Global, regional, and national burdens of late-onset epilepsy in adults aged 65 years and older from 1990 to 2021: A population-based study

Objective: Epilepsy remains one of the most widespread and severe neurological disorders worldwide. This study aims to evaluate the burden of late-onset epilepsy (LOE) and investigate its temporal trends and inequalities among older adults at global, regional, and national scales between 1990 and 2021. Methods: This analysis utilizes data from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Temporal trends in the age-standardized prevalence rate (ASPR), incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years (DALYs) rate for LOE were quantified through the calculation of average annual percentage change over the study period. Results: In 2021, the global ASPR and ASIR of LOE in adults aged 65 and older were estimated at 472.74 (95% UI: 332.21 to 654.96) and 33.12 (95% UI: 18.68 to 50.29) per 100,000 population, respectively. The global ASMR was 4.76 per 100,000 population (95% UI: 3.80 to 5.26), while the age-standardized DALYs rate reached 189.08 per 100,000 population (95% UI: 137.47 to 259.90). Among the five sociodemographic index (SDI) regions, high-SDI areas exhibited the greatest ASPR, ASIR, ASMR, and age-standardized DALY rate, whereas high-middle SDI regions reported the lowest. Geospatially, Andean Latin America recorded the highest ASPR, while Western Europe reported the highest ASIR. The highest ASMR and age-standardized DALY rate were observed in Central and Eastern Sub-Saharan Africa, respectively. Among 204 countries, Equatorial Guinea displayed the highest ASPR, while Germany had the highest ASIR. Notably, Zambia exhibited both the highest ASMR and age-standardized DALY rate for LOE. However, the inequalities associated with the SDI across countries gradually diminished over time. Conclusions: The study suggest that regions with high SDI continued to experience elevated ASPR, ASIR, ASMR, and age-standardized DALY rates. These findings highlight the importance of integrating LOE care into health systems, particularly for adults aged 65 years and older.