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

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.