117. The Global Burden of Neural Tube Defects and Disparities in Neurosurgical Care

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Authors: Alex Yacov; Chris Carr, MD, MPH; Jake Foote, BS; Aaron Dumont (New Orleans, LA)


Neural tube defects (NTDs) are among the most significant causes of pediatric morbidity and mortality worldwide. Despite the success of folic acid fortification campaigns, they continue to occur. The definitive treatment of NTDs is neurosurgical and lacking in low-income nations. To examine their global burden and identify disparities in access to neurosurgical treatment for NTDs, we analyzed Global Burden of Disease Study (GBD) data. We hypothesized that poor nations would have the highest disease burden.


We abstracted GBD data for deaths and years lived with disability (YLD) from NTDs for 195 nations in 2007 and 2017. GDP in 2015 was obtained from the Global Health Data Exchange. Nations were grouped by UN geoscheme. Data regarding folic acid fortification programs were obtained from the Food Fortification Initiative. The Healthcare Access and Quality Index was used to rate healthcare for each nation in 2000 and 2016. Histograms were constructed to visualize relationships.


20 of the 20 nations (100%) with the most deaths and 16 of the 20 (80%) with the highest YLD due to NTDs in 2017 were in the lowest 2 GDP quartiles. 13 of the 20 nations (65%) with the highest deaths and 11 of the 20 (55%) with the highest YLD have documented folic acid fortification programs. 5 of the 20 (25%) regions with the highest burden were in Africa, 3 (15%) were in Asia, and 2 (10%) were in Oceania. 


Low-income nations share a disproportionate disease burden from NTDs, with African and Asian regions most affected. Large burdens exist even in countries with documented folic acid fortification programs, a finding that highlights the need for definitive neurosurgical treatment worldwide. Unfortunately, this care is often deficient where it is needed most. The global neurosurgical community should be aware of and address these disparities.