population age standard was used to calculate age-standardized populations.The SDI is a measure of socioeconomic development that takes into account the total fertility rate for people under 25 years old, the mean years of education for those over 15, and the mean per capita income.The least developed (0) to most developed (1) is the range of the SDI. Incidence, prevalence,DALYs and mortality, statistics have been collected. Since the data was available to the public, neither ethics approval nor informed permission were needed for the study. The GATHER Guidelines for Accurate and Transparent Health Estimates Reporting were followed by the cross-sectional study[8].

Definitions

Parkinson's disease is a progressive, degenerative, chronic neurological condition characterized by a loss of motor control and movement, particularly tremors. PD is coded as G20, G21, and G22 in the International Classification of Diseases, Tenth Revision (ICD-10).According to GBD 2021, bradykinesia, postural instability, limb and torso rigidity, and tremors or trembling are the four main symptoms of PD. At least two of these symptoms must be present.

Statistical analysis

To describe the worldwide burden of PD, a descriptive analysis was conducted. Through the use of the 95% uncertainty interval (UI) retrieved from the database, we compared the age-standardized incidence, age-standardized prevalence, age-standardized mortality, and age-standardized DALYs of PD across various age groups, sexes, regions, and nations.The estimated annual percentage change (EAPC) was used to quantify temporal changes from 1990 to 2021 in order to evaluate the burden of Parkinson's disease. One often used statistic to evaluate ASR trends over specified time periods is the EAPC[9].If the EAPC and its 95% CI lower limit were both greater than 0, the ASR is assumed to be on the rise. On the other hand, it is considered that the ASR is trending downward if both are < 0. If not, the ASR is thought to be stable.

Furthermore, 54 regions were categorized into four groups using a hierarchical cluster analysis according to the temporal patterns in the PD ASR etiologies.Finally, we forecasted the trends in the PD ASRs from 2022 to 2046 using the Bayesian age-period-cohort analysis (BAPC) model.R Studio and the R program (version 4.3.1) were used to analyze the data.

Global level

In 2021, PD accounted for 1.34 million incidence cases globally.Over the previous 30 years, the age-standardized incidence rate (ASIR) has progressively grown.(11.24 per 100,000 population[95% UI: 10.01–12.49] in 1990 and 15.63 per 100,000 population [95% UI: 14.03–17.39] in 2021), with an EAPC of 1.09(95% CI: 1.07–1.11)(Table1,tableS1).Between 1990 and 2021, the prevalence of PD rose by 274% worldwide, from 3.15 million to 11.77 million cases. With an EAPC of 1.52(95CI%:1.49–1.54), the age-standardized prevalence rate of PD in this age group increased by 28% between 1990 and 2021, from 86.28 per 100,000 people to 138.63 per 100,000 people.(Table 1,TableS1).In contrast to frequency and incidence, there was less of a discernible trend in DALYs and PD-related mortality over the same time period. From 81.48 per 100,000 people in 1990 to 89.59 per 100,000 people in 2021(EAPC = 0.32,95% CI: 0.28–0.36)(Table 1.Table S2) .From 4.62 per 100,000 people in 1990 to 4.81 per 100,000 people in 2021, the age-standardized mortality of PD increased by 3.95%, with an estimated annual trend of 0.18(95% CI: 0.13–0.23)(Table 2,Table S2).

Global trends by sex

Globally, the prevalence cases of PD rose for both men and women between 1990 and 2021 (from 1.56 million to 6.44 million for males and from 1.59 million to 5.33 million for women).(Table S1)In comparison to women, men's PD prevalence increased more quickly (EAPC 1.70 vs. 1.25)..Male patients exhibited a higher incidence rate and a greater growing trend in ASIR (EAPC = 1.11, 95% CI: 1.09–1.13) during the same period compared to female patients(Table 1). Men experienced a greater increase in age-standardized DALYs from PD than did women (EAPC 0.37 vs. 0.14).From 1990 to 2021, the age-standardized mortality rate gradually decreased in women from 3.62 per 100,000 population in 1990 to 3.59 per 100000 population in 2021(EAPC =-0.01, 95% CI: -0.04-0.03).Contrarily,the age standardized mortality increased for men from 6.28 per 100,000 population in 1990 to 6.57 per 100,000 population in 2021(EAPC = 0.21, 95% CI: 0.14–0.28)(Table 2).Incidence, prevalence, mortality, and DALYs for PD all increased between 1990 and 2021, as illustrated in supplementary Fig. 1. Male burdens continuously exceeded female burdens, with the gender gap growing larger with age.

Global trends by age subgroup

Each age group saw an increase in new cases and patients with PD before a decline that peaked at ages 70–74 and 80–84 for mortality. After rising with age, the prevalence, incidence, DALYs, and mortality rates of PD peaked in the 80–84 age range for prevalence and incidence, and in the 90–94 age group for mortality. DALY rates peaked in the 85–89 age range(Table 1,Table 2,Table S1,Table S2,Fig. 2).

Global trends by sociodemographic index

In 2021,the countries with a high-middle SDI had the highest incidence and prevalence of PD (173.39 per 100,000 population).From 1990 to 2021, the age-standardized prevalence of PD rose globally, with a significant increase in high-middle SDI countries (EAPC: 1.61, 95% CI: 1.90–1.57).The ASR of PD incidence showed rising trends in all SDI areas, with the middle SDI area exhibiting the most significant one(EAPC = 1.47, 95% CI: 1.44–1.51).While PD related mortality decreased across subgroups of high-middle and middle SDI.The age standardized DALYs from PD increased across all sociodemographic subgroups.In 2021, countries with a high-middle score had the highest DALYs (94.16 per 100,000 population), while those with a low sociodemographic index had the lowest (83.09 per 100,000 population)(Table 1,Table 2,Table S1,Table S2,Fig. 3).

Regional trends

In 2021, among 21 geographic regions,the highest age standardized prevalence of PD was in East Asia(243.46 per 100,000 population).The age standardized prevalence of PD significantly increased across regions, except Eastern Europe(EAPC= -0.04,95%CI: -0.15 - -0.07]).East Asia saw the fastest rate of increase in the age-standardized prevalence of PD (EAPC = 3.17,95%CI:3.04–3.3), and the slowest increase in prevalence was in Central Europe (EAPC = 0.26,95%CI:0.23–0.29) during the same period.The largest incident number in 2021 appeared in East Asia (0.52 million ), while Oceania experienced the lowest one(0.69 thousand ). In 2021, the ASR of incidence ranged from8.23/100,000 in high-income Asia Pacific to 24.16/100,000 in East Asia. The ASR of incidence trends rose throughout most locations, especially in East Asia.(EAPC = 2.16, 95% CI:2.11–2.21). Whereas, only Eastern Europe had a minor downward trend.East Asia had the highest amount of DALYs (2.23 million), while Oceania had the lowest number.4.80 thousand. In high-income Asia Pacific, the ASR of DALYs was 60.24/100,000, while in East Asia, it was 107.68/100,000. The ASR of DALYs showed increasing trends across most locations, with high-income North America showing the strongest increase (EAPC = 1.15, 95% CI: 1.06–1.24). Central America did, however, show a little declining tendency.In high-income Asia Pacific, the ASR of mortality was 3.57/100,000, while in high-income North America, it was 5.72/100,000.The ASR of mortality trends showed the greatest drop in East Asia (EAPC = -0.73, 95% CI: -0.89–0.58) and the greatest increase in high-income North America (EAPC = 1.36, 95% CI: 1.25–1.48))(Table 1,Table 2,Table S1,Table S2,Supplementary Fig. 1,Supplementary Fig. 2).

Based on the temporal trends associated with PD ASRs, a hierarchical cluster analysis was performed to identify regions. These areas were grouped into four groups based on comparable patterns. The colors assigned to each group were as follows: major decline, constant or moderate decrease, significant rise, and minor increase (Supplementary Fig. 3).

National trends

In 2021, age-standardized prevalence rates of Parkinson’s disease by country varied greater than five times, with the highest rates generally in China (245.73 per 100000 population) and lowest rates in Somalia (49.02 per 100000 population).Across 204 nations and territories, the ASIR of PD varied, ranging from 7.28/100,000 in Japan to 24.34/100,000 in China. Norway exhibited the largest increase in age-standardized prevalence of PD between 1990 and 2021 (EAPC = 5.04,95%CI:4.65–5.43). Most nations and territories showed increasing trends in the ASIR, with Norway showing the most increases (EAPC = 3.39,95% CI: 3.15–3.64).Fifteen nations showed declining trends, with Italy being the most affected (EAPC = -1.16, 95% CI: -1.36–0.96).Cyprus demonstrated the greatest reduction in age-standardized DALYs for PD throughout that time (PD = − 2.55‌95%CI‚-2.77–2.33). Lesotho (EAPC = 1.67‌95%CI:1.41–1.93) had the biggest rise in age-standardized DALYs for PD. However, Honduras had the greatest age-standardized DALYs (157.67 per 100,000 people) The highest age standardized mortality for PD was in Honduras (9.65 per 100,000 population).United Arab Emirates saw the fastest increase in age-standardized mortality for PD. (EAPC = 1.98,95%:1.24–2.71), and the most rapid decine in prevalence was in Cyprus (EAPC=-3.32,95%: -3.61–3.03) during the same period(Table 1,Table 2,Table S1,Table S2,Fig. 4,Supplementary Fig. 4,Supplementary Fig. 5).

Global trends of PD predicted by the BAPC model

The global ASPR of PD was projected to show a continuous upward trend.The ASPR of males and females were projected to be 206.00 per 100,000 and 149.44 per 100,000 in 2046, respectively. The incidence rate of PD in both genders has increased with the ASIRs for the females and males, with populations increasing from 13.60 per 100,000, and 21.72 per 100,000 in 2029 to 15.59 per 100,000, and 24.06 per 100,000 in 2046.In general, the age-standardized death and DALY rates of PD in both sexes were predicted to decrease from 2020 to 2040. Sex differences persist, with men carrying a heavier disease burden than women(Fig. 5).

Our study presented a comprehensive analysis of PD prevalence worldwide over the past 30 years. It revealed a significant increase in the age-standardized prevalence of PD from 1990 to 2021, yet death and DALY rates did not change significantly.The current study's findings demonstrated that the age-standardized prevalence was 57.03% higher than in 1990, at 138.63 per 100,000 people. From the standpoint of age-standardized rates, the age-standardized incidence and prevalence rates of PD kept rising even after accounting for population aging.Furthermore, earlier studies have shown that the prevalence, death, and DALYs associated with PD peaked in older adults, and that men had greater rates of PD in almost all age categories, all of which are consistent with the findings of the current study [10, 11].

The increase in the prevalence of PD may be related to the following reasons:First,the aging population is strongly linked to the increased prevalence of PD, which is a chronic but non-fatal condition.Despite constant incidence and similar mortality patterns to the general population, the extended disease duration and increased prevalence of Parkinson's disease are likely due to longer life expectancies among those affected[12]. Underascertainment at older ages due to underdiagnosis, comorbidities, or healthcare in institutions could account for the drop shown in the oldest age groups after the peak between 85 and 89 years of age.Second, better estimates of prevalence, DALYs, and mortality after 1990 may have resulted from modifications in study techniques, the availability of higher quality studies, and increased awareness of diagnosis[13, 14].Door-to-door surveys, for instance, are less likely to overlook those who are undiagnosed and might go unnoticed in medical records[15]. Third, environmental variables associated with the global industrialization process may be responsible for the rise in the prevalence of PD. Parkinson's disease may become increasingly prevalent in high-middle SDI countries due to several environmental hazards associated with industrialization, such as metals, solvents, and pesticides[16,17,18].Fourth, while smoking rates are dropping in some nations[19], this benefit to global health may also be a factor in the increased prevalence of PD[20]. Smokers have a 40% lower chance of developing Parkinson's disease [21]. It is still up for debate whether this link is actually causative or can instead be attributed to biases or reverse causation[22]. A study in the USA has identified a potential link between smoking rates and the prevalence of Parkinson's disease. It suggests that if smoking rates in the nation decrease, the expected burden of PD by 2040 could increase by 10%[23].Finally, variations in the incidence rates of PD may be caused by shifts in the prevalence of other recognized (such as head trauma[24], genetic predisposition[25], Mediterranean diet[26,27,28], or undiscovered risk or protective variables.

According to our findings, men were considerably more likely than women to have PD-related point prevalence, death, and DALY rates. Gender inequalities may arise from variations in the frequency of exposure to distinct dangers. Moreover, estrogen may have neuroprotective benefits for females[29].

The high-middle SDI area, where the number of PD patients increased the most, showed the highest growing trend in ASR of prevalence across the SDI quintiles. East Asia showed the strongest rising trends in ASR prevalence when compared to other locations; this was presumably due to aging and population growth[30]. Significant advancements have also been made in the social insurance and health systems [31]. The changing trends across countries were explained by the substantial correlation between the prevalence trends and the morbidity of Parkinson's disease. Even though the ASR of DALYs in high-income Asia Pacific was lowest in 2021, high-income North America saw the fastest-rising trends in the ASR of DALYs.The enhanced treatment choices that are now accessible and extend the course of the disease are probably responsible for the higher incidence of PD in industrialized nations. Because of the longer life expectancy and greater frequency of long-term mental problems, such as psychosis, sadness, and anxiety, the striking increase in the illness load may also be linked to increased disability[32] (36).The Mediterranean diet has been linked to a lowering trend in ASIR in Italy, possibly due to its preventive effects on health and diseases associated with age[33,34,35].

China has the highest incidence and prevalence rates.With the aging of China's population and an increased proportion of the elderly, coupled with improvements in medical care and evolving screening and diagnostic approaches for PD, there has been an enhancement in the recognition and diagnosis of PD among patients and medical professionals. Concurrently, the country's economic growth has led to heightened exposure to industrial pollutants such as heavy metals and solvents, and the persistent overuse of pesticides poses a significant risk[36, 37].These factors are contributing to the increased incidence and prevalence of PD in China.

The predictive model suggests that the incidence and prevalence rates will gradually increase,but ASDR and ASMR have shown a gradual decline.Therefore, it is important that sufficient preparation be made for the aging of the population. The results suggested that proactive measures, such as civil health promotion plans, security and healthcare systems, and healthy lifestyle choices, should be implemented to address the issues brought on by Parkinson's disease[38, 39, 40].

The study does, however, have a few drawbacks. Firstly, PD is a heterogeneous illness with a range of symptoms, progression styles, and concurrent cognitive deficits[41]. [45]. Because of this, clinicians frequently misdiagnose PD, and a qualified,specialized physician is needed to accurately diagnose Parkinson's disease.The robustness and certainty of our results may have been impacted as a result. Second, we were unable to determine how the various risk variables affected the progression of PD because of the limitations of the GBD study. This emphasizes how important it is to incorporate risk variables into GBD project revisions going forward. Third, future studies should take into account the neurobiological links that we did not mention about the development of Parkinson's disease.

In conclusion, the current study concludes by offering a thorough review of the prevalence of PD and its trends from 1990 to 2021 at the national, regional, and worldwide levels. Widespread and in most countries and areas, there have been noticeable increases in the burden of PD, suggesting that PD is becoming a more serious threat to global health. Based on the fast growing aging population, the results showed that more efficient approaches are required to lessen the impact of Parkinson's disease.

Acknowledgments

We thank all the study participants for their assistants and supports.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Funding

Quanzhou City Science and Technology Program of China (No. 2024 NY026)

Startup Fund for scientific research, Fujian Medical University（Grant number：2023QH1125）

Authors' contributions

Mimi Li: project administration and drafting. Xiaofang Ye: data analysis and

validation. Zhengping Huang : data analysis and visualization. Lichao Ye: data collection and collation. Chunnuan Chen: supervision and drafting and editing.All authors contributed to the writing and revisions of the paper and approved the final version.

Acknowledgements

We thank all the study participants for their assistants and supports.

Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Table 1

Age-standardised incidence, prevalence of Parkinson’s disease in 2021 and EAPC from 1990 to 2021.
	Incidence		Prevalence
	ASR/100,000 (95% UI) 2021	EAPC (95% UI) 1990–2021	ASR/100,000 (95% UI) 2021	EAPC (95% CI) 1990–2021
Global	15.63 (14.03–17.39)	1.09 (1.07–1.11)	138.63 (123.06-157.62)	1.52 (1.49–1.54)
Sex
Female	12.36 (11.11–13.75)	0.93 (0.91–0.95)	114.47 (102.05-129.78)	1.25 (1.23–1.27)
Male	19.72 (17.69–21.88)	1.11 (1.09–1.13)	168.24 (148.41-191.71)	1.7 (1.67–1.73)
Age group
20–24 years	0.14 (0.03–0.27)	0.35 (0.3–0.39)	0.23 (0.06–0.45)	0.35 (0.3–0.39)
25–29 years	0.41 (0.1–0.79)	0.31 (0.27–0.35)	1.58 (0.39–3.06)	0.31 (0.27–0.35)
30–34 years	0.91 (0.56–1.33)	0.56 (0.54–0.59)	4.63 (2.19–7.9)	0.39 (0.35–0.42)
35–39 years	1.66 (0.67–2.95)	0.78 (0.75–0.8)	10.95 (6.78–15.87)	0.60 (0.58–0.63)
40–44 years	4.09 (2.84–5.61)	1.34 (1.15–1.53)	23.56 (15.98–34.26)	0.90 (0.84–0.95)
45–49 years	8.98 (5.49–13.4)	1.88 (1.63–2.14)	56.18 (41.18–74.68)	1.45 (1.32–1.59)
50–54 years	15.74 (11.62–20.54)	1.91 (1.76–2.06)	118.20 (87.94-158.08)	1.82 (1.65–1.98)
55–59 years	23.26 (14.26–35.42)	1.70 (1.62–1.78)	211.44 (164.56-269.41)	1.83 (1.69–1.97)
60–64 years	40.00 (30.71–50.95)	1.31 (1.24–1.38)	331.28 (257.97-427.06)	1.77 (1.67–1.88)
65–69 years	71.24 (48.71–95.61)	1.05 (0.98–1.12)	607.75 (501.46-747.05)	1.60 (1.57–1.63)
70–74 years	114.77 (91.14-138.23)	0.94 (0.9–0.97)	971.36 (792.3-1174.24)	1.42 (1.4–1.44)
75–79 years	173.04 (126.68-217.88)	0.93 (0.91–0.95)	1479.15 (1236.05-1747.76)	1.38 (1.35–1.41)
80–84 years	199.49 (157.2-240.19)	0.93 (0.91–0.96)	1978.22 (1630.05-2370.34)	1.42 (1.38–1.47)
85–89 years	191.67 (136.34-261.15)	0.92 (0.88–0.96)	2224.95 (1854.94-2624.86)	1.56 (1.54–1.59)
90–94 years	175.85 (118.44-242.73)	0.75 (0.68–0.82)	2124.52 (1743.48-2610.64)	1.66 (1.63–1.69)
95 + years	169.68 (86.91-295.64)	0.55 (0.48–0.62)	1907.07 (1471.73-2461.22)	1.54 (1.48–1.59)
SDI region
High-middle SDI	18.49 (16.31–21.03)	1.20 (1.18–1.23)	173.39 (151.36-200.71)	1.61 (1.57–1.64)
High SDI	14.99 (13.97–16.04)	0.92 (0.89–0.96)	125.17 (115.35-135.55)	1.05 (0.99–1.11)
Low-middle SDI	11.95 (10.71–13.14)	0.66 (0.62–0.7)	91.89 (79.39-106.58)	1.17 (1.12–1.23)
Low SDI	10.21 (9.2-11.29)	0.42 (0.37–0.47)	72.87 (63.07–83.78)	0.83 (0.76–0.9)
Middle SDI	16.87 (14.67–19.11)	1.47 (1.44–1.51)	154.79 (133.73-179.22)	2.28 (2.23–2.34)
GBD region
Andean Latin America	16.76 (14.97–18.67)	1.30 (1.28–1.32)	159.23 (134.66–187.2)	1.79 (1.75–1.83)
Australasia	11.81 (10.76–13.18)	0.73 (0.68–0.78)	86.62 (74.7-102.76)	0.94 (0.87–1.01)
Caribbean	9.88 (9.19–10.6)	0.54 (0.5–0.57)	74.29 (64.99–83.87)	0.84 (0.77–0.91)
CentralAsia	12.16 (11.2-13.02)	0.61 (0.57–0.65)	86.14 (74.03–97.94)	0.37 (0.29–0.46)
Central Europe	12.15 (11.31–12.98)	0.13 (0.11–0.16)	95.57 (85.76-104.99)	0.26 (0.23–0.29)
Central Latin America	11.95 (10.9-13.08)	0.65 (0.57–0.73)	99.21 (87.37-112.71)	0.96 (0.85–1.08)
Central Sub-Saharan Africa	8.49 (7.62–9.42)	0.25 (0.16–0.33)	60.96 (50.59–73.47)	0.51 (0.4–0.63)
East Asia	24.16 (20.61-28)	2.16 (2.11–2.21)	243.46 (207.08-285.31)	3.17 (3.04–3.3)
Eastern Europe	10.93 (9.53–12.37)	0.01 (-0.07-0.08)	92.06 (77.52-107.98)	-0.04 (-0.15-0.07)
Eastern Sub-Saharan Africa	8.71 (7.85–9.57)	0.29 (0.26–0.32)	59.28 (50.98–67.75)	0.50 (0.45–0.54)
High-income Asia Pacific	8.23 (7.39–9.1)	0.48 (0.39–0.58)	60.66 (52.91–69.77)	0.41 (0.23–0.59)
High-income North America	14.98 (13.89–16.13)	0.80 (0.74–0.86)	121.33 (113.4-130.16)	0.90 (0.84–0.96)
North Africa and Middle East	13.54 (12.22–14.88)	0.90 (0.86–0.93)	102.69 (88.7-117.78)	1.39 (1.34–1.44)
Oceania	11.13 (9.86–12.41)	0.23 (0.18–0.27)	82.67 (68.83–96.32)	0.38 (0.31–0.45)
South Asia	11.79 (10.27–13.28)	0.58 (0.52–0.64)	92.49 (78.24-109.01)	1.25 (1.17–1.33)
Southeast Asia	11.46 (10.49–12.52)	0.66 (0.63–0.68)	85.83 (75.67–97.87)	0.92 (0.88–0.96)
Southern Latin America	14.31 (13.06–16.14)	0.41 (0.37–0.46)	108.65 (94.03-128.38)	0.61 (0.52–0.7)
Southern Sub-Saharan Africa	9.82 (8.62–11.08)	0.55 (0.51–0.58)	68.45 (57.98–79.8)	0.58 (0.51–0.65)
Tropical Latin America	10.83 (9.38–12.26)	0.44 (0.4–0.49)	90.55 (77.15-106.24)	0.82 (0.74–0.9)
Western Europe	17.71 (16.41–19.08)	0.65 (0.57–0.73)	152.39 (138.17-166.73)	0.67 (0.56–0.79)
Western Sub-Saharan Africa	11.78 (10.69–12.99)	0.59 (0.55–0.63)	74.30 (64.05–84.96)	0.70 (0.63–0.76)

Table 2

Age-standardised DALYs and mortality, and of Parkinson’s disease in 2021and EAPC from 1990 to 2021.
	DALYs		Mortality
	ASR/100,000 (95% UI) 2021	EAPC (95% UI) 1990–2021	ASR/100,000 (95% UI) 2021	EAPC (95% CI) 1990–2021
Global	89.59 (80.69–97.5)	0.32 (0.28–0.36)	4.81 (4.28–5.17)	0.18 (0.13–0.23)
Sex
Female	68.56 (60.9-75.76)	0.14 (0.11–0.17)	3.59 (3.06–3.94)	-0.01 (-0.04-0.03)
Male	117.47 (106.15-128.88)	0.37 (0.31–0.42)	6.57 (5.93–7.14)	0.21 (0.14–0.28)
Age group
20–24 years	0.20 (0.17–0.24)	-0.8 (-0.85–0.76)	0.00 (0.00–0.00)	-1.03 (-1.09–0.97)
25–29 years	0.49 (0.3–0.75)	-0.09 (-0.13–0.05)	0.00 (0.00–0.00)	-0.50 (-0.61–0.4)
30–34 years	1.18 (0.74–1.78)	-0.01 (-0.05-0.03)	0.01 (0.01–0.01)	-0.67 (-0.82–0.53)
35–39 years	2.44 (1.6–3.56)	0.28 (0.25–0.3)	0.01 (0.01–0.01)	-0.54 (-0.64–0.45)
40–44 years	10.58 (8.7-12.92)	0.02 (-0.03-0.06)	0.14 (0.12–0.16)	-0.39 (-0.46–0.33)
45–49 years	21.64 (18.21–26.16)	0.22 (0.15–0.29)	0.30 (0.26–0.33)	-0.41 (-0.47–0.36)
50–54 years	44.03 (36.09–52.65)	0.20 (0.11–0.28)	0.67 (0.61–0.75)	-0.60 (-0.67–0.53)
55–59 years	74.97 (62.35–88.61)	0.23 (0.17–0.28)	1.29 (1.16–1.42)	-0.60 (-0.65–0.54)
60–64 years	135.60 (116.99-156.61)	0.22 (0.18–0.27)	3.00 (2.75–3.29)	-0.44 (-0.48–0.4)
65–69 years	286.60 (252.55-320.54)	0.17 (0.12–0.23)	8.17 (7.5–8.91)	-0.30 (-0.39–0.22)
70–74 years	620.55 (557.94-685.24)	0.16 (0.1–0.22)	24.15 (22.02–26.39)	-0.12 (-0.2–0.04)
75–79 years	1151.86 (1057.88-1253.43)	0.23 (0.19–0.28)	59.34 (54.33–64.85)	0.05 (-0.01-0.1)
80–84 years	1664.64 (1482.48-1807.07)	0.41 (0.36–0.46)	112.07 (98.81-121.25)	0.26 (0.2–0.32)
85–89 years	1958.79 (1695.2-2163.9)	0.59 (0.53–0.66)	168.38 (143.59-184.59)	0.47 (0.39–0.55)
90–94 years	1902.67 (1590.46-2099.56)	0.69 (0.64–0.73)	189.17 (154.38–209.9)	0.56 (0.5–0.61)
95 + years	1541.07 (1218.87-1749.86)	0.63 (0.56–0.7)	161.34 (120.38-183.81)	0.54 (0.46–0.61)
SDI region
High-middle SDI	94.16 (84.06-104.78)	0.11 (0.05–0.17)	4.81 (4.23–5.27)	-0.17 (-0.24–0.1)
High SDI	85.43 (77.18–92.02)	0.6 (0.52–0.67)	4.75 (4.12–5.08)	0.58 (0.49–0.68)
Low-middle SDI	86.15 (76.86–95.69)	0.44 (0.39–0.49)	4.90 (4.26–5.51)	0.45 (0.37–0.52)
Low SDI	83.09 (70.4-97.88)	0.3 (0.18–0.41)	4.92 (4.06–5.89)	0.40 (0.24–0.56)
Middle SDI	91.07 (80.79-100.96)	0.14 (0.09–0.18)	4.71 (4.16–5.2)	-0.20 (-0.26–0.14)
GBD region
Andean Latin America	97.63 (83.37-113.15)	0.36 (0.28–0.44)	5.2 (4.37–6.19)	0.17 (0.07–0.27)
Australasia	77.81 (69.3-83.77)	0.21 (0.1–0.33)	4.67 (4.05–5.01)	0.25 (0.12–0.37)
Caribbean	79.74 (71.55–88.4)	0.30 (0.26–0.35)	4.63 (4.11–5.13)	0.20 (0.14–0.26)
CentralAsia	72.28 (66.15–78.68)	0.18 (0.09–0.28)	4.03 (3.66–4.39)	0.26 (0.15–0.36)
Central Europe	84.57 (78.03–90.95)	-0.02 (-0.05-0.01)	4.90 (4.47–5.21)	-0.01 (-0.05-0.04)
Central Latin America	76.72 (69.18–84.83)	0.00 (-0.05-0.05)	4.25 (3.76–4.64)	-0.22 (-0.28–0.16)
Central Sub-Saharan Africa	76.23 (57.93–94.84)	-0.01 (-0.13-0.11)	4.41 (3.22–5.72)	-0.02 (-0.15-0.11)
East Asia	107.68 (91.45-124.81)	-0.01 (-0.11-0.1)	5.02 (4.18–5.86)	-0.73 (-0.89–0.58)
Eastern Europe	75.26 (68.96–81.95)	0.01 (-0.07-0.1)	4.19 (3.81–4.51)	0.02 (-0.09-0.14)
Eastern Sub-Saharan Africa	69.51 (54.12–89.95)	-0.14 (-0.17–0.1)	4.07 (3.01–5.52)	-0.07 (-0.1–0.04)
High-income Asia Pacific	60.24 (52.91–65.61)	0.46 (0.36–0.56)	3.57 (2.98–3.91)	0.53 (0.44–0.63)
High-income North America	97.44 (87.02-104.56)	1.15 (1.06–1.24)	5.72 (4.94–6.12)	1.36 (1.25–1.48)
North Africa and Middle East	88.60 (78.74-97)	-0.16 (-0.24–0.08)	5.13 (4.49–5.69)	-0.27 (-0.37–0.17)
Oceania	87.03 (71.23-109.69)	-0.34 (-0.39–0.29)	4.71 (3.83–6.04)	-0.43 (-0.48–0.37)
South Asia	83.24 (70.52–95.84)	0.43 (0.33–0.54)	4.70 (3.9–5.54)	0.45 (0.3–0.61)
Southeast Asia	87.93 (78.01-100.26)	0.40 (0.32–0.48)	5.11 (4.47–5.96)	0.41 (0.31–0.5)
Southern Latin America	83.84 (77.08–90.11)	0.01 (-0.06-0.08)	4.79 (4.33–5.07)	-0.02 (-0.11-0.08)
Southern Sub-Saharan Africa	73.56 (66.74–79.49)	0.95 (0.69–1.21)	4.43 (4-4.74)	1.01 (0.72–1.31)
Tropical Latin America	74.52 (67.23–80.35)	0.29 (0.24–0.34)	4.25 (3.71–4.55)	0.25 (0.18–0.32)
Western Europe	87.56 (78.67–95.4)	0.38 (0.31–0.46)	4.72 (4.08–5.05)	0.39 (0.3–0.47)
Western Sub-Saharan Africa	89.18 (76-100.52)	0.53 (0.46–0.59)	5.63 (4.86–6.33)	0.60 (0.52–0.68)

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Global Burden of Parkinson’s Disease from 1990 to 2021: A Population-Based Study

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