Shaping the neurological health agenda in the Americas: from mortality to chronic disability

Neurological disorders have moved from the periphery to become a central pillar of the noncommunicable disease agenda in the Americas.¹ In a timely and rigorous analysis, Martinez and colleagues use Global Burden of Disease Study 2023 data to provide regional and country-level estimates for noncommunicable and injury-related nervous system disorders across 38 countries and territories from 1990 to 2023.² This study reports that 470 million people in the region were living with at least one of these disorders in 2023. In addition, these conditions caused 1.1 million deaths and 37.5 million disability-adjusted life-years (DALYs), indicating that neurological health can no longer be ignored in regional health policy.

These historical trends can be interpreted as a profound epidemiological transition from premature mortality to chronic disability. Although age-standardised mortality and overall DALY rates for some acute or vascular conditions have declined over the past three decades, the absolute number of people living with long-term neurological impairment continues to increase.¹

Martinez and colleagues identify migraine, Alzheimer's disease and other dementias, ischaemic stroke, and intracerebral hemorrhage as dominant contributors to the overall DALY burden in the Americas. Neurodegenerative diseases also have increasing age-standardised DALY trends at the same time. These findings suggest that as populations age and survival improves in Latin America and the Caribbean, health systems will face growing challenges in managing long-term and progressive neurological morbidity that threatens functional independence, rather than primarily acute fatal events. However, this large database does not provide answers to important clinical and structural questions. GBD data provide a picture of the architecture of disease burden at a macro level but cannot fully capture diagnostic gaps or widespread underdiagnosis in under-resourced settings. The study also fails to provide granular information on access to treatment and rehabilitation, which are fragmented in many low- and middle-income countries. We must therefore ask whether primary care systems are genuinely prepared to manage chronic neurological disability. There remains an alarming deficit in dementia-care capacity in Latin America and the Caribbean,³ together with shortages of trained neurology personnel and restricted access to diagnostic services, essential medicines, and rehabilitation in resource-limited settings.⁴ True equity cannot be measured through counterfactual models alone; it requires understanding whether a patient in a rural or otherwise underserved community can access frontline clinical services and specialised long-term support.

From a public health and policy perspective, the implications are actionable and require stronger mitigation of modifiable risk factors. A substantial component of the burden from selected neurological conditions is attributable to preventable or modifiable exposures. High systolic blood pressure remains the leading modifiable risk factor for stroke burden, including ischaemic stroke and intracerebral haemorrhage,⁵ whereas high fasting plasma glucose has been identified as an attributable risk factor for the burden of Alzheimer's disease and other dementias.⁶ Environmental exposures also continue to cause preventable neurological harm. Lead exposure is an established contributor to idiopathic developmental intellectual disability.⁷ In Martinez and colleagues' analysis, lead exposure accounted for 55% of DALYs due to idiopathic developmental intellectual disability in the Americas. Policymakers must therefore move beyond passive clinical management towards population-level strategies that strengthen blood-pressure control, glycaemic management, broader cardiometabolic risk reduction, and the enforcement of chemical and industrial environmental regulations.

Ultimately, neurological health must no longer remain isolated within specialised tertiary hospital services. Neurological care should be integrated into comprehensive primary care networks, national noncommunicable disease programmes, rehabilitation systems, and long-term health and social care frameworks.⁸ Regional health equity strategies must actively dismantle structural barriers to diagnosis, treatment and ongoing support to meet the rising tide of chronic disability. The countries of the Americas can only prevent this ongoing crisis and protect the functional longevity of their populations by integrating neurological care into the universal health coverage agenda.

Contributors

MRV conceived the Comment, wrote the manuscript, critically revised it for important intellectual content, and approved the final version for submission.

Declaration of interests

MRV declares no competing interests.