Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019

TY - JOUR

T1 - Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050

T2 - an analysis for the Global Burden of Disease Study 2019

AU - Global Burden of Disease 2019 Collaborators

AU - Nichols, Emma

AU - Steinmetz, Jaimie D.

AU - Vollset, Stein Emil

AU - Fukutaki, Kai

AU - Chalek, Julian

AU - Abd-Allah, Foad

AU - Abdoli, Amir

AU - Abualhasan, Ahmed

AU - Abu-Gharbieh, Eman

AU - Akram, Tayyaba Tayyaba

AU - Al Hamad, Hanadi

AU - Alahdab, Fares

AU - Alanezi, Fahad Mashhour

AU - Alipour, Vahid

AU - Almustanyir, Sami

AU - Amu, Hubert

AU - Ansari, Iman

AU - Arabloo, Jalal

AU - Ashraf, Tahira

AU - Astell-Burt, Thomas

AU - Ayano, Getinet

AU - Ayuso-Mateos, Jose L.

AU - Baig, Atif Amin

AU - Barnett, Anthony

AU - Barrow, Amadou

AU - Baune, Bernhard T.

AU - Bejot, Yannick

AU - Bezabhe, Woldesellassie M. Mequanint

AU - Bezabih, Yihienew Mequanint

AU - Bhagavathula, Akshaya Srikanth

AU - Bhaskar, Sonu

AU - Bhattacharyya, Krittika

AU - Bijani, Ali

AU - Biswas, Atanu

AU - Bolla, Srinivasa Rao

AU - Boloor, Archith

AU - Brayne, Carol

AU - Brenner, Hermann

AU - Burkart, Katrin

AU - Burns, Richard A.

AU - Camera, Luis Alberto

AU - Cao, Chao

AU - Carvalho, Felix

AU - Castro-de-Araujo, Luis F. S.

AU - Catala-Lopez, Ferran

AU - Douiri, Abdel

AU - Lim, Stephen S.

AU - Phillips, Michael R.

AU - Sun, Jing

AU - Murray, Christopher J. L.

N1 - Funding Information: F Carvalho and E F Fernandes acknowledge support from the University of Porto (UID/MULTI/04378/2019 and UID/QUI/50006/2019 with funding from FCT/MCTES through national funds). L F S Castro-de-Araujo acknowledges support from the Medical Research Council (London; grant number MC_PC_MR/T03355X/1). V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória (DL57/2016/CP1334/CT0006). A Douiri acknowledges support from the NIHR Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, as well as the support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. N Ghith acknowledges her salary as a postdoc is covered by a grant to her research group provided by Novo Nordisk Foundation. V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. S Haque acknowledges support from Jazan University, Saudi Arabia, for providing access to the Saudi Digital Library for this study. C Herteliu is partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084). Y J Kim was supported by the Research Management Centre, Xiamen University, Malaysia (No. XMUMRF/2020-C6/ITCM/0004). M Kivimäki was supported by the MRC (S011676) and the Wellcome Trust (221854/Z/20/Z). M Kumar acknowledges support from Fogarty International Center (K43 TW010716-04). S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research, grant agreement number 01EA1808A). S Mondello was supported by the Italian Ministry of Health (GR-2013-02354960). A Raggi acknowledges support from a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C. Besta, Linea – Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). D A S Silva acknowledges support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES; Finance Code 001 / CAPES-PRINT). J P Silva acknowledges support from the Applied Molecular Biosciences Unit (UCIBIO; grant number UIDB/04378/2020), supported through Portuguese national funds via FCT/MCTES. Funding Information: Y Bejot reports honoraria for lectures from Boehringer-Ingelheim, Bristol Myers Squibb, Pfizer, Servier, Medtronic, and Amgen, outside the submitted work. C Brayne reports support for the present manuscript from the Economic and Social Research Council (ESRC), Alzheimer's Research UK, National Institute for Health Research (NIHR), Medical Research Council (MRC), Alzheimer's Society, East Anglia Regional Health Authority Public Health and Operational Research Advisory Council, Regional Health Authority (as research grants from 1990 to date for the Cognitive Function and Ageing Studies), paid to their institution; honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from the National Institute on Aging (NIA) Health and Retirement Study (HRS) Data Monitoring Committee and AXA Research Fund Scientific Board, paid to their institution, and from the Department of Biotechnology and Wellcome Trust India Alliance Fellowship Selection Committee, as a personal payment; support for attending meetings and travel from NIA HRS Data Monitoring Committee, Department of Biotechnology and Wellcome Trust India Alliance Fellowship Selection Committee, Canadian Longitudinal Study on Aging Scientific Advisory Board, Alzheimer's Society Research Strategy Council, BRAIN & HEADING International Oversight Committee, The Irish Longitudinal Study on Aging (TILDA) Scientific Advisory Board, ATHLOS Advisory Board, Barcelona Brain Health Initiative Scientific Advisory Board, DZNE International Scientific Review Panel (Humboldt), Faculty of Public Health Academic & Research Committee, and Faculty of Public Health Board; participation on a Data Safety Monitoring Board or Advisory Board with NIA HRS Data Monitoring Committee, AXA Research Fund Scientific Board, Department of Biotechnology and Wellcome Trust India Alliance Fellows, Canadian Longitudinal Study on Aging Scientific Advisory Board, Alzheimer's Society Research Strategy Council, BRAIN & HEADING International Oversight Committee, TILDA Scientific Advisory Board, Chinese University of Hong Kong Project Advisory Board, University of Sheffield Health Lifespan Institute Advisory Board, ATHLOS Advisory Board, Barcelona Brain Health Initiative Scientific Advisory Board, DZNE International Scientific Review Panel (Humboldt), Scientific Advisory Board for UKPRP Air Pollution and Cognitive Health Consortium, and InSPIRE; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with Faculty of Public Health Academic & Research Committee as Chair, Faculty of Public Health Board as a trustee, Public Health England–University of Cambridge Academic Liaison Committee meeting as Chair, and East of England Public Health England Research and Evaluation Hub as co-Chair; all outside the submitted work. I Filip reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Avicenna Medical and Clinical Research Institute in the form of financial support, outside the submitted work. B J Hall reports consulting fees from WHO, and holds a US S&P index fund and a US Bond Index fund, all outside the submitted work. C Herteliu reports grants from the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084), outside the submitted work. A Kandel reports grants from the University at Buffalo Clinical and Translational Institute. M Kivimäki reports support for the present manuscript from the MRC (S011676) and the Wellcome Trust (221854/Z/20/Z) as a grant paid to their institution. S Lorkowski reports grants or contracts from Akcea Therapeutics as payments made to their institution; consulting fees from Danone, Swedish Orphan Biovitrum (SOBI), and Upfield; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Akcea Therapeutics, AMARIN, Amedes Holding, Amgen, Berlin-Chemie, Boehringer-Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Lilly Deutschland, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, and SYNLAB Holding and SYNLAB Akademie as personal payments; support for attending meetings and travel from Amgen as personal payments; participation on a Data Safety Monitoring Board or Advisory Board with Akcea Therapeutics, Amgen, Daiichi Sankyo, and Sanofi-Aventis as personal payments; all outside the submitted work. J Massano reports consulting fees from Roche, Biogen, Bial, and AbbVie; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Bial, GE Healthcare, Boston Scientific, and Merck Sharp & Dohme; support for attending meetings and travel from Bial and Roche; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with the Portuguese Brain Aging and Dementia Study Group as President; all outside the submitted work. C D Pond reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Dementia Training Australia; leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid, as an advisor for the Primary Health Network. A Radfar reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Avicenna Medical and Clinical Research Institute. J A Singh reports consulting fees from Crealta–Horizon, Medisys, Fidia, Two Labs, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, WebMD, Practice Point communications, the NIH, and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings and travel from OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies; participation on a Data Safety Monitoring Board or Advisory Board as a member of the Food and Drug Administration Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with OMERACT as a member of the steering committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a director and editor; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals; all outside the submitted work. D J Stein reports personal fees from Lundbeck, Takeda, Johnson & Johnson, and Servier, outside the submitted work. A Wimo reports support for the present manuscript from WHO as payment to their institution and from the Swedish Government (SNAC project) paid to their county council; grants or contracts from Merck Sharp & Dohme (research grant, EU-project IMI2: MOPEAD, EU-project H2020; PRODEMOS, EU-project JPND: MindAD), paid to their institution; royalties and licenses with an RUD instrument as a partial license holder; support for attending meetings and travel to Geneva from WHO, and to Seattle, WA, USA, from the Institute of Health Metrics and Evaluation (IHME); participation on a Data Safety Monitoring Board or Advisory Board with Biogen, Elsai, and IHME; all outside the submitted work. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2022/2

Y1 - 2022/2

N2 - Background: Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. Methods: We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. Findings: We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4–65·1) million cases globally in 2019 to 152·8 (130·8–175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [–7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64–1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52–1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41–67]) and western Europe (74% [58–90]), and the largest in north Africa and the Middle East (367% [329–403]) and eastern sub-Saharan Africa (357% [323–395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. Interpretation: Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia. Funding: Bill & Melinda Gates Foundation and Gates Ventures.

AB - Background: Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. Methods: We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. Findings: We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4–65·1) million cases globally in 2019 to 152·8 (130·8–175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [–7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64–1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52–1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41–67]) and western Europe (74% [58–90]), and the largest in north Africa and the Middle East (367% [329–403]) and eastern sub-Saharan Africa (357% [323–395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. Interpretation: Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia. Funding: Bill & Melinda Gates Foundation and Gates Ventures.

UR - http://www.scopus.com/inward/record.url?scp=85123842750&partnerID=8YFLogxK

U2 - 10.1016/S2468-2667(21)00249-8

DO - 10.1016/S2468-2667(21)00249-8

M3 - Article

SN - 2468-2667

VL - 7

SP - E105-E125

JO - The Lancet Public Health

JF - The Lancet Public Health

IS - 2

ER -