Abstract 169: Neurovascular Disease is the Second Leading Cause of Death in the United States (US): A Modern Disease Burden Analysis

Abstract

Introduction: The World Health Organization (WHO) in 2017 voted to return cerebrovascular disease from Circulatory Disorders to its historic home in Neurologic Disorders (forthcoming ICD-11), due to advances in cerebrovascular disease therapy and increased recognition of neurovascular contributions to dementia. Methods: Analyzing the WHO Global Burden of Disease Project 2015 data, we calculated the impact on attributable deaths and attributable disability (disability-adjusted life years lost - DALYs) of: 1) return of cerebrovascular diseases to the Neurologic Disorders category, and 2) use “neurovascular disease” state to include both “cerebrovascular diseases” and proportion of dementia due to neurovascular insults. Results: Reclassification of cerebrovascular disease as a Neurologic Disorder, in the US, increased the number of deaths attributable to Neurologic Disorders by 50.5%, from 326,000 to 490,000 per year, and increased DALYs lost by 37.3% (6.0 to 8.3 million). Worldwide, this reclassification increased the number of deaths attributable to Neurologic Disorders by 280% (2.3 to 8.6 million), and increased DALYs lost by 136%, (87.1 to 205.7 million). Systematic literature review shows vascular brain lesions contribute to 51% of clinically diagnosed Alzheimer disease and 65% of clinically diagnosed vascular dementia. Adding these cases to focal strokes, in the US, the number of deaths attributable to neurovascular disease increased by 90% (164,000 to 313,000), and DALYs lost increased by 37.3%, (2.3 to 3.7 million). Worldwide, the number of deaths attributable to neurovascular increased by 18% (6.3 to 7.5 million), and DALYs lost increased by 10.4% (119 to 131 million). Conclusions: When correctly classified according to modern pathophysiology, neurovascular disease moves from the 5 th to the 2 nd leading cause of death in the US; Neurologic Disorders moves from the 12 th to the 4 th leading cause of disability worldwide. This more accurate delineation of the national and global burden of neurovascular disease, should guide more informed allocation of resources for neurovascular research and clinical care.