Socio-ecological determinants of neurological disease Burden: A hospital-based cross-sectional study in Medan, Indonesia

Background: Neurological diseases represent a significant and growing global health burden, particularly in Low- and Middle-Income Countries (LMICs) like Indonesia, where data for effective health planning is scarce. This study aimed to analyze the socio-ecological determinants contributing to the neurological disease burden at a tertiary referral hospital in Medan, Indonesia. Methods: A hospital-based cross-sectional study was conducted at dr. Pirngadi Hospital, Medan. A sample of 500 elderly patients was selected through purposive sampling. Data on six latent variables (access, education, environment, lifestyle, social factors, and neurological disease burden) were collected using a validated questionnaire with a Likert scale and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). Results: The analysis revealed that lifestyle was the most dominant predictor of neurological disease burden (β = 0.663, p = 0.000). Access to health services (β = 0.194, p = 0.000) and social factors (β = 0.093, p = 0.012) also showed a significant but more moderate influence. Conversely, education (p = 0.236) and environment (p = 0.308) did not have a significant direct effect on the neurological disease burden. Conclusion: Lifestyle is the most critical determinant of neurological disease burden in this population. These findings strongly suggest a need for a paradigm shift in health policy from curative-focused approaches to preventive strategies that prioritize the promotion of healthy lifestyles to effectively mitigate the rising burden of neurological disorders.