Global inequalities in epilepsy of genetic or unknown cause: Mortality–disability divergence across socio‐demographic settings, 1990–2023

Abstract Aims To quantify global, long‐term trends in epilepsy of genetic/unknown cause, defined as “idiopathic epilepsy” in the Global Burden of Disease (GBD) framework, assessing how mortality, disability, and their balance have evolved across socio‐demographic settings from 1990 to 2023. Methods Using GBD 2023 estimates for 1990–2023, we analyzed age‐standardized disability‐adjusted life years (DALYs), years of life lost (YLL), and years lived with disability (YLD) across the five Socio‐demographic Index (SDI) categories. Temporal patterns were examined descriptively and through segmented regression to identify SDI‐specific breakpoints. Long‐term changes were quantified using Estimated Annual Percentage Change (EAPC). Differences across SDI strata were assessed using interaction models. The mortality–disability balance was evaluated using the YLL/YLD ratio, modeled on the log scale with year, SDI, and their interaction. Results DALY and YLL rates declined across all SDI groups, with steeper reductions in High‐middle and High SDI. YLD rates showed smaller declines, with a modest SDI gradient. EAPCs confirmed consistent socioeconomic differences: declines were modest in Low, Low‐middle, and Middle SDI but nearly doubled in High‐middle and High SDI. The YLL/YLD ratio decreased during the 1990s and early 2000s but increased again in recent years in Low SDI. Log‐linear modeling showed significantly lower baseline ratios in all higher‐SDI groups and steeper long‐term improvements in High‐middle and High SDI. Conclusions Global inequalities in epilepsy persist, driven primarily by divergent mortality patterns. Higher‐SDI settings show faster improvements, especially in mortality‐related outcomes, whereas Low‐SDI regions face stagnation or reversal in mortality trends despite relatively stable disability patterns.