The burden of noncommunicable and injury-related nervous system disorders in the Americas, 1990-2023: an analysis of the Global Burden of Disease Study 2023.

Background: Noncommunicable and injury-related nervous system disorders (NINSDs)-including cerebrovascular and neurodegenerative diseases, neurodevelopmental disorders, neuromuscular conditions, brain cancers, and traumatic brain injuries-are major contributors to morbidity, disability, and premature mortality in the Americas. However, comprehensive regional and national assessments remain limited. We assessed the burden of NINSDs and their attributable risk factors in the Americas from 1990 to 2023. Methods: We analysed prevalence, mortality, and disability-adjusted life years (DALYs), with 95% uncertainty intervals (UIs), for 19 NINSDs by age and sex across 38 countries and territories, using estimates from the Global Burden of Disease Study 2023. Temporal trends were assessed using annual percentage change (APC) estimated through log-linear regression. Burden attributable to modifiable risk factors was also examined. Findings: In 2023, an estimated 470 million (95% UI 418-523) people in the Americas were living with at least one NINSD. These conditions caused 1·1 million (0·8-1·7) deaths and 37·5 million (27·9-51·8) DALYs, representing 12% of the total burden from noncommunicable diseases in the region. Migraine, Alzheimer's disease and other dementias, ischaemic stroke, and intracerebral haemorrhage were the leading contributors to DALYs. From 1990 to 2023, age-standardised DALY rates declined for ischaemic stroke, haemorrhagic stroke, and neural tube defects, but increased for neurodegenerative disorders, including multiple sclerosis and motor neuron diseases. High systolic blood pressure was the leading risk factor for stroke subtypes, high fasting plasma glucose for dementias, and lead exposure accounted for nearly 60% of DALYs from idiopathic intellectual disability. Interpretation: NINSDs impose a substantial and persistent burden in the Americas, with disability increasingly outweighing premature mortality. Strengthening prevention of modifiable risk factors, integrating neurological health into noncommunicable disease strategies, and expanding long-term care, rehabilitation, and disability support are essential to address this growing challenge. Funding: No funding to declare.