Report on the Global Burden of Epilepsy in the Elderly (1990-2021) and its Alignment with Sustainable Development Goals

Executive Summary

This report analyzes the global, regional, and national trends of epilepsy in the population aged 60 and over from 1990 to 2021. The findings highlight a significant increase in the absolute burden of epilepsy, posing considerable challenges to the achievement of Sustainable Development Goal 3 (Good Health and Well-being). Disparities across socioeconomic, regional, and gender lines underscore the need for targeted interventions to meet SDG 10 (Reduced Inequalities) and SDG 5 (Gender Equality). While some progress in reducing age-standardized mortality and disability rates is noted, projected increases in incidence and prevalence demand urgent and strategic public health action aligned with the 2030 Agenda for Sustainable Development.

Global Trends: A Growing Challenge to SDG 3

Between 1990 and 2021, the global burden of epilepsy among the elderly increased substantially. This trend directly impacts SDG Target 3.4, which aims to reduce premature mortality from non-communicable diseases. Although age-standardized rates show modest increases, the sharp rise in absolute cases indicates a growing strain on global health systems.

Key Global Changes (1990-2021)

• Incidence: Absolute cases increased by 191.45% (from 116,560 to 339,711). The age-standardized incidence rate (ASIR) rose by 26.64%.
• Prevalence: Absolute cases increased by 175.17%. The age-standardized prevalence rate (ASPR) rose by 20.01%.
• Mortality: Absolute deaths increased by 141.65%, while the age-standardized mortality rate (ASMR) saw a smaller increase of 4.45%.
• Disability-Adjusted Life Years (DALYs): Absolute DALYs rose by 126.33%, though the age-standardized DALY rate (ASDR) remained almost stable (+0.32%).

Temporal Trend Analysis (AAPC)

Analysis of the Average Annual Percentage Change (AAPC) reveals a slowing of rate increases in the more recent period (2012–2021) compared to the entire study period (1990–2021). This may suggest that public health efforts are beginning to mitigate the rate of growth, a positive sign for long-term SDG 3 attainment.

1. Incidence Rate (AAPC): Decreased from 0.78 (1990-2021) to 0.53 (2012-2021).
2. Mortality Rate (AAPC): Decreased from 0.16 (1990-2021) to 0.09 (2012-2021).
3. DALY Rate (AAPC): Shifted from a minimal 0.02 (1990-2021) to a decline of -0.10 (2012-2021).

Regional Disparities: An Obstacle to SDG 10 and SDG 3

Significant regional variations in the epilepsy burden highlight deep-seated inequalities in health infrastructure and access to care, directly challenging SDG 10 (Reduced Inequalities) and SDG Target 3.8 (Universal Health Coverage).

Incidence and Prevalence Disparities

• Highest Incidence (ASIR): Western Europe (50.85 per 100,000).
• Lowest Incidence (ASIR): Eastern Europe (17.02 per 100,000).
• Highest Prevalence (ASPR): Andean Latin America (726.39 per 100,000).
• Lowest Prevalence (ASPR): Eastern Europe (296.32 per 100,000).
• High-income North America saw a substantial 64.47% increase in ASIR, indicating that socioeconomic development does not automatically resolve the rising incidence.

Mortality and DALYs Disparities

• The High-income Asia Pacific region experienced a 794.89% increase in absolute deaths and a 178.38% increase in ASMR, posing a severe challenge to SDG 3.
• Conversely, East Asia’s ASMR declined by 45.54%, demonstrating that targeted regional strategies can successfully reduce the mortality burden.
• The most significant relative change in DALYs was in High-income Asia Pacific (+231.09%), while East Asia and Andean Latin America showed declining trends in disability rates despite absolute increases in cases.

National-Level Analysis and Socioeconomic Factors

Trends at the national level reveal a complex picture of progress and setbacks, while analysis by Socio-Demographic Index (SDI) confirms that socioeconomic status is a critical determinant of health outcomes, reinforcing the link between SDG 3 and SDG 10.

National Trends

• Greatest Increase in Burden: Qatar showed staggering increases in incidence (+916.74%) and prevalence (+777.24%). Germany led upward trends in age-standardized rates for incidence (+116.29%) and DALYs (+91.14%).
• Notable Decreases in Burden: Nauru, Georgia, and Afghanistan reported declines in both incidence and prevalence. Ukraine showed the most significant decrease in mortality (-28.05%).

Socioeconomic Disparity and SDG 10

The relationship between epilepsy burden and SDI reveals that while incidence and prevalence have a complex, non-linear relationship with development, outcomes are strongly correlated.

• Mortality and DALYs: Strong negative correlations were found between SDI and rates for mortality (ρ = −0.58) and DALYs (ρ = −0.69).
• Implication for SDGs: This demonstrates that populations in lower-SDI regions suffer disproportionately worse outcomes from epilepsy. Achieving SDG 10 by reducing these inequalities is fundamental to making progress on SDG 3. Better outcomes in high-SDI regions point to the effectiveness of well-resourced health systems, a cornerstone of SDG 3.8.

Demographic Dimensions: Addressing SDG 5 and Ageing Populations

Analysis by sex and age reveals specific vulnerabilities that must be addressed to ensure equitable health outcomes for all, in line with SDG 5 (Gender Equality) and the broader goals of healthy ageing within SDG 3.

Sex-Specific Disparities and SDG 5

• Globally, males generally exhibited higher age-standardized rates for incidence, mortality, prevalence, and DALYs.
• However, in certain regions (e.g., South Asia, Andean Latin America), females had higher rates for one or more metrics, such as mortality in Pakistan and prevalence in Afghanistan.
• These disparities highlight the need for gender-responsive health policies to ensure that progress toward SDG 3 benefits all sexes equally, a key component of SDG 5.

Age-Related Burden

While absolute case numbers decline in the oldest age groups, age-specific rates for all metrics increased steadily with age, peaking in the 95+ population. This underscores the growing challenge of managing NCDs like epilepsy in globally ageing populations, a critical focus for achieving sustainable health and well-being.

Future Projections and Recommendations for the 2030 Agenda

Projections to 2035 indicate that the burden of epilepsy will continue to evolve, requiring forward-looking policies to stay on track for the 2030 Agenda.

Projected Trends (2022-2035)

• Incidence and Prevalence: ASIR and ASPR are projected to continue increasing, signaling a growing number of people who will require diagnosis and care.
• Mortality and Disability: ASMR and ASDR are projected to decline, suggesting that improvements in treatment and management can reduce the deadliest and most disabling consequences of the condition.

Conclusion and SDG Alignment

The rising absolute burden of epilepsy, coupled with significant regional and socioeconomic disparities, presents a formidable challenge to the Sustainable Development Goals. The projected increase in cases will strain health systems, while the disparities in outcomes undermine the principles of equity central to SDG 10 and SDG 5. However, the projected decline in age-standardized mortality and disability rates offers hope that strategic investment in universal health coverage (SDG 3.8) and targeted public health interventions can mitigate the worst impacts of the disease. To achieve the 2030 Agenda, global and national strategies must prioritize equitable access to diagnostics, treatment, and care for elderly populations with epilepsy.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on the global burden of epilepsy in the elderly population connects to several Sustainable Development Goals (SDGs). The primary connections are with goals related to health, equality, and socioeconomic development.

• SDG 3: Good Health and Well-being

  This is the most directly relevant SDG. The article’s entire focus is on a specific health issue—epilepsy, a non-communicable neurological disease. It analyzes trends in incidence, prevalence, mortality, and disability, which are central to ensuring healthy lives and promoting well-being for all ages, particularly the elderly population discussed.

• SDG 5: Gender Equality

  The article explicitly addresses gender by providing a “sex-specific analysis” of the epilepsy burden. It finds that “Males generally had higher ASIR, ASMR, ASPR, and ASDR than females, with exceptions in specific regions.” By highlighting these disparities in health outcomes between males and females, the article touches upon the core principles of SDG 5, which aims to achieve gender equality and empower all women and girls.

• SDG 10: Reduced Inequalities

  The article investigates disparities in the burden of epilepsy across different socioeconomic contexts. It uses the Socio-demographic Index (SDI) to show that “outcomes significantly improve in higher-SDI regions.” Furthermore, it details vast differences in incidence, mortality, and DALYs between various countries and regions (e.g., “High-income North America” vs. “Eastern Europe”). This analysis of inequality within and among countries directly aligns with the objectives of SDG 10.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

     The article directly addresses this target by analyzing mortality and disease burden from epilepsy, a non-communicable disease. It reports on the “age-standardized mortality rate (ASMR)” and “Disability-Adjusted Life Years (DALYs),” which are key metrics for tracking progress on this target. The discussion of rising incidence and prevalence points to the challenges in prevention and treatment.

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…

     While not explicitly mentioned, this target is strongly implied. The finding that “stronger negative correlations emerged for mortality (ρ = −0.58, P

2. SDG 5: Gender Equality

   • Target 5.1: End all forms of discrimination against all women and girls everywhere.

     The article’s “sex-specific analysis” provides data that can be used to identify and address health inequalities based on sex. For instance, it notes that in “South Asia,” females had a higher “age-standardized mortality rate (ASMR)” from epilepsy. Such data is crucial for understanding and tackling the underlying factors that may lead to discriminatory or unequal health outcomes.

3. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

     The article’s focus on the elderly (“population aged 60 years and above”), people with a disability-causing condition (epilepsy), and its analysis of disparities by sex and socioeconomic status (SDI) directly relates to this target. The data showing worse outcomes in lower-SDI regions underscores the need to reduce inequalities to ensure the health and inclusion of vulnerable populations.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article is rich with quantitative data that serve as direct or analogous indicators for measuring progress towards the identified targets.

• Indicators for SDG 3 (Good Health and Well-being)

  The article provides several metrics that align with official SDG indicators for health.

  1. Mortality Rate from a Non-Communicable Disease: The article extensively uses the Age-Standardized Mortality Rate (ASMR) for epilepsy. This is a direct measure for tracking progress on Target 3.4.
  2. Burden of Disease: The use of Disability-Adjusted Life Years (DALYs) and the Age-Standardized DALY Rate (ASDR) measures the total health loss from epilepsy, encompassing both premature death and disability. This is a comprehensive indicator of well-being, relevant to Target 3.4.
  3. Incidence and Prevalence Rates: The Age-Standardized Incidence Rate (ASIR) and Age-Standardized Prevalence Rate (ASPR) are used throughout the article. These indicators are essential for monitoring the effectiveness of prevention and treatment efforts under Target 3.4.

• Indicators for SDG 5 (Gender Equality)

  The primary indicator is the disaggregation of health data by sex.

  1. Sex-Disaggregated Health Data: The article provides ASIR, ASMR, ASPR, and ASDR data broken down by male and female populations. For example, it states, “In Andean Latin America, Southeast Asia, South Asia, and Oceania, females had higher ASIR.” This sex-disaggregated data is the key indicator for monitoring health-related gender inequalities under Target 5.1.

• Indicators for SDG 10 (Reduced Inequalities)

  The article uses socioeconomic and geographical data to measure inequality.

  1. Health Outcomes by Socioeconomic Status: The analysis uses the Socio-demographic Index (SDI) to correlate health outcomes with development levels. The finding of “stronger negative correlations” between SDI and mortality/DALYs serves as a clear indicator of socioeconomic inequality in health, relevant to Target 10.2.
  2. Health Outcomes by Geographic Region and Country: The article presents data for “21 GBD regions” and “204 countries and territories.” Comparing metrics between, for example, “High-income Asia Pacific” and “East Asia” provides a direct indicator of the inequalities that exist between nations.
  3. Age-Specific Data: By focusing on the elderly and providing age-specific rates that peak in the “95+ population,” the article provides indicators relevant to monitoring the well-being of specific age groups as per Target 10.2.

4. Table of SDGs, Targets, and Indicators

Source: bmcmedicine.biomedcentral.com