Comparative trends in idiopathic epilepsy burden in China and worldwide based on Global Burden of Disease Study 2021

Background Idiopathic epilepsy, defined by the absence of identifiable structural or metabolic etiologies, remains a significant contributor to the global neurological disease burden. However, long-term comparisons between China and the global level are limited. This study analyzed and compared trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of idiopathic epilepsy between China and the global level from 1990 to 2021, and included predictive analysis of future trends. Methods The key metrics including incidence, prevalence, mortality, and DALYs, along with their corresponding age-standardized rates, were extracted and analyzed. Joinpoint regression was employed to assess temporal trends, Bayesian age-period-cohort models were used for future projections, and decomposition analysis quantified the contributions of population growth, population aging, and epidemiological changes. Results From 1990 to 2021, both China and the world showed increasing trends in incidence and prevalence. In contrast, DALYs and mortality decreased significantly, with China showing a more pronounced decline (AAPC: −1.790%; −2.649%) than the global level (AAPC: −0.525%; −0.535%). Decomposition analysis revealed that epidemiologic changes played a greater role in China's DALY and mortality reductions. Projection analysis suggested continued increases in incidence and prevalence, but ongoing declines in DALYs and mortality by 2045, especially in China. Discussion The burden of idiopathic epilepsy has evolved differently in China compared with global trends, with China experiencing a more substantial reduction in disease severity and mortality. These findings highlight the need for targeted prevention strategies and health system enhancements tailored to specific demographic and epidemiological profiles.