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. 2025 Sep 18;97(1):e335535. doi: 10.1136/jnnp-2024-335535

Global burden of early-onset Parkinson’s disease, 1990–2021: results from the Global Burden of Disease Study 2021

Qiwei Ji 1,0, Zujie Chen 1,0, Yuning Ma 1,0, Qing Guan 2,0, Feifan Chu 1, Lumin Chen 1, Jinzhong Ji 1, Mingxin Sun 1, Gaozhan Ren 1, Tingyang Huang 3, Haihan Song 4,5, Xiaojun Xu 6,7,*, Xiuquan Lin 8,*,1, Hao Zhou 1,✉,1
PMCID: PMC12703261  PMID: 40967886

Abstract

Objectives

Early-onset Parkinson’s disease (EOPD) is an increasingly serious disorder, yet there is currently a scarcity of epidemiological data and reports on this disease worldwide.

Methods

By using data from the 2021 Global Burden of Disease Study, we analysed the number of incident cases, prevalent cases and years lived with disability (YLDs) for EOPD (diagnosis after the age of 20 years and before the age of 50 years) from 1990 to 2021, along with their corresponding age-standardised rates. Additionally, we calculated the average annual percent change of the age-standardised rates and analysed the negative correlation between smoking and the disability-adjusted life years (DALYs) burden for EOPD.

Results

From 1990 to 2021, the incidence, prevalence and YLDs associated with EOPD have tripled globally. Most countries have seen a consistent increase in the age-standardised incidence and prevalence rates of this disease, especially those with high-middle Socio-Demographic Index scores. In 2021, smoking contributed to a 9.03% decrease in the global burden of DALYs, a decline from −14.14% in 1990.

Conclusions

EOPD is increasing at an alarming rate worldwide, necessitating the attention of global health organisations and the implementation of effective intervention measures to address this serious challenge.

Keywords: PARKINSON'S DISEASE, EPIDEMIOLOGY

WHAT IS ALREADY KNOWN ON THIS TOPIC

  • Parkinson’s disease is the neurological disease with the fastest growing prevalence and disability, as reported by the Global Burden of Disease Study 2015. However, the global burden of early-onset Parkinson’s disease (EOPD) remains under-reported.

  • Previous studies have predominantly focused on investigating EOPD in localised regions.

WHAT THIS STUDY ADDS

  • The number of incident cases, prevalent cases and years lived with disability of EOPD have increased by 286.72%, 239.34% and 249.59%, respectively, from 1990 to 2021.

  • EOPD exhibits a strikingly high incidence in Latin America, yet this region has received insufficient attention in prior research.

  • The protective effect of smoking specifically against EOPD has weakened over the past three decades.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • This study may offer personalised guidance for the prevention and management of EOPD across nations, particularly highlighting the need for global scholarly attention to Latin America, where region-specific challenges remain understudied.

Introduction

Parkinson’s disease (PD) is a widely recognised neurodegenerative disorder, with its prevalence second only to Alzheimer’s disease, placing it as the second most common neurodegenerative condition.1 Typically affecting those aged 65 and above, PD was once considered rare in individuals under 50.2,4 However, as the pace of social life accelerates, the younger population faces unprecedented social pressures.5 Coupled with unhealthy lifestyle habits such as lack of exercise, PD is increasingly affecting younger individuals.6

The International Parkinson and Movement Disorder Society’s Task Force on Early-Onset Parkinson’s Disease recommends that the onset of Parkinsonian motor symptoms between the ages of 20 and 49 should be classified as early-onset Parkinson’s disease (EOPD).7 This condition significantly impacts individuals’ health and imposes considerable economic and social burdens on society. However, there is a lack of awareness among the public and medical community about the possibility of young patients developing PD. Compared with patients with late-onset PD, those with EOPD exhibit slower disease progression but suffer from more severe dystonia and have a higher risk of developing motor complications when treated with Levodopa, a commonly prescribed medication.8 The quality of life for patients with EOPD tends to deteriorate more significantly than for patients with late-onset PD. The motor and non-motor symptoms often make it challenging for them to work, and their ability to walk and drive is also greatly impaired. And those in their prime working years often face workplace discrimination and higher psychological stress, increasing the likelihood of early retirement or job termination.9 A study comparing patients with EOPD with patients with late-onset PD revealed that 97% of patients with EOPD retire early, whereas only 73% of patients with late-onset PD do so.9 Another study estimates that in the USA alone, the direct and indirect costs associated with PD amount to $23 billion annually.10 Given that adults aged 20–49 form the backbone of the labour force, the resulting economic and social burdens are notable. Thus, comprehending the global burden and economic costs of EOPD in this demographic is critical for optimising healthcare resource allocation across different regions.

However, there are currently no comprehensive studies that provide statistical analyses of the incidence and trends of global EOPD. Additionally, there are no studies that describe the differences between genders and countries with varying levels of social development. Smoking, known to be a risk factor inversely associated with PD, also lacks effective data on its protective role in patients with EOPD. The Global Burden of Disease (GBD) Study 2021 provides an opportunity to understand the increasing burden of EOPD. Additionally, the GBD includes data on the disease burden of smoking in relation to EOPD, which can further substantiate the impact of smoking on this condition. We hope that our research can offer valuable insights into the burden of EOPD and inform the planning of public health policies.

To this end, we planned to use data from GBD 2021 to describe the global burden of EOPD. First, we investigated the global epidemiological features of EOPD and the trends in disease changes from 1990 to 2021. Furthermore, we assessed the degree to which smoking negatively impacts EOPD. Second, we analysed the gender distribution and disability-adjusted life years (DALYs) associated with EOPD.

Methods

The GBD 2021 study involved the collection of data via systematic evaluations of surveys and censuses, civil registration, population surveillance and numerous other health-related data sources. Following data collection, the Bayesian meta-regression tool DisMod-MR 2.1 was employed to assess and correct for bias risk in each data source. The comprehensive methodologies for collecting, processing and generating these data are extensively detailed in the GBD 2021 study. Publicly available estimated data can be accessed at https://vizhub.healthdata.org/gbd-results/.11

Data sources

Based on the definition of EOPD, our study focuses on individuals aged 20–49. We obtained data on the incidence, prevalence, years lived with disability (YLDs) and DALYs (including 95% CIs), categorised by age, gender and region, from the Global Health Data Exchange. We have also calculated the incidence, prevalence, YLDs and DALYs with 95% CIs for PD to facilitate comparative analysis.

Estimation of burden attributable to risk factors

Smoking is the only risk factor for EOPD in the GBD 2021 study. Detailed data and methodologies about smoking can be found elsewhere.12 In brief, a comprehensive approach using spatiotemporal Gaussian process regression and mixed-effects modelling was used to estimate the exposure levels and distribution of smoking for each age, sex, location and year.12 The burden of smoking was assessed by applying the population attributable fraction (PAF) to the total YLDs of EOPD. The PAF quantifies the proportion of YLDs that could be prevented in a certain population and period if the exposure to the risk factor were minimised to the lowest possible level.

Statistical analysis

We obtained data on the incidence, prevalence and YLDs of EOPD (ages 20–49) to determine their proportion of the total PD burden. Using the world population age standard from GBD 2021, we calculated age-standardised rates for incidence, prevalence and DALYs for EOPD, along with their 95% CIs. All rates were presented per 100 000 individuals.

We compared the age-standardised incidence, prevalence, DALYs rates and average annual percent change (AAPC) among male and female patients with EOPD across various age groups (20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years).

To assess the protective effect of EOPD, we divided the smoking-attributable age-standardised YLDs rate by the total age-standardised YLDs rate for EOPD. We compared the global and regional and different Socio-Demographic Index (SDI regional smoking-attributable proportions, using R software for statistical analysis (p<0.05 was considered statistically significant).

Results

Global distribution of EOPD in 2021 (compared with PD)

In 2021, the number of incident cases, prevalent cases and YLDs for EOPD was 81 047, 483 872 and 78 423, respectively. These figures accounted for 6.07%, 4.11% and 4.70% of the total PD cases (age 20+) in each respective category (figure 1). The global age-standardised incidence rate, prevalence rate and YLDs were 2.35 (95% CI 1.39 to 3.55), 14.00 (95% CI 9.49 to 19.79) and 2.27 (95% CI 1.34 to 3.50) per 100 000 population, respectively (figure 1). According to the SDI classification, we found that the age-standardised prevalence rate and DALYs were highest in middle SDI countries, followed by high-middle SDI countries. Regarding the age-standardised incidence rate, the countries with a middle SDI, which originally ranked first, were surpassed by countries with a high-middle SDI around the year 2000. Unlike the steadily increasing incidence and prevalence rates, DALYs exhibited significant fluctuations but still showed an overall upward trend over the past 30 years (figure 2). At the country level, the nations with the highest incidence rates in 2021 were Peru (5.17), Bolivia (5.13), Ecuador (4.92) and China (4.62). The countries with the highest prevalence rates were the same: Peru (30.72), Bolivia (29.77), Ecuador (29.44) and China (21.63). However, the countries with the highest DALYs were different, with Saudi Arabia (9.75), Afghanistan (9.25), North Korea (8.98), Guinea-Bissau (8.28) and Seychelles (7.97) leading the list.

Figure 1. The proportion (A) and trends (B) of incident cases, prevalent cases and YLDs of EOPD at the global level. EOPD, early-onset Parkinson’s disease; YLDs, years lived with disability.

Figure 1

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Figure 2. Time trends of age-standardised incidence, prevalence and DALY rates of EOPD/PD from 1990 to 2021 (by gender and SDI). DALYs, disability-adjusted life years; EOPD, early-onset Parkinson’s disease; PD, Parkinson’s disease; SDI, Socio-Demographic Index.

Figure 2

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In 2021, at both the global and SDI levels, the age-standardised incidence and prevalence rates for men were higher than for women (figure 2). Examining the distribution of EOPD across different age groups in 2021, it is evident that the DALYs for men aged 20–49 were significantly higher than for women, primarily due to the older age groups. Age analysis revealed that with increasing age, the DALYs for EOPD in both men and women increased exponentially in 2021 (figure 3).

Figure 3. Comparison of DALYs for EOPD by age group and gender in 1990 and 2021. DALYs, disability-adjusted life years; EOPD, early-onset Parkinson’s disease.

Figure 3

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For PD, middle-high SDI countries consistently exhibited the highest age-standardised incidence, prevalence and DALYs (figure 2). At the national level, the countries with the highest incidence rates in 2021 were China (24.34), Qatar (24.22), Israel (21.87), Germany (21.53) and Canada (21.05). Similarly, the countries with the highest prevalence rates were largely the same, though the order differed slightly: China (245.73), Israel (199.71), Canada (197.61) and Germany (186.45).

Trends over time in EOPD from 1990 to 2021 (compared with PD)

Over the past 30 years, the number of incident cases, prevalent cases and YLDs of EOPD has increased by 286.72%, 239.34% and 249.59%, respectively (figure 4). Globally, the age-standardised incidence rate, prevalence rate and YLDs have shown a significant upward trend. However, in recent years, the pace of this upward trend has shown a slight slowdown (figure 1). At the SDI level, from 1990 to 2021, middle-high SDI countries experienced the fastest growth in incidence and prevalence rates, reaching 3.46 and 2.22, respectively. In all SDI regions, the growth rates of incidence and prevalence among men were higher than those among women (figure 5). In addition, the results showed that Age-standardised incidence rate (ASIR) and SDI were basically positively correlated with EOPD in 2021 (figure 6).

Figure 4. (A) Changes in the number of EOPD/PD cases from 1990 to 2021. (B) Age-standardised incidence rate of EOPD/PD in 2021. EOPD, early-onset Parkinson’s disease; PD, Parkinson’s disease.

Figure 4

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Figure 5. (A)–(C) The average annual percentage change for the age-standardised rates of EOPD/PD, globally and by SDI category, from 1990 to 2021. (A) Both sexes combined, (B) male and (C) female. DALYs, disability-adjusted life years; EOPD, early-onset Parkinson’s disease; PD, Parkinson’s disease; SDI, Socio-Demographic Index.

Figure 5

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Figure 6. The relationship between the age-standardised incidence rate of EOPD and SDI from 1990 to 2021 across 204 countries and territories. EOPD, early-onset Parkinson’s disease; SDI, Socio-Demographic Index.

Figure 6

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At the regional level, from 1990 to 2021, East Asia had the fastest growth in age-standardised incidence and prevalence rates, with AAPCs of 3.36 and 2.54, respectively, which were significantly higher than those of other regions.

At the national level, from 1990 to 2021, China experienced the fastest growth in age-standardised incidence and prevalence rates, with almost exaggerated increases (AAPCs of 3.41 and 2.58, respectively), followed by Norway (AAPCs of 2.43 and 1.69). Among the 204 countries and regions studied, 88.73% and 90.69% (180/204 and 185/204, respectively) showed an upward trend in age-standardised incidence and prevalence rates over time. Of these, 21.08% (43/204) and 29.41% (60/204) of the countries and regions had AAPCs exceeding 0.7 and 0.5, respectively (figure 7).

Figure 7. (A) Global map of ASIR, ASPR, ASDR of EOPD/PD for both sexes combined in 2021. (B) Corresponding AAPC from 1990 to 2021. ASIR, age-standardised incidence rate; ASPR, age-standardised prevalence rate; ASDR, age-standardised DALYs rate; AAPC, average annual percent change; EOPD, early-onset Parkinson’s disease; PD, Parkinson’s disease.

Figure 7

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We found that from 1990 to 2021, the age-standardised DALYs rate for EOPD fluctuated but generally showed an upward trend, rising from 4.97 in 1990 to 5.22 in 2021. At the SDI level, except for the low SDI region, all SDI regions had AAPCs of age-standardised DALY rates >0. Compared with the volatile increases in other SDI regions, the low-middle-SDI regions showed a clear rise in DALYs. Furthermore, DALY rates increased for men in all regions and for women in the high SDI and low-middle SDI regions, while the DALY rates of women in the high-middle SDI, middle SDI and low SDI regions decreased (figure 2). At the regional level, Australasia and the Caribbean region had the highest growth rates in age-standardised DALYs rates, with AAPCs of 0.60 and 0.46, respectively. Additionally, nearly half of the countries and regions (90/204) showed an upward trend in age-standardised DALYs rates (figure 7).

The fastest growth in PD incidence and prevalence was observed in middle SDI countries, with increases of 1.43 and 2.31, respectively (figure 5). Between 1990 and 2021, Norway experienced the most rapid rise in age-standardised incidence and prevalence rates (AAPC of 2.92 and 4.52, respectively), followed by China (AAPC of 2.10 and 3.23) and Germany (AAPC of 1.95 and 2.20).

The protective effect of smoking on EOPD (compared with PD)

In 2021, smoking contributed to a 9.03% reduction in the global burden of DALYs. Regionally, the greatest impact was observed in Eastern Europe (−17.93%), while the smallest impact was in Western Sub-Saharan Africa (−2.88%). From a gender perspective, the reduction in DALYs due to smoking was significantly higher for men, being 7.09 times greater than that for women. In Eastern Europe, smoking led to a 25.09% reduction in EOPD DALYs among men, followed by East Asia (−22.1%) and Central Europe (−17.79%). In contrast, the global reduction in DALYs for women due to smoking was only 1.87%. Among Central Europe women, smoking had the most pronounced protective effect at 10.63%, whereas for women in South Asia and Central and Western Sub-Saharan Africa, the protective effects were minimal at −0.59%, −0.54% and −0.36%, respectively.

Over the past 30 years, the reduction in EOPD DALYs among women due to smoking has remained stable globally. However, the impact of smoking on men with EOPD has been steadily decreasing across the world and within various SDI regions, with the most significant reduction observed in high-SDI regions. Regionally, the greatest changes occurred in Tropical Latin America countries, where the impact decreased from −14.55% to −5.12% (a decrease of 64.8%), and the change in the high-income Asia-Pacific region is also considerable (from −18.15% to −10.68%) (figure 8).

Figure 8. DALYs attributable to smoking for EOPD/PD from 1990 to 2021 (by region and gender). DALYs, disability-adjusted life years; EOPD, early-onset Parkinson’s disease; PD, Parkinson’s disease; SDI, Socio-Demographic Index; YLDs, years lived with disability.

Figure 8

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In PD, the contribution of smoking to the reduction of DALYs in men was only 5.58 times that in women. Additionally, it was observed that the protective effect of smoking for women in European and American regions in EOPD was significantly higher compared with its effect in PD.

Discussion

It is estimated that one in three individuals will suffer from a neurological disorder at some stage in their lives, positioning neurological disorders as the primary cause of disability and the second leading cause of death.13 Among these disorders, PD stands out as a critical condition that demands attention.

It is essential to consider the impact of EOPD on work, as patients are often within the working-age population. In the workplace, patients may experience uncontrollable tremors, difficulty concentrating and challenges in multitasking. Some may even struggle to perform basic tasks like typing, significantly affecting their work performance. For those with severe symptoms, driving can also become a major challenge, forcing many to give up driving altogether.

A European cohort study found that the employment rate within 5 years of diagnosis ranges from 15% to 46%, indicating that approximately half of individuals diagnosed with PD will become unemployed within 5 years.14 Additionally, the cost of treating PD is associated with disease progression and the need for long-term care. Compared with those with late-onset PD, patients with EOPD face significant social and economic burdens due to early retirement and a longer duration of illness, resulting in substantial healthcare and social costs.

Our research reveals that the incidence, prevalence and YLDs of EOPD in 2021 have tripled compared with 1990 on a global scale. In addition, the age-standardised incidence and prevalence rates of EOPD have steadily increased in most countries, with the most notable rises in high-middle SDI nations. The protective effect of smoking against EOPD seen in 1990 has weakened by 2021, a trend uniformly observed across all SDI regions.

Previous investigations have reported on the global burden of PD across all age groups from 1990 to 2016,15 the burden within China,16 or included PD as part of neurological disorders.13 17 18 However, there has yet to be a dedicated study examining the global disease burden of EOPD. However, no studies have exclusively focused on the global burden of EOPD. Given the increasing reports of PD in younger age groups, we sought to understand the true burden of EOPD. By integrating the concept of EOPD with the GBD framework, we specifically examined the disease burden among this population to address the epidemiological gaps related to country and region, gender and age. Our analysis demonstrates a significant rise in the disease burden of EOPD over the past 30 years, suggesting a potential shift in the global perspective on PD prevention and control strategies.

In 2021, Peru, Bolivia and Ecuador in South America ranked among the top three in terms of the age-standardised incidence and prevalence of EOPD. Moreover, 7 out of the top 10 countries in this regard are located in Latin America. The reason for this may be that the pathogenic variants of relevant genes are more prevalent in the Latin American population compared with other continents. Genes such as PRKN and GBA1 all exhibit a relatively high carriage rate of pathogenic mutations in the Latin American population. Specifically, PRKN gene mutations are the main cause of EOPD in the Mexican Mestizo population.19 The GBA1 gene mutations have a high carriage rate in the Colombian and Peruvian populations, and the Colombian population has a specific variant (p.K198E). Additionally, patients carrying the GBA1 gene exhibited a significantly earlier age of onset.20 Besides, LRRK2 mutations are widely distributed throughout Latin America and demonstrate a direct correlation with the estimated proportion of European ancestry at each location. The frequency of LRRK2 carriers positively correlates with the estimated proportion of Spanish ancestry: this proportion ranges from approximately 20% in Peru to 80% in Uruguay and Argentina, with corresponding carrier frequencies increasing from 2/543 in Peru to 6/188 in Argentina and 13/288 in Uruguay.21 22 Furthermore, studies reveal distinct distributions of PD susceptibility genes across different Latin American countries. In Peru, PRKN mutations constitute the vast majority of identified PD gene mutations, significantly outnumbering other susceptibility genes. Conversely, among Colombian PD patients, GBA1 mutations predominate. Brazil, characterised by high population heterogeneity, exhibits considerable diversity in susceptibility gene distribution among affected individuals: GBA1 mutations show the highest carrier rate, followed by notable frequencies of LRRK2 and PRKN mutations, with other genes (FBXO7, PARK7, SNCA, etc) sporadically distributed.23 The high carriage rate of these gene mutations may be an important genetic factor contributing to the relatively high incidence of EOPD in Latin American countries. Our search also identified arsenic contamination as a potentially significant environmental factor for the high PD burden in Latin America. Research demonstrates a significant association between environmental arsenic exposure and PD incidence in local populations.24 High-risk arsenic contamination has been reported in 14 Latin American countries, primarily attributable to the region’s unique geology. Arsenic originates largely from natural sources like volcanic rocks and sulfide mineral deposits, leaching into surface and groundwater via rivers. Studies suggest indigenous populations may have suffered arsenicosis as early as 7000 years ago due to high arsenic exposure from drinking water and geological sources. However, widespread recognition of arsenic contamination in water supplies only emerged in the mid-20th century, and initial detections in ten Latin American countries, including Peru, Bolivia, Brazil and Colombia, occurred only within the last 10–15 years. The delayed recognition and mitigation of this environmental health risk may contribute to the high incidence of EOPD in the region.25

Moreover, exposure to toxic agents is also identified as a PD risk factor. For instance, in coastal rural Ecuador, where carpentry is a common occupation, exposure to dust and toxic agents in this specific work environment appears to negate the potentially lower PD risk associated with significantly elevated prevalence of PD observed in the Ecuadorian population.26 Based on the above findings, we conclude that the regionally elevated incidence and prevalence of EOPD in Latin America are likely collectively driven by its distinctive historically shaped genetic factors and environmental exposures. While China, Israel and Germany ranked highest in terms of PD incidence and prevalence, this suggests that the factors influencing EOPD and PD may differ significantly. Yet, our review indicates that existing studies have not deeply explored the reasons underlying this divergence. Investigating this area could provide critical insights for developing differentiated prevention and management strategies for these two conditions.

Between 1990 and 2021, the age-standardised incidence and prevalence rates of EOPD have significantly increased, with AAPCs of approximately 1.50 and 1.07. This rise may be due to the excessive use of heavy metal pollution in recent years.27 Regionally and nationally, East Asia and China have experienced the most rapid increases in age-standardised incidence and prevalence rates, both surpassing 2.0 and 3.0. The rapid growth of incidence and prevalence rates in East Asia may be closely linked to environmental issues stemming from economic development in developing countries over the past three decades. Specifically, in China, the age-standardised incidence rate of PD grew by 89.7%, and the age-standardised prevalence rate grew by 167.8% from 1990 to 2021. Compared to 1990, the number of incident cases and prevalent cases in China rose by 455.7% and 678.9%, respectively.16 East Asian countries, including China, have been long affected by heavy metal pollution due to the transfer of heavy industries from developed Western countries during the last century.28,30 Besides, literature indicates that genetic factors also play a significant role. Specifically, studies suggest that, compared with Western populations, the L444P mutation in the GBA gene represents a distinct genetic risk factor for PD in the Chinese population.31 Furthermore, studies show that individuals carrying the GBA L444P mutation exhibit a significantly earlier age of PD onset and more pronounced clinical symptoms.32 In addition, as a developed country, Norway has the second-highest growth rate of age-standardised incidence and prevalence among all countries and regions in the past nearly 30 years, second only to China. We attribute this primarily to the recent expansion and enhanced comprehensiveness of Norsk Parkinsonregister og biobank, which is now recognised as one of the most complete national PD registries globally. This system enables the efficient identification of potential EOPD cases.33 In addition, global researchers should pay attention to the increasing trend of EOPD in Norway in recent years and analyse the underlying influencing factors.

Smoking is a well-recognised protective factor against PD.34 35 This study is the first to use data from the GBD database to investigate the relationship between EOPD and smoking. Our research indicates that smoking leads to a decrease in DALYs associated with EOPD. From 1990 to 2021, we observed that the smoking-attributable fraction for EOPD reduced to 63.86% of its original value (from −14.14% to −9.03%), likely due to the global decline in smoking rates. Furthermore, the reduction in smoking-attributable fraction is particularly evident among men in high SDI regions compared with other SDI areas, suggesting that anti-smoking measures and education in high SDI regions have been effective.36 Meanwhile, further research is needed to explore the mechanisms through which tobacco provides protective effects against PD. In summary, this study indicates that the protective effect on EOPD has weakened in recent years.

Using data from GBD 2021, we comprehensively assessed the global distribution and temporal trends of EOPD and the contribution of smoking as the only attributable risk factor. Nevertheless, our study has several limitations. First, despite the robustness and reliability attributed to GBD methods and results, as derived from the DisMod-MR 2.1 model, caution is warranted in interpreting country or sub-national level results due to the quality of current data. The 2021 GBD study employed various techniques to reduce bias and inaccuracies, but bias cannot be entirely ruled out. Second, the disease burden of EOPD depends on screening methods, detection methods and the reliability of data registration. Given the significant differences in public healthcare systems across countries, the burden of EOPD in low-income countries may be somewhat underestimated. Third, although individuals aged 20–29 with EOPD also suffer from disability and other adverse outcomes due to the disease, the GBD 2021 currently lacks DALYs data for this age group. Future efforts could focus on improving this data. Fourth, studies have shown that coffee, tea and moderate physical activity exhibit protective effects against PD,37,39 while EOPD is also associated with other risk factors such as pesticide exposure, heavy metal pollution and a history of trauma.40 However, the current GBD database only allows for the quantification of smoking as an individual risk factor and does not separately include these specific factors in its statistical analysis of PD. As a result, it is not possible to further clarify the precise impact of factors like coffee consumption on EOPD. Quantifying the attributable proportion of these risk factors in the future remains an important area of research.

Conclusion

EOPD is an increasingly serious global health issue that requires significant attention from both the WHO and individual nations. Especially, East Asian countries and Norway should closely monitor the swift rise of EOPD in their respective populations. Meanwhile, researchers should further explore the potential factors contributing to the EOPD in Latin American countries. Furthermore, different countries should develop tailored health policies based on the severity of the disease within their own borders to effectively address this global health concern.

Acknowledgements

We are immensely grateful to all the collaborators of the GBD 2021.

Footnotes

Funding: This work was supported by the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China (No. LHDMZ24H050001), National Natural Science Foundation of China (No. 82074166), Fujian Provincial Natural Science Foundation (No. 2018J01121), Fujian Provincial Health Technology Project (No. 2020GGA026) and Medical Discipline Construction Project of PudongHealth Pudong Health Committee of Shanghai (No. PWYts2021-18).

Data availability free text: The data used in this study are freely available for download from the GBD 2021 website (https://vizhub.healthdata.org/gbd-results/). All data used in this study will also be made available on request to the corresponding author.

Patient consent for publication: Not applicable.

Provenance and peer review: Not commissioned; externally peer reviewed.

Map disclaimer: The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

Ethics approval: This GBD study mainly relies on existing publicly available large datasets. These data are aggregated data accumulated from past large-scale public health monitoring projects, routine statistical reports submitted by medical and health institutions, and other processes. For example, they cover macro-level statistical indicators such as the incidence, prevalence and mortality rates of diseases among people in various regions and age groups. When all the data were included in this public database, they had already undergone strict de-identification and anonymisation processing, forming a general overview of group data that is not associated with specific individuals. There is no situation of direct interaction with individual human participants or collection of their personal information. Therefore, the Ethics Committee exempted the study.

Data availability statement

Data are available in a public, open access repository.

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Data Availability Statement

Data are available in a public, open access repository.

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