Cross-country inequalities and trends in the global burden of COVID- 19-induced Guillain-Barré syndrome, 2020 to 2021: a population-based study

Background : This groundbreaking study is the first to meticulously analyze the disability burden of COVID-19-induced Guillain-Barré Syndrome (GBS) in 204 countries and regions from 2020 to 2021, with a detailed breakdown by etiology, age, sex, and socio-demographic index (SDI). Methods : We estimated the distribution of GBS patients by age and sex in each region due to COVID-19 infection from 2020 to 2021. Next, we assessed the burden of COVID-19-induced GBS by prevalence and the related years lived with disability (YLDs). Subsequently, we applied two recommended metrics of absolute and relative gradient inequality as recommended by the World Health Organization (WHO) - the concentration index and the inequality slope index - to quantify the distribution inequality of the COVID-19-induced GBS burden. Furthermore, we utilized frontier analysis as a quantitative approach to determine the achievable minimum age-standardized YLD rate, in accordance with the development status gauged by the socio-demographic index (SDI). Results : In 2021, there were 306,289 cases of COVID-19-induced GBS globally [95% uncertainty interval (UI): 236,557 to 377,083], resulting in 90,619 YLDs [95% UI: 56,631 to 136,617]. Compared to 2020, the global age-standardized prevalence rate of COVID-19-induced GBS per 100,000 people increased by 3% in 2021. The highest and lowest age-standardized incidence rates were in Central Sub-Saharan Africa and East Asia, respectively (per 100,000 people). Nationally, Iraq [9.64 (95% UI: 5.93 to 12.82)] and China [0 (95% UI: 0 to 0)] had the highest and lowest age-standardized incidence rates, respectively (per 100,000 people). The age-standardized burden of COVID-19-induced GBS generally increased with age, peaking in the 10-14 age group. In all age groups, males experienced a higher disease burden than females. According to a series of disease analyses using the SDI: descriptive analysis showed a negative correlation between the incidence of COVID-19-induced GBS and SDI; cross-country inequality analysis indicated that the incidence and YLDs of COVID-19-induced GBS were predominantly from countries with low SDI, though this inequality is diminishing. Conclusions : Compared to 2020, the burden of COVID-19-induced GBS has significantly increased. It is crucial to consider targeted interventions, focusing on improving diagnosis and treatment in specific populations and regions.