Global epidemiological and indirect economic burden of neurological, mental, and substance use disorders: An analysis based on the global burden of disease data

Tao Rong-Shan; Sun Zhi-Hong; Long Rui-Yu

doi:10.1016/j.cmsj.2026.08.002

Your Location：

Home >

Browse articles >

Global epidemiological and indirect economic burden of neurological, mental, and substance use disorders: An analysis based on the global burden of disease data

中国医学科学杂志 2026年41卷第2期页码：62-71

Research Article | Updated：2026-10-16

- Global epidemiological and indirect economic burden of neurological, mental, and substance use disorders: An analysis based on the global burden of disease data
- Affiliations：
  
  School of Public Health, Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China
  School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
- Author bio：
  
  Corresponding author. E-mail: long951236@126.com (R.-Y. Long) .
- Funds：
  
  the Guizhou Health Development Research Institute(KP2026013)
- DOI：10.1016/j.cmsj.2026.08.002
  中图分类号：
- 纸质出版：2026-06
- Accepted：
Scan QR Code
Tao Rong-Shan, Sun Zhi-Hong, Long Rui-Yu. Global epidemiological and indirect economic burden of neurological, mental, and substance use disorders: An analysis based on the global burden of disease data[J]. 中国医学科学杂志, 2026,41(2):62-71.

Tao Rong-Shan, Sun Zhi-Hong, Long Rui-Yu. Global epidemiological and indirect economic burden of neurological, mental, and substance use disorders: An analysis based on the global burden of disease data[J]. Chinese Medical Sciences Journal, 2026, 41(2): 62-71.
Tao Rong-Shan, Sun Zhi-Hong, Long Rui-Yu. Global epidemiological and indirect economic burden of neurological, mental, and substance use disorders: An analysis based on the global burden of disease data[J]. 中国医学科学杂志, 2026,41(2):62-71. DOI： 10.1016/j.cmsj.2026.08.002.

Tao Rong-Shan, Sun Zhi-Hong, Long Rui-Yu. Global epidemiological and indirect economic burden of neurological, mental, and substance use disorders: An analysis based on the global burden of disease data[J]. Chinese Medical Sciences Journal, 2026, 41(2): 62-71. DOI： 10.1016/j.cmsj.2026.08.002.

摘要

Abstract

Objective:

To evaluate the global disease burden and indirect economic costs of neurological

mental

and substance use disorders (NMSDs) from 1990 to 2023.

Methods:

This study analyzed data on incidence

prevalence

and disability-adjusted life years (DALYs) for NMSDs using data from the Global Burden of Disease 2023 database. Joinpoint regression analysis was used to calculate average annual percentage change. Spearman correlation was applied to examine the association between age-standardized rates and socio-demographic index (SDI). The indirect economic burden was estimated using the human capital approach

incorporating age-adjusted productivity weights and gross domestic product (GDP) per capita.

Results:

From 1990 to 2023

the absolute numbers of incident cases

prevalent cases

and DALYs for NMSDs increased substantially

with DALYs for neurological and mental disorders approximately doubling. Age-standardized rates demonstrated

divergent trends across disease categories. For mental disorders

the age-standardized incidence

prevalence

and DALY rates increased by 15.00%

24.00%

and 29.00%

respectively

with the overall burden rising markedly in 2019. In contrast

while the overall burden of substance use disorders declined

a notable exception emerged in high-income North America

where rising rates were observed specifically for opioid and cocaine use disorders. The burden of neurological and mental disorders was higher in females than in males

whereas substance use disorders showed the opposite pattern. The age-standardized DALY rate for motor neuron disease exhibited a significant positive correlation with SDI (

= 0.82

＜ 0.001). The indirect economic burden and its share of GDP increased in most countries

while the share for substance use disorders in China declined by 46.19%.

Conclusion:

The disease burden and economic costs of NMSDs increased globally from 1990 to 2023

with significant geographic

national

and demographic disparities. These findings highlight an urgent need for targeted resource allocation and integrated interventions.

关键词

Keywords

references

Patel V, Chisholm D, Parikh, et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from disease control priorities, 3rd edition. Lancet . 2016;387(10028):1672-1685. doi: 10.1016/S0140-6736(15)00390-6 .

Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol . 2011;21(9):655-679. doi: 10.1016/j.euroneuro.2011.07.018 .

Organization WH. World Mental Health Report: Transforming Mental Health for All . Geneva: World Health Organization; 2022 .

GBD 2023 Disease and Injury and Risk Factor CollaboratorsBurden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the global burden of disease study 2023. Lancet . 2025;406(10513):1873-1922 . doi: 10.1016/S0140-6736(25)01637-X .

Winkler AS, Gupta S, Patel V, et al. Global brain health —the time to act is now. Lancet Glob Health . 2024;12(5):e735-e736. doi: 10.1016/S2214-109X(23)00602-2 .

World Health Organization. Educating Medical and Nursing Students to Provide Mental Health, Neurological and Substance Use Care: a Practical Guide for Pre-Service Education . Geneva: World Health Organization; 2025 .

Lu J, Xu X, Huang Y, et al. Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study. Lancet Psychiatry . 2021;8(11):981-990. doi: 10.1016/S2215-0366(21)00251-0 .

Turner M, Laws M, Griffiths M, et al. The relationships between multidimensional sleep health and work productivity in individuals with neurological conditions. J Sleep Res . 2024;33(4):e14107. doi: 10.1111/jsr.14107 .

Li Y, Jönsson L. The health and economic burden of brain disorders: consequences for investment in diagnosis, treatment, prevention and R & D. Cereb Circ Cogn Behav . 2025;8:100377. doi: 10.1016/j.cccb.2025.100377 .

Chisholm D, Sweeny K, Sheehan P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry . 2016;3(5):415-424. doi: 10.1016/S2215-0366(16)30024-4 .

Tzioras M, McGeachan RI, Durrant CS, et al. Synaptic degeneration in Alzheimer disease. Nat Rev Neurol . 2023;19(1):19-38. doi: 10.1038/s41582-022-00749-z .

Rocha GS, Freire MAM, Falcao D, et al. Neurodegeneration in Parkinson's disease: are we looking at the right spot? Mol Brain . 2025;18(1):68. doi: 10.1186/s13041-025-01218-6 .

Foster LA, Salajegheh MK. Motor neuron disease: pathophysiology, diagnosis, and management. Am J Med . 2019;132(1):32-37. doi: 10.1016/j.amjmed.2018.07.012 .

Headache classification committee of the International Headache Society (IHS)The International Classification of Headache Disorders, 3rd edition. Cephalalgia . 2018;38(1):1-211. doi: 10.1177/0333102417738202 .

Keller J, Gomez R, Williams G, et al. HPA axis in major depression: cortisol, clinical symptomatology and genetic variation predict cognition. Mol Psychiatry . 2017;22(4):527-536. doi: 10.1038/mp.2016.120 .

Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci . 2011;12(11):652-669. doi: 10.1038/nrn3119 .

Böttinger BW, Baumeister S, Millenet S, et al. Orbitofrontal control of conduct problems? Evidence from healthy adolescents processing negative facial affect. Eur Child Adolesc Psychiatry . 2022;31(8):1-10. doi: 10.1007/s00787-021-01770-1 .

Piccolo M, Belleau EL, Holsen LM, et al. Alterations in resting-state functional activity and connectivity for major depressive disorder appetite and weight disturbance phenotypes. Psychol Med . 2023;53(10):4517-4527. doi: 10.1017/S0033291722001398 .

Wimo A, Seeher K, Cataldi R, et al. The worldwide costs of dementia in 2019. Alzheimers Dement . 2023;19(7):2865-2873. doi: 10.1002/alz.12901 .

Luppa M, Heinrich S, Angermeyer MC, et al. Cost-of-illness studies of depression: a systematic review. J Affect Disord . 2007;98(1-2):29-43. doi: 10.1016/j.jad.2006. 07.017 .

Fan Y, Fan A, Yang Z, et al. Global burden of mental disorders in 204 countries and territories, 1990-2021: results from the global burden of disease study 2021. BMC Psychiatry . 2025;25(1):486. doi: 10.1186/s12888-025-06932-y .

GBD 2021 Nervous System Disorders CollaboratorsGlobal, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol . 2024;23(4):344-381. doi: 10.1016/S1474-4422(24)00038-3 .

Wang Y, Liang J, Fang Y, et al. Burden of common neurologic diseases in Asian countries, 1990-2019: an analysis for the Global Burden of Disease Study 2019. Neurology . 2023;100(21):e2141-e2154. doi: 10.1212/WNL.0000000000207218 .

GBD 2019 Mental Disorders CollaboratorsGlobal, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiat. . 2022;9(2):137-150. doi: 10.1016/S2215-0366(21)00395-3 .

GBD 2016 Neurology CollaboratorsGlobal, regional, and national burden of neurological disorders, 1990-2016: a systematic analy sis for the Global Burden of Disease Study 2016. Lancet Neurol . 2019;18(5):459-480. doi: 10.1016/S1474-4422(18)30499-X .

Mitchell AJ, Cogswell IE, Dalos J, et al. Estimating global direct health-care spending on neurological and mental health between 2000 and 2019: a modelling study. Lancet Public Health . 2025;10(5):e401-e411. doi: 10.1016/S2468-2667(25)00089-1 .

Zhou XY, Wang X, Cai SY, et al. Indirect economic burden of cancer in populations in China, 2021: a measurement based on a human capital approach. J Cancer Policy . 2025;46:100648. doi: 10.1016/j.jcpo.2025.100648 .

Pearce A, Sharp L, Hanly P, et al. Productivity losses due to premature mortality from cancer in Brazil, Russia, India, China, and South Africa (BRICS): a populationbased comparison. Cancer Epidemiol . 2018;53:27-34. doi: 10.1016/j.canep.2017. 12.013 .

GBD 2021 Diseases and Injuries CollaboratorsGlobal incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet . 2024;403(10440):2133-2161. doi: 10.1016/S0140-6736(24)00757-8 .

Kim HJ, Chen HS, Byrne J, et al. Twenty years since Joinpoint 1.0: two major enhancements, their justification, and impact. Stat Med . 2022;41(16):3102-3130 .

Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications t o cancer rates. Stat Med . 2022;41(3):3102-3130. doi: 10.1002/sim.9407 .

Luo Z, Yang YY, Jia W, et al. Trend analysis of the indirect economic burden among patients with chronic obstructive pulmonary disease in China. Health Econ Res . 2025;42(6):73-78 in Chinese. doi: 10.14055/j.cnki.33-1056/f.2025.06.020 .

Liu W, Zhang Y, Chen J, et al. Global burden and trends of major mental disorders in individuals under 24 years of age from 1990 to 2021, with projections to 2050: insights from the Global Burden of Disease Study 2021. Front Public Health . 2025;13:1635801. doi: 10.3389/fpubh.2025.1635801 .

Zhang C, Yang X, Wan D, et al. Burden of neurological disorders in China and its provinces, 1990-2021: findings from the global burden of disease study 2021. Med . 2025;6(8):100692. doi: 10.1016/j.medj.2025.100692 .

Yang R, Liu X, Zhao Z, et al. Burden of neurological diseases in Asia, from 1990 to 2021 and its predicted level to 2045: a Global Burden of Disease study. BMC Public Health . 2025;25(1):706. doi: 10.1186/s12889-025-21928-9 .

Feng J, Hong G, Qian W, et al. Aging in China: an international and domestic comparative study. Sustainability . 2020;12(12):5086. doi: 10.3390/su12125086 .

Charlson FJ, Baxter AJ, Cheng HG, et al. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. Lancet . 2016;388(10042):376-389. doi: 10.1016/S0140-6736(16)30590-6 .

Naumova EN. Public health inequalities, structural missingness, and digital revolution: time to question assumptions. J Public Health Policy . 2021;42(4):531-535. doi: 10.1057/s41271-021-00312-y .

Casella CB, Kousoulis AA, Kohrt BA, et al. Data gaps in prevalence rates of mental health conditions around the world: a retrospective analysis of nationally representative data. Lancet Glob Health . 2025;13(5):e879-e887. doi: 10.1016/S2214-109X(24)00563-1 .

The LancetMotor neuron disease: improving quality of life for patients. Lancet . 2024;403(10439):1821. doi: 10.1016/S0140-6736(24)00972-3 .

Wang CM, Whiting AH, Rath A, et al. Operational description of rare diseases: a reference to improve the recognition and visibility of rare diseases. Orphanet J Rare Dis . 2024;19(1):334. doi: 10.1186/s13023-024-03322-7 .

Simon NM, Saxe GN, Marmar CR. Mental health disorders related to COVID-19-related deaths. JAMA . 2020;324(15):1493. doi: 10.1001/jama.2020.19632 .

Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic —United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep . 2020;69(32):1049-1057. doi: 10.15585/mmwr.mm6932a1 .

Chau LW, Lam RW, Minas H, et al. Digital health interventions for depression and anxiety in low- and middle-income countries: rapid scoping review. JMIR Ment Health . 2025;12:e68296. doi: 10.2196/68296 .

Cummins I. The impact of austerity on mental health service provision: a UK perspective. Int J Env Res Public Health . 2018;15(6):1145. doi: 10.3390/ijerph15061145 .

The LancetPromises and pitfalls: UK health under Labour. Lancet . 2024;404(10465):1783. doi: 10.1016/S0140-6736(24)02466-8 .

Trautmann S, Rehm J, Wittchen HU. The economic costs of mental disorders: do our societies react appropriately to the burden of mental disorders? EMBO Rep . 2016;17(9):1245-1249. doi: 10.15252/embr.201642951 .

Florence C, Luo F, Rice K. The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017. Drug Alcohol Depend . 2021;218:108350. doi: 10.1016/j.drugalcdep.2020.108350 .

Jones CM, Einstein EB, Compton WM. Changes in synthetic opioid involvement in drug overdose deaths in the United States, 2010-2016. JAMA . 2018;319(17):1819. doi: 10.1001/jama.2018.2844 .

Hoffman KA, Ponce Terashima J, McCarty D. Opioid use disorder and treatment: challenges and opportunities. BMC Health Serv Res . 2019;19(1):884. doi: 10.1186/s12913-019-4751-4 .

Rehm J, Mathers C, Popova S, et al. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet . 2009;373(9682):2223-2233. doi: 10.1016/S0140-6736(09)60746-7 .

Volkow ND, Blanco C. Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspec ts, treatment and prevention. World Psychiatry . 2023;22(2):203-229. doi: 10.1002/wps.21073 .

Karapareddy V. A review of integrated care for concurrent disorders: cost effectiveness and clinical outcomes ] . J Dual Diagn . 2019;15(1):56-66. doi: 10.1080/15504263.2018.1518553 .

Rocks S, Berntson D, Gil-salmeron A, et al. Cost and effects of integrated care: a systematic literature review and meta-analysis. Eur J Health Econ . 2020;21(8):1211-1221. doi: 10.1007/s10198-020-01217-5 .

Patwardhan V, Gil GF, Arrieta A, et al. Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Public Health . 2024;9(5):e282-e294. doi: 10.1016/s2468-2667(24)00053-7 .

Rajan KB, Weuve J, Barnes LL, et al. Population estimate of people with clinical Alzheimer's disease and mild cognitive impairment in the United States (2020-2060). Alzheimers Dement . 2021;17(12):1966-1975. doi: 10.1002/alz.12362 .

Steiner TJ, Stovner LJ, Jensen R, et al. Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. J Headache Pain . 2020;21(1):137. doi: 10.1186/s10194-020-01208-0 .

Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull . 2017;143(8):783-822. doi: 10.1037/bul0000102 .

Zito S, Nosari G, Pigoni A, et al. Association between testosterone levels and mood disorders: a minireview. J Affect Disord . 2023;330:48-56. doi: 10.1016/j.jad.2023.02.108 .

Wu Y, Wang L, Tao M, et al. Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years. Epidemiol Psychiatr Sci . 2023;32:e63. doi: 10.1017/s2045796023000756 .

Baranne ML, Falissard B. Global burden of mental disorders among children aged 5-14 years. Child Adolesc Psychiatry Ment Health . 2018;12:19. doi: 10.1186/s13034-018-0230-2 .

Auersperg F, Vlasak T, Ponocny I, et al. Long-term effects of parental divorce on mental health —a meta-analysis. J Psychiatr Res . 2019;119:107-115. doi: 10.1016/j.jpsychires.2019.09.011 .

Krugers HJ, Arp JM, Xiong H, et al. Early life adversity: lasting consequences for emotional learning. Neurobiol Stress . 2017;6:14-21. doi: 10.1016/j.ynstr.2016. 11.005 .

Honeycutt JA, Demaestri C, Peterzell S, et al. Altered corticolimbic connectivity reveals sex-specific adolescent outcomes in a rat model of early life adversity. Elife . 2020;9:e52651. doi: 10.7554/eLife.52651 .

Weyandt LL, Clarkin CM, Holding EZ, et al. Neuroplasticity in children and adolescents in response to treatment intervention: a systematic review of the literature. Clin Transl Neurosci . 2020;4(2):2514183X2097423. doi: 10.1177/2514183X20974231 .

Jackson-Morris A, Meyer CL, Morgan A, et al. An investment case analysis for the prevention and treatment of adolescent mental disorders and suicide in England. Eur J Public Health . 2024;34(1):107-113 .

Strickland JC, Victor G, Ray B. Perception of resource allocations to address the opioid epidemic. J Addict Med . 2024;34(5):107-113. doi: 10.1093/eurpub/ckad193 .

Gyamfi S, Boakye P, Giannotti N, et al. Understanding the multi-faceted nature of the public stigma of mental illness: insights and implications from a structural violence perspective. Int J Ment Health Nurs . 2025;34(4):e70121. doi: 10.1111/inm. 70121 .

Murthy RS. National mental health survey of India 2015-2016. Indian J Psychiatry . 2017;59(1):21-26. doi: 10.4103/psychiatry.IndianJPsychiatry10217 .

Phillips M, Zhang J, Shi Q, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey. Lancet . 2009;373(9680):2041-2053. doi: 10.1016/s0140-6736(09)60660-7 .

Rocco L, Fumagalli E, Mirelman AJ, et al. Mortality, morbidity and economic growth. PLoS One . 2021;16(5):e0251424. doi: 10.1371/journal.pone.0251424 .

Reuter P, Mcginnis S, Reuter KE. Public health professionals' perceptions of mental health services in Equatorial Guinea, Central-West Africa. Pan Afr Med J . 2016;25:236. doi: 10.11604/pamj.2016.25.236.10639 .

Zhang ZY, Han SK, Ma X, et al. Disease burden of drug use disorders in the Chinese po pulation from 1990 to 2021 and trend projection from 2022 to 2046. Chin Gen Pract . 2026;29(8):1069-1076 in Chinese .

Zhao XW, Fang C. Comparative analysis of disease burden and trends of drug use disorders in China and the United States from 1990 to 2021. J Air Force Med Univ . 2026:1-16[2026-07-20 ] . https://link.cnki.net/urlid/61.1526.R.20260304.1049.006 Chinese.

浏览量

Downloads

Scopus

文章被引用时，请邮件提醒。

Submit

关联资源

A predictive model for heart failure in patients with hypertension and persistent atrial fibrillation: A retrospective single-center study

Gu Fangzhou: A monument to polio elimination in China

Continuous wound infiltration with local anesthetics in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis

Dedication to a lifelong mission: Gu Fangzhou and the Chinese road to polio elimination

Post-traumatic dementia: Advances in understanding neurodegenerative mechanisms