MS and other neurological disorders in India

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This freely accessible article published in Lancet Global Health is the most comprehensive data on the prevalence of neurological disorders across India to date.

Around 18% of the worlds population live in India and like other nations they also have a significant level of morbidity related to those with neurological disorders. But, owing to a lack of resources as well as cultural taboos, it has always been difficult to get an idea of health indices for neurological disorders in India. The prevalence of MS in India in 2019 106,600 (95% uncertainty intervals 83,800-130,300) cf. UK 131,720 and like every other nation before it, commoner in women, increasing after adolescence. What I noted also was that the disorder peaked at 50-54 years old, which is no different to that of the UK (Figures 1 and 2).

Figure 1: Age-specific prevalence or incidence rate of neurological disorders in India, 2019
Figure 6 Column chart of proportion of patients in 5 year age bands by males and females of MS cases in THIN dataset and GP registered population
Figure 2: Multiple Sclerosis – age distribution of patients with MS and GP registered population by sex (financial year April 2016 to March 2017 for MS cases, 2017 for registered population, England)

Abstract

Lancet Glob Health. 2021 Jul 14;S2214-109X(21)00164-9. doi: 10.1016/S2214-109X(21)00164-9. Online ahead of print.

The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990-2019

India State-Level Disease Burden Initiative Neurological Disorders Collaborators Collaborators

Background: A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India.

Methods: Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates.

Findings: The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2-5·0) in 1990 to 8·2% (6·6-10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2-0·3) to 0·6% (0·5-0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5-4·8) to 1·1% (0·9-1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9-46·1]), headache disorders (17·5% [3·6-32·5]), epilepsy (11·3% [9·0-14·3]), cerebral palsy (5·7% [4·2-7·7]), and encephalitis (5·3% [3·7-8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution.

Interpretation: The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation.

Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

About the author

Neuro Doc Gnanapavan

9 comments

  • How is it possible that India has fewer total MS cases than the UK with 10-20 times the population?

    • Genetic background, higher levels of sunlight and less chance of diagnosis would be my guess off the top of my head.

      • Most likely those three, possibly diet as well.

        Possibly genetics less so as there is this idea that the geography before ~15 is relevant for the risk.

      • But if an individual from India moves to Edinburgh (say to study at university and stay on afterwards) do they acquire Scotland risk? All these known unknowns… genes v environment

        • Yes, if they move before their mid-teens, their risk increases. You see the same thing with the incidence of MS in the second generation south asian heritage population in the UK as a whole.

        • We have the East London Cohort a large Banglideshi/Asian population we see MS in second generation

      • I have an Indian friend living in the UK. MRI is not used very much in India, if it is used , it’s by private healthcare patients.
        The state healthcare system is very basic in India and even more basic in rural areas. There are very few state benefits in India and the state doesn’t provide a pension, other than to government worker’s. Family members look after each other, rather than relying on the state for care.
        From what I have been told, if you are unwell you get to see a state funded healthcare assistant, rather than a nurse or doctor at least initially. In other words, there may be more/ many more undiagnosed pwMS than documented. MS is also seen as bad luck in India and some pwMS may be hiding their MS or pretending disability it is caused by an accident.

        Also, alternative healthcare is seen as standard medicine in India. Ayervedic medine of taking herbal medicine and Vedic treatments.

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