Neurological mortality transition in Ecuador, 1997–2024: age-standardized trends and demographic decomposition
W skrócie
[Preprint - wstępne wyniki] Badacze analizowali dane dotyczące zgonów z powodu chorób neurologicznych w Ekwadorze przez 27 lat i odkryli, że choroby neurologiczne wpływają coraz bardziej na śmiertelność w populacji, szczególnie demencja i choroba Parkinsona, chociaż gdy bierze się pod uwagę wiek, niektóre choroby takie jak udar mózgu wykazują zmniejszającą się śmiertelność. Zmiany w liczbie zgonów wynikają głównie ze starzejącej się populacji i przyrostu ludności, a nie ze wzrostu ryzyka samych chorób. Wyniki wskazują, że planowanie opieki zdrowotnej powinno rozróżniać, czy zwiększona liczba zgonów wynika z demografią, czy z rzeczywistym wzrostem śmiertelności z danej choroby.
Oryginalny abstract (angielski)
Abstract Background Long-term cause-specific neurological mortality trends in Ecuador remain insufficiently characterized. This study examined mortality trends from 1997 to 2024 and quantified the contributions of demographic change and age-specific mortality rates to changes in annual deaths. Methods We conducted a nationwide time-series study using national mortality and population data for 1997–2024. Six neurological conditions were examined: cerebrovascular disease, dementia/Alzheimer disease, Parkinson disease, epilepsy/status epilepticus, meningitis, and malignant brain neoplasm. Crude and World Health Organization age-standardized mortality rates were calculated. Temporal trends were assessed using weighted segmented log-linear regression with overdispersion-adjusted inference and bootstrap assessment of breakpoint stability. Changes in annual deaths were decomposed into population growth, age structure, and age-specific mortality-rate effects using a Shapley approach. Results Cerebrovascular deaths increased from 2,280 to 4,836, although age-standardized mortality declined by 16.5% (average annual percentage change, − 0.85%; 95% confidence interval, − 1.29 to − 0.40). Dementia/Alzheimer mortality increased markedly (average annual percentage change, + 7.73%), with changes in age-specific mortality accounting for the largest share of the increase in deaths. Parkinson mortality also increased (+ 2.50% annually), whereas epilepsy (− 1.33%) and meningitis (− 3.12%) declined. For cerebrovascular disease, declining age-specific mortality partly offset strong contributions from population growth and population aging. Sensitivity analyses using three-year endpoints and the pre-pandemic period preserved the main directions. Conclusions Neurological mortality in Ecuador underwent a heterogeneous transition. Disease-specific planning should distinguish changes in absolute mortality burden from changes in age-standardized recorded mortality. Clinical trial registration Clinical trial number: not applicable. This study was a retrospective analysis of publicly available national mortality and population data and did not involve any clinical intervention or prospective assignment of participants.