{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T19:16:23Z","timestamp":1772133383696,"version":"3.50.1"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study outlines the changes in the age- and sex-specific burden of motor neuron disease (MND) in China from 1990 to 2021, focusing on the prevalence, incidence, number of disability-adjusted life years and mortality. Additionally, these trends are evaluated in comparison to the Global Burden of Disease data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Public data from the Global Burden of Disease database covering the period from 1990 to 2021 were analyzed to explore the burden of motor neuron disease in China and worldwide. Trends in prevalence, incidence, disability-adjusted life years (DALYs) and mortality were examined in the analysis. The average annual percentage change was calculated using Joinpoint, and the relevant 95% confidence intervals (95% CIs) were examined to identify changes in the MND burden over time. Additionally, a thorough comparative analysis was performed to investigate the differences in the MND burden between China and other regions worldwide, considering factors such as age, sex, and time periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1990 to 2021, the age-standardized incidence rate (ASIR) of motor neuron disease (MND) in China declined from 0.65 per 100,000 to 0.46 per 100,000, whereas the global ASIR decreased slightly from 0.81 per 100,000 to 0.77 per 100,000. In contrast, the age-standardized prevalence rate (ASPR) in China increased from 2.131 per 100,000 to 2.298 per 100,000, whereas the global ASPR decreased slightly from 3.356 per 100,000 to 3.31 per 100,000. The age-standardized mortality rate (ASMR) in China increased from 0.151 per 100,000 to 0.181 per 100,000; the global ASMR also increased from 0.38 per 100,000 to 0.46 per 100,000 during this period. Moreover, the age-standardized disability-adjusted life year (ASDR) rate in China decreased slightly from 7.995 per 100,000 to 7.672 per 100,000, whereas the global ASDR increased from 11.221 per 100,000 to 12.167 per 100,000. The average annual percentage changes (AAPCs) for the ASPR, ASIR, ASDR, and ASMR in China were \u22121.10%, 0.25%, 0.57%, and \u22120.14%, respectively. In contrast, the global AAPCs were \u22120.16%, \u22120.04%, 0.58%, and 0.26%, respectively. Age and sex played distinct roles in shaping MND burden. The ASIR of MND decreased but then increased for both sexes, remaining higher for males. Its ASPR trends differed: a slight increase in males versus an increase then decrease in females. While the ASMR was consistently higher for males, the DALYs for males started to decrease but surpassed those for females. Global MND rates have remained stable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence, incidence, DALYs and mortality of motor neuron disease in China decreased between 1990 and 2021, suggesting a relative decrease in the total burden of MND in the country. Age influences the burden of MND, with a higher occurrence incidence in children and middle-aged individuals; the prevalence of MND is highest in the younger population, whereas MND-related mortality is the highest within the middle-aged and senior populations. Compared with females, males are more likely to be affected by MND and have a greater likelihood of death. Given the rapid population aging in China, MND is expected to remain a significant public health issue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0343818","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T18:37:06Z","timestamp":1772131026000},"page":"e0343818","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis and comparison of the trends in the burden of motor neuron disease in China and worldwide from 1990 to 2021"],"prefix":"10.1371","volume":"21","author":[{"given":"Yanan","family":"Fu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"YuXin","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ZiKun","family":"Pang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9234-3654","authenticated-orcid":true,"given":"XinGang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"issue":"11","key":"pone.0343818.ref001","doi-asserted-by":"crossref","first-page":"5475","DOI":"10.1007\/s00415-023-11888-8","article-title":"Presymptomatic geographical distribution of ALS patients suggests the involvement of environmental factors in the disease pathogenesis","volume":"270","author":"R Vasta","year":"2023","journal-title":"J Neurol"},{"issue":"1","key":"pone.0343818.ref002","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13024-025-00890-5","article-title":"Entering the era of precision medicine to treat amyotrophic lateral sclerosis","volume":"20","author":"F Theunissen","year":"2025","journal-title":"Mol Neurodegener"},{"key":"pone.0343818.ref003","doi-asserted-by":"crossref","first-page":"103732","DOI":"10.1016\/j.ebiom.2021.103732","article-title":"Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis","volume":"74","author":"W-M Su","year":"2021","journal-title":"EBioMedicine"},{"issue":"12","key":"pone.0343818.ref004","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/S1474-4422(18)30404-6","article-title":"Global, regional, and national burden of motor neuron diseases 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"17","author":"GBD 2016 Motor Neuron Disease Collaborators","year":"2018","journal-title":"Lancet Neurol"},{"issue":"5","key":"pone.0343818.ref005","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/WCO.0000000000000730","article-title":"Epidemiology of amyotrophic lateral sclerosis: an update of recent literature","volume":"32","author":"E Longinetti","year":"2019","journal-title":"Curr Opin Neurol"},{"issue":"3","key":"pone.0343818.ref006","doi-asserted-by":"crossref","first-page":"391","DOI":"10.3934\/Neuroscience.2025021","article-title":"Rethinking ALS: Current understanding and emerging therapeutic strategies","volume":"12","author":"ASPM Arachchige","year":"2025","journal-title":"AIMS Neurosci"},{"issue":"8","key":"pone.0343818.ref007","doi-asserted-by":"crossref","first-page":"5541","DOI":"10.1007\/s00415-024-12513-y","article-title":"Clinical and genetic characteristics of 1672 cases of amyotrophic lateral sclerosis in China: a single-center retrospective study","volume":"271","author":"D Shen","year":"2024","journal-title":"J Neurol"},{"key":"pone.0343818.ref008","doi-asserted-by":"crossref","first-page":"114774","DOI":"10.1016\/j.jep.2021.114774","article-title":"China amyotrophic lateral sclerosis registry of patients with Traditional Chinese Medicine (CARE-TCM): Rationale and design","volume":"284","author":"Y Song","year":"2022","journal-title":"J Ethnopharmacol"},{"issue":"7","key":"pone.0343818.ref009","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1080\/01616412.2022.2029292","article-title":"Survival analysis of clinical and genetic factors in an amyotrophic lateral sclerosis cohort from China","volume":"44","author":"Z Cai","year":"2022","journal-title":"Neurol Res"},{"issue":"10","key":"pone.0343818.ref010","doi-asserted-by":"crossref","first-page":"4922","DOI":"10.1007\/s00415-023-11811-1","article-title":"Economic evaluation of Motor Neuron Diseases: a nationwide cross-sectional analysis in Germany","volume":"270","author":"F Heinrich","year":"2023","journal-title":"J Neurol"},{"key":"pone.0343818.ref011","article-title":"Global, regional, and National Burden of chronic kidney disease attributable to dietary risks from 1990 to 2021","volume":"12","author":"K Wang","year":"2025","journal-title":"Front Nutr"},{"issue":"10440","key":"pone.0343818.ref012","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global 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","volume":"403","author":"GBD 2021 Diseases and Injuries Collaborators","year":"2024","journal-title":"Lancet"},{"key":"pone.0343818.ref013","doi-asserted-by":"crossref","first-page":"994619","DOI":"10.3389\/fpubh.2022.994619","article-title":"Long-term trends in the burden of inflammatory bowel disease in China over three decades: A joinpoint regression and age-period-cohort analysis based on GBD 2019","volume":"10","author":"Y Zhang","year":"2022","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0343818.ref014","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1186\/s12889-021-11401-8","article-title":"Trends in cervical cancer mortality in China from 1989 to 2018: an age-period-cohort study and Joinpoint analysis","volume":"21","author":"M Guo","year":"2021","journal-title":"BMC Public Health"},{"issue":"10","key":"pone.0343818.ref015","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1002\/cac2.12197","article-title":"Cancer incidence, mortality, and burden in China: a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020","volume":"41","author":"H Qiu","year":"2021","journal-title":"Cancer Commun (Lond)"},{"key":"pone.0343818.ref016","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.envres.2016.11.023","article-title":"Motor neuron disease mortality and lifetime petrol lead exposure: Evidence from national age-specific and state-level age-standardized death rates in Australia","volume":"153","author":"S Zahran","year":"2017","journal-title":"Environ Res"},{"issue":"10","key":"pone.0343818.ref017","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(20)30190-0","article-title":"The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017","volume":"5","author":"G Deuschl","year":"2020","journal-title":"Lancet Public Health"},{"issue":"1","key":"pone.0343818.ref018","doi-asserted-by":"crossref","first-page":"2399962","DOI":"10.1080\/07853890.2024.2399962","article-title":"Clinical features and progress in diagnosis and treatment of amyotrophic lateral sclerosis","volume":"56","author":"D Yuan","year":"2024","journal-title":"Ann Med"},{"issue":"4","key":"pone.0343818.ref019","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1002\/jgc4.1691","article-title":"Current attitudes toward carrier screening for spinal muscular atrophy among pregnant women in Eastern China","volume":"32","author":"Y Li","year":"2023","journal-title":"J Genet Couns"},{"issue":"10293","key":"pone.0343818.ref020","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1016\/S0140-6736(20)32708-2","article-title":"A Lancet Commission on 70 years of women\u2019s reproductive, maternal, newborn, child, and adolescent health in China","volume":"397","author":"J Qiao","year":"2021","journal-title":"Lancet"},{"issue":"1","key":"pone.0343818.ref021","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/bmb\/ldae010","article-title":"New developments in the diagnosis and management of motor neuron disease","volume":"152","author":"D O\u2019Brien","year":"2024","journal-title":"Br Med Bull"},{"issue":"8","key":"pone.0343818.ref022","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1038\/s41583-024-00829-7","article-title":"Gene therapy for CNS disorders: modalities, delivery and translational challenges","volume":"25","author":"J Gao","year":"2024","journal-title":"Nat Rev Neurosci"},{"key":"pone.0343818.ref023","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41434-022-00349-y","article-title":"Curing SMA: Are we there yet?","volume":"30","author":"A Reilly","year":"2023","journal-title":"Gene Ther"},{"issue":"12","key":"pone.0343818.ref024","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1038\/s41588-021-00973-1","article-title":"Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology","volume":"53","author":"W van Rheenen","year":"2021","journal-title":"Nat Genet"},{"issue":"5","key":"pone.0343818.ref025","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1093\/brain\/awac470","article-title":"Physical activity as an exogenous risk factor for amyotrophic lateral sclerosis: a review of the evidence","volume":"146","author":"L Chapman","year":"2023","journal-title":"Brain"},{"key":"pone.0343818.ref026","doi-asserted-by":"crossref","first-page":"864339","DOI":"10.3389\/fneur.2022.864339","article-title":"The Global Burden of Motor Neuron Disease: An Analysis of the 2019 Global Burden of Disease Study","volume":"13","author":"J Park","year":"2022","journal-title":"Front Neurol"},{"issue":"10","key":"pone.0343818.ref027","doi-asserted-by":"crossref","first-page":"6508","DOI":"10.1007\/s00415-024-12657-x","article-title":"Narrative review of diagnosis, management and treatment of dysphagia and sialorrhea in amyotrophic lateral sclerosis","volume":"271","author":"B Bjelica","year":"2024","journal-title":"J Neurol"},{"issue":"1","key":"pone.0343818.ref028","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/ene.14499","article-title":"Incidence of motor neuron disease\/amyotrophic lateral sclerosis in South Africa: a 4-year prospective study","volume":"28","author":"F Henning","year":"2021","journal-title":"Eur J Neurol"},{"issue":"10","key":"pone.0343818.ref029","doi-asserted-by":"crossref","DOI":"10.1111\/ene.70382","article-title":"Diagnostic and Prognostic Value of Blood and Cerebrospinal Fluid Biomarkers in Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis","volume":"32","author":"K Obara","year":"2025","journal-title":"Eur J Neurol"},{"key":"pone.0343818.ref030","doi-asserted-by":"crossref","first-page":"298409","DOI":"10.1155\/2015\/298409","article-title":"Motor Neuron Diseases in Sub-Saharan Africa: The Need for More Population-Based Studies","volume":"2015","author":"E Quansah","year":"2015","journal-title":"Biomed Res Int"},{"issue":"6","key":"pone.0343818.ref031","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000207474","article-title":"Global Prevalence and Incidence of Amyotrophic Lateral Sclerosis: A Systematic Review","volume":"101","author":"C Wolfson","year":"2023","journal-title":"Neurology"},{"issue":"5","key":"pone.0343818.ref032","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/WCO.0000000000001415","article-title":"Heterogeneity of frequencies of motor neuron disease across ethnicities and geographical areas: focus on Arabic countries in the Mediterranean area","volume":"38","author":"G Logroscino","year":"2025","journal-title":"Curr Opin Neurol"},{"issue":"5","key":"pone.0343818.ref033","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1159\/000516752","article-title":"Estimated Prevalence and Incidence of Amyotrophic Lateral Sclerosis and SOD1 and C9orf72 Genetic Variants","volume":"55","author":"CA Brown","year":"2021","journal-title":"Neuroepidemiology"},{"issue":"3","key":"pone.0343818.ref034","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s00415-025-12975-8","article-title":"Advancements in genetic research and RNA therapy strategies for amyotrophic lateral sclerosis (ALS): current progress and future prospects","volume":"272","author":"P Ruffo","year":"2025","journal-title":"J Neurol"},{"issue":"14","key":"pone.0343818.ref035","doi-asserted-by":"crossref","first-page":"11732","DOI":"10.3390\/ijms241411732","article-title":"Frontotemporal Dementia, Where Do We Stand? A Narrative Review","volume":"24","author":"A Antonioni","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"10","key":"pone.0343818.ref036","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1111\/ene.14393","article-title":"Amyotrophic lateral sclerosis: a clinical review","volume":"27","author":"P Masrori","year":"2020","journal-title":"Eur J Neurol"},{"key":"pone.0343818.ref037","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.brainres.2018.02.035","article-title":"The epidemiology and genetics of Amyotrophic lateral sclerosis in China","volume":"1693","author":"X Liu","year":"2018","journal-title":"Brain Res"},{"issue":"5","key":"pone.0343818.ref038","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1097\/WCO.0000000000001421","article-title":"Amyotrophic lateral sclerosis in Mainland China: clinical translational challenges and opportunities","volume":"38","author":"J He","year":"2025","journal-title":"Curr Opin Neurol"},{"key":"pone.0343818.ref039","doi-asserted-by":"crossref","first-page":"102228","DOI":"10.1016\/j.arr.2024.102228","article-title":"Sex biology in amyotrophic lateral sclerosis","volume":"95","author":"A Zamani","year":"2024","journal-title":"Ageing Res Rev"},{"issue":"10","key":"pone.0343818.ref040","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1038\/s41582-023-00867-2","article-title":"The amyotrophic lateral sclerosis exposome: recent advances and future directions","volume":"19","author":"SA Goutman","year":"2023","journal-title":"Nat Rev Neurol"},{"issue":"1","key":"pone.0343818.ref041","doi-asserted-by":"crossref","first-page":"287","DOI":"10.3390\/jcm15010287","article-title":"Establishing Diagnostic and Differential Diagnostic Criteria for Amyotrophic Lateral Sclerosis","volume":"15","author":"E Dziadkowiak","year":"2025","journal-title":"J Clin Med"},{"issue":"11","key":"pone.0343818.ref042","doi-asserted-by":"crossref","first-page":"6330","DOI":"10.1007\/s12035-023-03472-y","article-title":"The Molecular Link Between TDP-43, Endogenous Retroviruses and Inflammatory Neurodegeneration in Amyotrophic Lateral Sclerosis: a Potential Target for Triumeq, an Antiretroviral Therapy","volume":"60","author":"M Dubowsky","year":"2023","journal-title":"Mol Neurobiol"},{"issue":"9","key":"pone.0343818.ref043","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1038\/s41576-023-00592-y","article-title":"Amyotrophic lateral sclerosis: translating genetic discoveries into therapies","volume":"24","author":"F Ak\u00e7imen","year":"2023","journal-title":"Nat Rev Genet"},{"key":"pone.0343818.ref044","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1177\/10430342251372898","article-title":"Targeting Amyotrophic Lateral Sclerosis with Gene Therapy: From Silencing Genes to Enhancing Neuroprotection","volume":"36","author":"S Verd\u00e9s","year":"2025","journal-title":"Hum Gene Ther"},{"issue":"6","key":"pone.0343818.ref045","doi-asserted-by":"crossref","first-page":"2743","DOI":"10.1002\/jcsm.13618","article-title":"Prognostic Value of Systemic Inflammation, Nutritional Status and Sarcopenia in Patients With Amyotrophic Lateral Sclerosis","volume":"15","author":"Y Zhu","year":"2024","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"5","key":"pone.0343818.ref046","doi-asserted-by":"crossref","first-page":"937","DOI":"10.3233\/JND-230054","article-title":"Identifying Biomarkers of Spinal Muscular Atrophy for Further Development","volume":"10","author":"J Glascock","year":"2023","journal-title":"J Neuromuscul Dis"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343818","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T18:37:13Z","timestamp":1772131033000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343818"}},"subtitle":[],"editor":[{"given":"Masoud","family":"Rahmati","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0343818","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}