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ISSN: 0138-7103 | RNPS: 2030
Original
Mortality due to Neurodegenerative Diseases in
Ecuadorian Adults
Mortalidad por enfermedades neurodegenerativas en
adultos ecuatorianos
José Alejandro Valdevila Figueira1,2,3*
María Alejandra Espinosa de los Monteros Andrade4,5
Xavier Rodrigo Yambay-Bautista6
Rocío Valdevila Santiesteban3
Indira Dayana Carvajal Parra1,3
Pedro Martínez-Suarez3,7
María José Pico Cucalon1,3
1Instituto de Neurociencias de Guayaquil, Ecuador
2Universidad Ecotec, Km. 13.5. Samborondón, EC092302, Ecuador.
3Red de Investigación en Psicología y Psiquiatría (RIPYP), Ecuador
4Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Ecuador
5Departamento de Investigación Hospitalaria, Hospital Alfredo G. Paulson, Junta de Beneficencia, Guayaquil, Ecuador.
6Universidad Católica de Cuenca, Unidad Académica de Salud y Bienestar, Ecuador.
7Universidad Internacional de la Rioja, España
Recibido: 26/09/2025
Aceptado:19/10/2025
Editor: Arturo Chi Maimó, Magdalena Sosa
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Abstract
Introduction: Neurodegenerative diseases have a variety of debilitating signs which can lead
to death. Individuals affected by this group of pathologies show higher mortality rates than
those with general and nervous system diseases.
Objective: Describe the epidemiological profile of deaths due to neurodegenerative diseases
in Ecuadorian adults in 2023.
Methods: A descriptive study using mortality data from the National Institute of Statistics
and Census (INEC, Spanish acronym). The mean, median, standard deviation, skewness and
kurtosis were calculated according to age and sex.
Results: The percentage of deaths was higher in women (56 %) than in men. The median age
was 85 years, and the predominant age group was 81-90 years (40.9 %). 69% of deaths
occurred at home. Most of the deceased had a low educational level (70%). 537 were married,
and 402 were widowed. 48% lived in the two most populated provinces of the country
(Pichincha, n = 431, and Guayas, n = 210). Alzheimer's disease/dementia was the leading
cause of death in both sexes. The 81-90 age group was the most affected (9.4 % for men and
13.8 % for women).
Conclusion: High mortality rates due to dementia/Alzheimer's disease and Parkinson's
disease were found among adults of both sexes, primarily in the 81-90 age group. The most
populated provinces had the highest number of deaths. Deaths were more frequent among
men and in older age groups, with an increasing trend starting at age 80.
Keywords: Parkinson's disease, Alzheimer's disease, neurodegenerative disease, mortality
Resumen
Introducción: las enfermedades neurodegenerativas presentan una variedad de
manifestaciones debilitantes que pueden conducir a la muerte. Las personas afectadas por
este grupo de patologías muestran tasas de mortalidad más altas que aquellas con otras
enfermedades generales y del sistema nervioso.
Objetivo: describir el perfil epidemiológico de las muertes por enfermedades
neurodegenerativas en adultos ecuatorianos durante 2023.
Método: estudio descriptivo utilizando datos de mortalidad del Instituto Nacional de
Estadística y Censos (INEC). Se calcularon la media, mediana, desviación estándar, asimetría
y curtosis según edad y sexo.
Resultados: el porcentaje de muertes fue mayor en mujeres (56 %) que en hombres. La edad
mediana fue de 85 años, y el grupo etario predominante fue de 81 a 90 años (40,9 %). El 69 %
de las muertes ocurrieron en el domicilio. La mayoría de los fallecidos tenía un nivel
educativo bajo (70 %). De ellos, 537 eran casados y 402 viudos. El 48 % residía en las dos
provincias más pobladas del país (Pichincha, n = 431, y Guayas, n = 210). La enfermedad de
Alzheimer/demencia fue la principal causa de muerte en ambos sexos. El grupo de 81 a 90
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años fue el más afectado (9,4 % en hombres y 13,8 % en mujeres). Conclusión: se
encontraron altas tasas de mortalidad por demencia/enfermedad de Alzheimer y enfermedad
de Parkinson en adultos de ambos sexos, principalmente en el grupo de 81 a 90 años. Las
provincias más pobladas concentraron el mayor número de fallecimientos. Las muertes
fueron más frecuentes en hombres y en los grupos de mayor edad, con una tendencia
creciente a partir de los 80 años.
Palabras clave: enfermedad de Parkinson, enfermedad de Alzheimer, enfermedad
neurodegenerativa, mortalidad
Introduction
In 2021, more than 3 thousand million people worldwide were living with a neurological
condition.(1) Currently, neurological conditions are the leading cause of poor health and
disability globally, with an 18 % increase in the total volume of disability, disease, and
premature death (DALY) since 1990.(2) This data indicates that the increase in absolute
figures is mainly due to demographic changes and the increase in human lifespan. (3) More
than 80% of deaths and poor health due to neurological causes occur in low- and middle-
income countries (LMICs), where access to timely and appropriate treatment is limited.(4)
Neurodegenerative diseases (ND) represent one of the most pressing challenges for
healthcare systems in the 21st century. These conditions, characterized by the progressive
loss of function and structure of neurons, include diseases such as Alzheimer’s disease,
Parkinson’s disease, amyotrophic lateral sclerosis (ALS), frontotemporal dementia, among
others.(5) Their prevalence and mortality have been increasing, largely due to the aging of the
global population.(1)
Neurodegenerative diseases not only affect quality of life but are also among the leading
causes of death in many developed countries. For example, Alzheimer’s disease and other
dementias rank 7th in the list of global causes of death according to the World Health
Organization.(6) In countries such as the United States and the United Kingdom, deaths
attributed to NDs have increased significantly in recent decades, particularly among those
over 75 years old.(7-9) In most cases, these diseases have a chronic and irreversible course,
culminating in complications such as infections, severe falls, or multisystemic organ
deterioration.(10)
The mortality associated with these diseases is influenced by factors such as advanced age,
which is the main risk factor. As life expectancy increases, so does the incidence of NDs.
(11,12) Additionally, comorbidities such as diabetes, cardiovascular diseases, and respiratory
diseases worsen the course of NDs, increasing the risk of premature death.(13,14) In many cases,
death does not directly result from the neurological disease itself, but from its consequences,
such as aspiration pneumonia, pressure ulcers, or systemic infections.(15)
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The lack of early diagnosis also becomes a negative factor, as diagnoses are often made in
advanced stages, when medical intervention and support are already limited.(16) The treatment
of NDs involves high economic and human costs.(17)
Regions with higher socioeconomic levels, such as Europe, have surprisingly high mortality
rates from NDs compared to other countries, posing a heavy burden on both individuals and
society.(18) Among deaths due to NDs, dementia and Parkinson’s disease (PD) are particularly
linked to the increase in population longevity.(19,20) In 2021, dementia and PD were among the
top 10 NDs contributing most to health loss. However, it is important to note that other
factors, such as changes in exposure to risk factors, improvements in diagnostics,
multidisciplinary treatments, and the quality of health records may also influence the
observed trend.(21)
Currently, research on NDs has mainly focused on their pathogenesis, diagnosis, treatment,
and other medical techniques.(22) Previous studies found significant increases in ND mortality
worldwide from the start of the century until 2023.(23) Examples of countries with this
phenomenon include Iceland, Finland, Malta, and Croatia,(24) as well as the United States.(1,25)
In contrast, China showed a decreasing trend in ND mortality from 1990 to 2019 and is likely
to continue decreasing between 2020 and 2030.(26)
According to recent data from the World Health Organization (WHO) published in 2020,
deaths caused by AD/Dementias in Ecuador reached 2,565 (3.59 % of all deaths) [27,28]. The
age-adjusted mortality rate was 14.34 per 100,000 inhabitants, ranking Ecuador 140th in the
world. However, regardless of the relevance of NDs in Latin American populations, Ecuador
has not had a reliable registry for these diseases. For this reason, this manuscript shows the
most up-to-date epidemiology in Ecuador on deaths from NDs, with the goal of generating
collaborations to improve diagnosis and treatment due to the increase in the life expectancy of
the population.
Methodology
Study design
A retrospective observational study with a quantitative approach, which consisted of the
analysis of secondary data from the death registry in Ecuador published by the National
Institute of Statistics and Census (INEC, Spanish acronym), from January 1 to December 31,
2023 (n = 84,774).
Data sources
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The data used were obtained from the INEC death reports, which include the cause of death,
coded according to the International Classification of Diseases, 10th revision (ICD-10) [29],
and sociodemographic information of the deceased individuals (age, sex, place of death, self-
identified ethnicity, education level, province of residence, and marital status).
Study population
The data from 1,353 death records of individuals over 18 years old due to NDs were analyzed:
Alzheimer's Disease/Dementias (AD/D) (n = 908), Parkinson’s Disease (PD) (n = 284),
Primary Muscle Disorders (PMD) (n = 22), Huntington's Disease (HD) (n = 9), Cerebellar
Ataxia (n = 8), Multiple Sclerosis (MS) (n = 16), and Other (Central Nervous System
Demyelinating Disease (CNSDD), Spinal Muscular Atrophy and Related Syndromes
(SMARS), Creutzfeldt-Jakob Disease (CJD), Other Neurodegenerative Diseases Not
Classified Elsewhere (ONDNE), and Other Neurodegenerative Diseases of the Basal Nuclei
(ONDB) (n = 106).
Statistical analysis
The extracted information was analyzed using the statistical package Jamovi® v.2.3.28, and
the results are shown in tables and figures for better understanding. The primary outcome of
the study was the percentage of deaths for each ND by sex, age, and geographic region. The
analysis of sociodemographic characteristics and deaths from NDs was reflected in
frequencies and percentages. Descriptive statistics were used, focusing on age and its
distribution by sex (mean, median, standard deviation, skewness, and kurtosis). Skewness
was calculated to understand the bias in the age distribution. A negative skewness value
indicates that the distribution is biased toward older ages. Kurtosis showed the concentration
of values around the mean.
Finally, a latent class analysis was performed to classify the deceased into mortality profiles
(low, moderate, high) by type of ND, according to the geographic region of Ecuador (Coast,
Highlands, and Amazon).
Results
Sociodemographic characteristics of the sample
A total of 1,353 deaths associated with NDs were recorded in Ecuador. Regarding sex, there
was a slight predominance of females (56 %, n = 753) compared to males (44 %, n = 600).
With respect to the place of death, most deaths occurred at the patient's home (69 %, n = 930),
followed by deaths in Ministry of Public Health (MSP, Spanish acronym) facilities (13 %, n =
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175) and deaths in units of the Ecuadorian Institute of Social Security (IESS, Spanish
acronym) (8.6 %, n = 116). 5.8 % (n = 79) died in hospitals, clinics, or private consultations,
while 2.8% (n = 38) died in unspecified locations. Only 1.0 % (n = 14) died in other public
facilities, and one case (<0.1 %) did not have available information.
With regard to education level, the most common group was people with basic education (29
%, n = 391), followed by those with primary education (22 %, n = 298) and secondary
education (20 %, n = 276). 10 % (n = 142) had completed high school, while only 8.2 % (n =
111) had higher education. 3.1 % (n = 42) did not provide information on their education
level.
Regarding marital status, 40 % (n = 537) of the deceased were married at the time of death,
followed by widowed (30 %, n = 402) and single (25 %, n = 332). Divorced accounted for
5.3 % (n = 72), whereas separated individuals and those in common-law unions were less
frequent (<1 %). Only 0.1 % (n = 2) had no available information.
In terms of province of residence, the province with the highest number of cases was
Pichincha (32 %, n = 431), followed by Guayas (16 %, n = 210), Manabí (8.0 %, n = 108), and
Azuay (7.5 %, n = 102). Other provinces had percentages lower than 6 %. Only one case
(<0.1 %) involved a person residing abroad.
Regarding self-identified ethnicity, the majority of the deceased were mestizo (87 %, n =
1,181). Other groups included montubio (2.7 %, n = 37), indigenous (2.8%, n = 38), Afro-
Ecuadorians (0.9 %, n = 12), white (1.8 %, n = 25), mulattos and blacks (<1%). In 3.8 % (n =
51), this information was not recorded.
Finally, the distribution by age group showed a high concentration of older individuals: 40.9
% (n = 554) were between 81 and 90 years old, 25.2 % (n = 341) were 91 years or older, and
24.2 % (n = 328) were between 65 and 80 years old. Only 9.6% (n = 130) were between 19
and 64 years old.
Table 1. Socio-demographic variables of those who died of neurodegenerative diseases in
Ecuador
Sociodemographic characteristics
n (%)
Sex
Male
600 (44%)
Female
753 (56%)
Place of death
Home
930 (69%)
IESS facilities
116 (8.6%)
Ministry of Health facilities
175 (13%)
Hospital, clinic or private practice
79 (5.8%)
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Other
38 (2.8%)
Other public facilities
14 (1.0%)
No information
1 (<0.1%)
Level of education
Basic Education
391 (29%)
Secondary education / Baccalaureate
142 (10%)
High School
276 (20%)
Primary
298 (22%)
Secondary
93 (6.9%)
No information
42 (3.1%)
Higher
111 (8.2%)
Marital status
Married
537 (40%)
Divorced
72 (5.3%)
Separated
1 (<0.1%)
No information
2 (0.1%)
Single
332 (25%)
Unmarried
7 (0.5%)
Widowed
402 (30%)
Province of residence
Azuay
102 (7.5%)
Bolívar
20 (1.5%)
Carchi
15 (1.1%)
Cañar
36 (2.7%)
Chimborazo
32 (2.4%)
Cotopaxi
20 (1.5%)
El Oro
58 (4.3%)
Esmeraldas
27 (2.0%)
Exterior
1 (<0.1%)
Guayas
210 (16%)
Imbabura
73 (5.4%)
Loja
64 (4.7%)
Los Ríos
34 (2.5%)
Manabí
108 (8.0%)
Morona Santiago
11 (0.8%)
Napo
3 (0.2%)
Orellana
1 (<0.1%)
Pastaza
3 (0.2%)
Pichincha
431 (32%)
Santa Elena
14 (1.0%)
Santo Domingo de los Tsáchilas
33 (2.4%)
Sucumbíos
11 (0.8%)
Tungurahua
43 (3.2%)
Zamora Chinchipe
3 (0.2%)
Ethnicity
Afro-Ecuadorian / Afro-descendant
12 (0.9%)
White
25 (1.8%)
Indigenous
38 (2.8%)
Mestizo
1,181 (87%)
Montubio
37 (2.7%)
Mulatto
3 (0.2%)
Black
6 (0.4%)
No information
51 (3.8%)
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Note: Age range = 81-90 years n =554 (40.9 %), 91 and over n = 341 (25.2 %), 65-80 years n = 328 (24.2
%), 19-64 years n = 130 (9.6 %).
Age and sex analysis
The overall average age was 81.9 years (SD = 13.4; M = 85 years), with a range between 19
and 109 years. The age distribution showed negative skewness (skewness = −1.67). The
kurtosis was 3.80.
When breaking down the data by sex, it was observed that deceased women (n = 753) had a
higher average age (M = 83.3, SD = 13.3) compared to men (n = 600; M = 80.2, SD = 13.2).
The median age was also higher in women (86 years) compared to men (83 years). The
minimum age was 22 years for women and 19 years for men, while the maximum age was
109 and 102 years, respectively.
The age distribution was more skewed in men (skewness = −1.79) than in women (skewness
= −1.64), and kurtosis was also higher in the male group (4.59 vs. 3.38).
Table 2. Descriptive of age and sex
n
Mean
Median
SD
Minimun
Maximun
Skewness
Kurtosis
Total
1353
81.9
85
13.4
19
109
-1.67
3.80
Age
Men
600
80.2
83.0
13.2
19
102
-1.79
4.59
Women
753
83.3
86
13.3
22
109
-1.64
3.38
Causes of death, sex, and age group
The analysis of specific causes of death from NDs revealed differences in distribution by sex
and age group. Overall, AD/D was the most prevalent cause of death. In women, deaths due
to AD/D were most frequent in the 81–90 years age range (n = 240, 17.74 %), followed by the
91 years and older group (n = 221, 16.33 %) and the 65–80 years group (n = 89, 6.58 %). In
comparison, men showed lower proportions in the same age groups: 81-90 years (n = 174,
12.86 %), 91 years and older, and 65–80 years (n = 85, 6.28 %).
Regarding PD, there was a higher incidence in men, particularly in the 81–90 years (5.5 %)
and 65–80 years (5.0 %) groups. In women, the frequency was lower: 3.9 % in the 81–90
years group and 2.7 % in the 65–80 years group.
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Other less prevalent conditions included PMDs, with higher representation in the 19–64 years
age group, especially in men (0.9 %, n = 12). HD, CA, MS, CNSDD, SMARS, and CJD also
showed low percentages, mostly concentrated in the 19–64 years age group, indicating an
earlier onset of these conditions.
Notably, OED was present in all age groups starting from 65 years, though in very low
proportions. A similar trend was observed with ONDB, whose presence was marginal.
Table 3. Cause of death, sex and ethnic group
Cause of death
Sex
Age group
n
%
81-90
174
12.86
Male
91 and more
85
6.28
65-80
85
6.28
Alzheimer’s disease / Dementia
19-64
2
0,15
81-90
240
17.74
Female
91 and more
221
16.33
65-80
89
6,58
19-64
12
0,89
81-90
74
5.47
Male
91 and more
17
1.26
65-80
68
5.03
Parkinson Disease
19-64
12
0.89
81-90
53
3.92
Female
91 and more
15
1.11
65-80
36
2.66
19-64
9
0.67
81-90
0
0.00
Male
91 and more
0
0.00
65-80
2
0.15
Muscular Diseases
19-64
12
0.89
81-90
0
0.00
Female
91 and more
0
0.00
65-80
1
0.07
19-64
7
0.52
81-90
0
0.00
Male
91 and more
0
0.00
65-80
0
0.00
Huntington Disease
19-64
2
0.15
81-90
0
0.00
Female
91 and more
0
0.00
65-80
0
0.00
19-64
7
0.52
81-90
0
0.00
Male
91 and more
0
0.00
65-80
1
0.07
Cerebellar Ataxia
19-64
3
0.22
81-90
0
0.00
Female
91 and more
0
0.00
65-80
0
0.00
19-64
4
0.30
Cause of death
Sex
Age group
n
%
81-90
0
0.00
Multiple Sclerosis
Male
91 and more
0
0.00
65-80
4
0.30
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19-64
5
0.37
81-90
1
0.07
Female
91 and more
0
0.00
65-80
2
0.15
19-64
4
0.30
81-90
5
0.37
Others (Demyelinating diseases of the central
nervous system. Muscular Atrophy, Spinal.
Creutzfeldt-Jakob Syndrome. Degenerative
disease of the nervous system, unspecified. Other
degenerative diseases of the basal ganglia).
Male
91 and more
1
0.07
65-80
22
1.63
19-64
26
1.92
81-90
7
0.52
Female
91 and more
2
0.15
65-80
18
1.33
19-64
25
1.85
Overall, the data show that AD/D and PD are the leading causes of death from NDs in the
Ecuadorian population, predominantly in women and older adults. In contrast, other less
frequent NDs are concentrated in younger age groups and have a lesser proportional impact
on overall mortality.
Causes of death according to geographic region
The analysis of the geographic distribution of causes of death revealed marked differences
between the three regions of Ecuador that contributed cases. The Sierra region had the highest
number of deaths (n = 836, 61.79 %), and AD/D represented more than 50 % of all deaths in
each geographic zone (see figure 1).
Figure 1. Causes of death due to neurodegenerative diseases by region of Ecuador
Note: AD/D (Alzheimer's disease/Dementias), CA (Cerebellar ataxia), HD (Huntington's disease), MS
(Multiple sclerosis), OTH (Other neurodegenerative diseases), PD (Parkinson's disease), PMD (Primary
muscle disorders).
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The lowest number of deaths occurred in the Amazon (2%). AD/D was the most frequent
cause in this region (n = 18, 54.55 %), followed by PD (n = 10, 30.3 %). The low mortality
from NDs in this region could be influenced by the low population density and diagnostic
underreporting, as it is mostly made up of indigenous populations that turn to their ancestral
practices for health issues.
In the Coast region, AD/D was also the most common cause of death, accounting for 63.43 %
of deaths (n = 307), reflecting a significant burden of these conditions in this region.
Following AD/D, PD was the second most frequent (22.11 %, n = 107) and PMDs (1.86 %, n
= 9).
The majority of deaths nationwide occurred in the Sierra region. The AD/D group accounted
for the highest percentage of deaths in this area (69.73 %, n = 583), followed by PD (19.98 %,
n = 167). This region also showed high mortality from PMDs (1.55 %, n = 13) and MS (1.43
%, n = 12).
Figure 2 shows the latent class analysis that identified three hidden mortality profiles (low,
moderate, high), considering both the cause of death from NDs and regional distribution
(Amazon, Coast, and Sierra). The following proportions were identified in each latent class:
38.7 % (low mortality), 15.7 % (moderate mortality), and 45.6 % (high mortality).
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Figure 2.
Latent Class Analysis plot
Note: Class 1= Low mortality, Class 2= Moderate mortality, Class 3= High mortality. Cause of death: 1=
Alzheimer's disease/Dementias), 2= Parkinson's disease, 3= Primary muscle disorders, 4=. Huntington's
disease, 5= Cerebellar ataxia, 6= Multiple sclerosis, 7= Other neurodegenerative diseases. Región:
1=Amazon, 2=Coast, 3=Highlands
Class 1 (Low Mortality Profile) was mostly composed of individuals who died from AD/D
(63.9 %) and PD (20.9 %). This class was strongly associated with the Coast region (68.9 %).
Class 2 (Moderate Mortality) showed a predominance of AD/D (54.6 %) and a notable
increase in deaths from PD (30.3 %) compared to Class 1. It had a more balanced regional
distribution: 48.8 % from Sierra, 35.7% from Coast, and 15.5 % from the Amazon.
Additionally, there was a growth in the proportion of deaths from MS (3.0 %), indicating
greater clinical diversity.
Class 3 (High Mortality Profile) showed AD/D as the primary cause of death (74.2 %),
although deaths from PD (17.8 %) and MS (1.56 %) were also observed. This class was
highly concentrated in the Sierra region (92.3 %), with marginal presence in the Coast (7.7
%).
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Discussion
Mortality, place of death, education level, marital status, residence province, and ethnic
self-identification
Most deaths occurred at the patient's home. The most common educational level was basic
education. Most of the deceased were married at the time of death. The provinces of
Pichincha and Guayas contributed the highest number of cases. Most of the deceased
identified as mestizo. Finally, the age distribution showed a high concentration of deaths in
people aged 81 to 90 years.
Regarding the place of death, the results of this study differ significantly from the literature
reviewed, as it was found that over 69 % of deaths occurred at home, which contrasts with
data from countries such as France, Hungary, and South Korea, where hospital deaths
predominate, ranging from 40%-60 %. In countries like Belgium, the United States, and
Canada, 48%-52% of cases die in nursing homes.(24) It is important to note that only in Italy
and Spain do the results show a pattern similar to Ecuador (46%-54 %), with the home being
the main place of death,(30) and particularly in Mexico, where the indicators exceed the results
of this study (73 %). This finding could be linked to cultural factors, limitations in access to
hospital services, or family preferences related to end-of-life care.
Ethnic self-identification revealed that 84 % of the deceased identified as mestizo, in line with
the general demographic composition of the country. However, this concentration could also
reflect a bias in the formal diagnosis of neurodegenerative diseases (ND) across different
ethnic groups. Previous studies have pointed to the underrepresentation of ethnic minorities
in clinical records of neurodegenerative diseases due to structural barriers in healthcare
systems.(31)
Mortality, age, and sex
The results of this study show an average age of the deceased of 81.9 years, with a range from
19 to 109 years. The negative skew of the age distribution suggests a higher concentration of
values in older age groups, while the kurtosis result indicates a leptokurtic distribution, with
more pronounced tails than expected in a normal distribution.
Deceased women had a higher average age compared to men. The minimum age for women
was 22 years and 19 years for men, while the maximum age was 109 and 102 years,
respectively. The higher skewness in the male distribution suggests that the age range is
slightly more extreme in men, with a greater concentration of values around the mean but also
the presence of outliers at both ends.
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These results reflect greater longevity in women affected by neurodegenerative diseases
compared to men, which aligns with global epidemiological patterns showing a higher life
expectancy in the female population. Additionally, the high median and negative skew
reinforce the concentration of these deaths in older ages.
Consistent with European studies on Alzheimer's disease (AD), it was observed that the
mortality rate for women was higher than for men, which is consistent with literature
reporting rates of 4.7 % in men and 6 % in women in European countries between 1994 and
2013.(23) This difference may be influenced by the higher life expectancy of women and a
higher prevalence of AD in older ages.
Regarding sex and age, various studies in high-income countries have demonstrated that men,
particularly those under 80 years of age, are more likely to die in hospitals, as reported in
Belgium, France, Italy, the United States, Mexico, and Canada, (32,33) Our data, however,
reflect a different pattern, considering all neurodegenerative diseases (ND) globally, not just
a single condition like Parkinson's disease (PD), where international trends are better
documented.(34) This suggests the need for disaggregated studies by disease type, sex, and age
in Ecuador for a more detailed understanding of the factors associated with mortality and
place of death.
In summary, the findings of this study show both similarities and divergences with
international literature and highlight the importance of considering sociocultural and
structural contexts when analyzing ND mortality in different countries. As the Ecuadorian
population ages, it will be essential to implement public policies that ensure equitable access
to diagnosis, treatment, and palliative care, especially in rural areas and historically
marginalized groups.
Age distribution and regional mortality
The age group 81 to 90 years represented the highest percentage of deaths (40.9 %),
confirming the strong association between aging and the prevalence of neurodegenerative
diseases. Geographically, the provinces of Pichincha (n = 431) and Guayas (n = 210)
accounted for the highest number of deaths, which can be explained by their high population
density, greater availability of healthcare services, and better registration systems. This
concentration is consistent with findings by Tharwani et al. in the U.S. [35,36], where high
rates of Parkinson’s disease (PD) were also reported in rural and suburban areas with aging
populations.
Cause of death and geographic region
The analysis of the geographic distribution of ND deaths in this study revealed marked
differences between the three natural regions of the country: Amazon, Coast, and Sierra. The
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highest number of deaths occurred in the more populated regions, with fewer deaths in the
Amazon, likely influenced by multiple factors, including low population density, limited
access to specialized services, and diagnostic underreporting. However, the high
concentration in more populated areas suggests a more balanced distribution and greater
availability of diagnoses compared to the Amazon. The high concentration in the Sierra
region may be related to the greater concentration of neurological and geriatric services in
cities located in the Sierra, closer to the capital, with better coverage by both the public and
private healthcare systems compared to other regions.
The results of this study confirm that Alzheimer's disease (AD) and dementia (D) were the
leading causes of death from ND in Ecuador in 2023, affecting the age group of 81 to 90 years
more significantly, in both men and women. This age distribution remained consistent across
other conditions such as Parkinson’s disease (PD), though with lower absolute percentages.
In all cases, deaths among younger individuals were exceptional (<0.1 %), reaffirming the
strong relationship between aging and neurodegeneration.
In contrast with more common neurodegenerative diseases, rarer or less frequent diseases,
such as Huntington’s disease (HD), multiple sclerosis (MS), and muscular dystrophy (MD),
have a different age distribution, affecting mainly the 19 to 64-year-old group, with no
significant differences between sexes. In Ecuador, the incidence and mortality of HD is low,
consistent with trends observed internationally. For instance, reported mortality rates range
from 0.2x100,000 inhabitants in countries like Malta and Spain, to 1.58x100,000 inhabitants
in the United Kingdom.(37,38) In the United States, HD mortality is estimated at 0.97x100,000
inhabitants.(39) These figures reflect the relative rarity of HD, although its clinical and social
impact is considerable due to its degenerative progression and lack of curative treatments.
This study also shows a slight female predominance in MS, consistent with global indicators
from the Atlas of MS, which indicates that approximately two-thirds of MS cases occur in
women.(40) While MS does not significantly reduce life expectancy, it does considerably
affect the quality of life. Mortality estimates from the Atlas of MS and Global Burden of
Disease (GBD) report national rates for Ecuador and Argentina around 0.11x100,000
inhabitants, slightly higher than Peru (~0.10x100,000) (41) suggesting a moderate burden in
this Andean region, possibly influenced by genetic and environmental factors.
In Ecuador, while MD cases were rare, their impact is considerable due to early disease onset,
often during adolescence or early adulthood, and the high disability rate associated with these
conditions. International studies show a clear male predominance: in Spain, 73.8% of deaths
from muscular dystrophies between 1981 and 2016 were male (42) in the U.S., between 2006
and 2015, the mortality rate among non-Hispanic white males was 0.46x100,000,
significantly higher than in other ethnic groups, with 71% of deaths occurring between the
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ages of 15 and 29.(43,44) This pattern highlights the aggressive nature and early onset of the
disease, particularly in non-Hispanic white males.
Overall, national data reflect both coincident and divergent patterns compared to
international literature. While more prevalent NDs follow a global trend, less common
diseases require greater visibility in health systems, along with strengthened epidemiological
and genetic registries to better quantify their true burden and plan effective intervention
strategies.
Parkinson’s disease (PD) is one of the most prevalent neurodegenerative disorders globally,
second only to dementias. Its estimated prevalence exceeds 1 % in people over 65 years of
age, making it one of the leading causes of neurological morbidity in the elderly population.
In Ecuador, the Ministry of Public Health (MSP, Spanish acronym) reported 27,710
consultations for PD in 2024, approximately two-thirds of which (18,000) were among older
adults, aligning with the global trend of an aging affected population.
Regarding mortality, according to the World Health Organization (WHO), in 2020 there were
658 deaths attributed to Parkinson's disease in Ecuador, representing 0.92 % of total deaths in
the country.(45) This corresponds to an age-adjusted mortality rate of 3.88x100,000
inhabitants, placing Ecuador 105th globally.(45) This level is comparable to neighboring
countries like Peru, but significantly lower than Bolivia, where an estimated rate of about
7.53x100,000 inhabitants was reported.(45) This regional difference may be related to factors
such as demographic profile, diagnostic coverage, access to healthcare services, or possible
underreporting in health information systems.
Internationally, a sustained increase in mortality from PD has been documented. In Brazil,
mortality shows a significant upward trend in both sexes (APC males = 3.32; females = 2.81),
particularly in the 70-79 age group (APC = 4.93) [46, 47, 48]. Similarly, in China, from 2004
to 2021, PD mortality rates significantly increased in both sexes, with a global APC of 7.14 %
(7.65 % in males and 7.03% in females); the fastest-growing age group was females over 85
years (APC = 5.69 %) [49]. In Mexico, between 2000 and 2020, the adjusted mortality rate
was 1.26x100,000 inhabitants (50) with a male-to-female ratio of 1.60, consistent with patterns
observed in Ecuador.
Other studies highlight that, beyond aging, factors such as race, sex, and geographic region
significantly influence mortality patterns. In the U.S., age-adjusted PD mortality doubled in
males compared to females between 1999 and 2019 (from 5.4 to 8.8x100,000), with higher
rates in non-Hispanic white individuals [46, 51,52]. Similarly, research in Italy, Estonia, and
the United Kingdom has shown a progressive increase in age-standardized PD mortality
rates, contrasting with the decline seen in many other causes of death.(47) In England and
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Wales, for instance, PD mortality increased by 105% between 2001 and 2014, reflecting a
pattern seen in countries with robust surveillance systems.(53)
These findings may be attributed, at least in part, to improved diagnostic accuracy and
heightened medical awareness of movement disorders. It has been suggested that the
apparent increase in mortality from neurodegenerative diseases may be due more to better
clinical recognition and more rigorous coding in death certificates than to a true rise in
incidence. However, factors related to access to treatment, comorbidities, age at diagnosis,
motor progression, and cognitive decline also contribute to the disease burden and mortality
rates.
In this context, it should be noted that other forms of parkinsonism, such as progressive
supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD),
and dementia with Lewy bodies (DLB), although less common, present high mortality rates
and reduced survival. PSP and CBD have an average onset age of 63 years, with post-
diagnosis survival ranging from 6.9 to 7.2 years, respectively. Meanwhile, MSA has an
average life expectancy of 6.2 to 7.5 years, and its clinical presentation varies geographically,
being more prevalent in North America, Europe, and Japan.(54,55)
Improving the quality of vital records, particularly the accuracy of death certificates and
standardization of diagnostic criteria, remains a challenge in Ecuador. The lack of an
integrated epidemiological and clinical information system limits the country's ability to
effectively monitor the evolution of these diseases. Implementing a national
neurodegenerative disease repository that integrates data on mortality, morbidity, outpatient
and inpatient care would enable a more accurate assessment of the health and social impact of
these diseases, fostering more effective and equitable public policies.
Although HD, MS, and MD represent a smaller fraction of ND mortality in Ecuador, their
identification in younger groups and their complex clinical evolution highlight the need to
strengthen early diagnosis, genetic registries, and specialized care. The implementation of
public health policies focused on rare diseases, such as dystrophies and cerebellar ataxias, is
critical to ensuring access to innovative therapies and appropriate supportive care.
Finally, national data aligns with global estimates of the prevalence and incidence of
neurodegenerative disorders, particularly AD/dementias and PD. This concordance can be
attributed to various factors, such as the sustained increase in longevity, favorable changes in
lifestyle, decreased tobacco and other neurotoxic substance consumption, as well as the
indirect effects of industrialization and urbanization. These findings underscore the urgent
need for public policies that recognize the growing impact of NDs on the health system,
promoting early diagnosis and access to comprehensive palliative care.
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Conclusion
This study significantly contributes to the understanding of the sociodemographic variables
associated with mortality due to neurodegenerative diseases (ND) in Ecuador. The findings
provide valuable information on the most common diagnoses, as well as the distribution of
deaths by age, sex, and geographical region. Given that currently 8.2 % of the Ecuadorian
population is 65 years or older, and the country ranks 159th globally with an overall mortality
rate of 5.17x1,000 inhabitants,(28) there is a high likelihood of an increase in deaths from
aging-related diseases such as neurodegenerative diseases.
As strategies are developed to reduce the burden of these diseases and improve clinical
outcomes, it is crucial to recognize the complexity in both the diagnosis and the assessment of
mortality related to ND. In this context, the development and implementation of innovative
treatments and comprehensive public policies are essential to slow their progression and
improve the quality of life for those affected.
References
1. Erkkinen MG, Kim M-O, Geschwind MD. Clinical neurology and epidemiology of
the major neurodegenerative diseases. Cold Spring Harb Perspect Biol.
2018;10(4):a033118. Available from:
https://cshperspectives.cshlp.org/content/10/4/a033118.short
2. Mayeux R, Stern Y. Epidemiology of Alzheimer disease. Cold Spring Harb Perspect
Med. 2012;2(8):a006239. Available from:
https://perspectivesinmedicine.cshlp.org/content/2/8/a006239.short
3. Sosa-Ortiz AL, Acosta-Castillo I, Prince MJ. Epidemiology of dementias and
Alzheimer’s disease. Arch Med Res. 2012;43(8):600–8. Available from:
https://www.sciencedirect.com/science/article/abs/pii/S0188440912003311
4. Rovira MC, Castell MMS. Prevalencia y mortalidad de la enfermedad de Huntington
a partir del registro poblacional de enfermedades raras de las Islas Baleares durante el
período 2010-2013. Rev Esp Salud Pública. 2017;91:e1–6 [cited 2024 Jul 10].
Available from: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-
57272017000100205
5. GBD 2019 Collaborators. Global mortality from dementia: application of a new
method and results from the Global Burden of Disease Study 2019. Alzheimers
Dement (N Y). 2021;7(1):e12200. doi:10.1002/trc2.12200. Available from:
https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/trc2.12200
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
6. World Health Rankings. Mundo total de muertes. OMS, CDC, Banco Mundial, ONU.
Available from:
https://www.worldlifeexpectancy.com/es/country-health-profile/ecuador
7. Pritchard C, Silk A, Hansen L, Panesar H, Berendt T. Aceleración de las muertes
neurológicas en el siglo XXI en el Reino Unido y los principales países occidentales:
¿Causas demográficas y/o ambientales interactivas múltiples? J Neurol Sci. 2024 Jul
15;462:123094. [Epub 2024 Jun 13]. PMID: 38897154. Available from:
https://www.sciencedirect.com/science/article/abs/pii/S0022510X24002296
8. Steinmetz JD, Seeher KM, Schiess N, Nichols E, Cao B, Servili C, et al. Global,
regional, and national burden of disorders affecting the nervous system, 1990–2021: a
systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol.
2024 Apr;23(4):344–81. [cited 2024 Jul 10]. Available from:
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00038-3/
fulltext
9. Evans SJ, Douglas I, Rawlins MD, Wesler NS, Tabrizi SJ, Smeeth L. Prevalence of
adult Huntington disease in the UK based on diagnoses recorded in general practice
records. J Neurol Neurosurg Psychiatry. 2013;84(10):1156–60. Available from:
https://jnnp.bmj.com/content/84/10/1156.short
10. De la Rosa T, Scorza FA. Parkinson's disease inpatient mortality: Attention to sudden
death. Clinics (Sao Paulo). 2024 Apr 20;79:100366.
PMID: 38643608; PMCID:
PMC11046233. Available from:
https://www.scielo.br/j/clin/a/YMGtxj9K5Wp8CSm8db8GPnz/?lang=en
11. Wang G, Li XJ, Hu YS, Cheng Q, Wang CF, Xiao Q, et al. Mortalidad por
enfermedad de Parkinson en China: hallazgos de un estudio de seguimiento de cinco
años en Shanghai. Can J Neurol Sci. 2015 Jul;42(4):242–7. PMID: 26153040.
Available from: https://www.cambridge.org/core/journals/canadian-journal-of-
neurological-sciences/article/mortality-from-parkinsons-disease-in-china-findings-
from-a-fiveyear-follow-up-study-in-shanghai/
40A6DF0C5AC70F16F4E8EDCC8BD4FD1F
12. Halonen P, Raitanen J, Jämsen E, Enroth L, Jylhä M. Enfermedades crónicas y
multimorbilidad en población de 90 años o más: asociaciones con la mortalidad y el
ingreso en cuidados de larga duración. Age Ageing. 2019 Jul 1;48(4):564–70.
doi:10.1093/ageing/afz019. PMID: 30843581. Available from:
https://academic.oup.com/ageing/article/48/4/564/5371058?login=false
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
13. Reitz C, Brayne C, Mayeux R. Epidemiology of Alzheimer disease. Nat Rev Neurol.
2011;7:137–52. Available from: https://www.nature.com/articles/nrneurol.2011.2
14. Valdevila Figueira JA, Valdevila Santiesteban R, Carvajal Parra ID, Benenaula
Vargas LP, Ramírez A, Leon-Rojas JE, Rodas JA. Multimorbidity patterns in
dementia and mild cognitive impairment. Front Psychiatry. 2024;15:1432848.
Available from: https://pubmed.ncbi.nlm.nih.gov/39575196/
15. Rossel C. Desafíos demográficos para la organización social del cuidado y las
políticas públicas. 2016. Available from:
https://ideas.repec.org/p/ecr/col040/40239.html
16. Chávez-León E, Ontiveros-Uribe MP, Carrillo-Ruiz JD. La enfermedad de
Parkinson: neurología para psiquiatras. Salud Ment. 2013;36(4):315–24. Available
from: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-
33252013000400006
17. Seo HG, Byun SJ, Oh BM, Park SJ. Ten-year relative survival from the diagnosis of
Parkinson's disease: A nationwide database study. J Am Med Dir Assoc. 2021
Aug;22(8):1757–61. [Epub 2020 Dec 17]. PMID: 33340454. Available from:
https://www.sciencedirect.com/science/article/abs/pii/S1525861020309865
18. Pérez Menéndez A. Una de cada tres personas, en el mundo, padece algún tipo de
trastorno neurológico. Sociedad Española de Neurología. [citado 2024 Jul 10].
Available from: https://www.sen.es/saladeprensa/pdf/Link381.pdf
19. Rossel C. Prestaciones familiares y cuidados de larga duración: lecciones de Europa y
apuestas estratégicas para un estado de bienestar en América Latina. 2023. Available
from: https://ideas.repec.org/p/ecr/col022/48788.html
20. Organización Mundial de la Salud (OMS). Enfermedad de Parkinson. 2024.
Available from:
https://dominiodelasciencias.com/ojs/index.php/es/article/view/3708
21. Organización Mundial de la Salud (OMS). Demencia. 2025. Available from:
https://www.who.int/es/news-room/fact-sheets/detail/dementia
22. Estella Pérez FJ. Bioingeniería aplicada a la creación de base de datos, análisis y
clasificación de variables anatómicas y coordenadas estereotáxicas. Relación con el
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
resultado clínico en el tratamiento de enfermedades neurodegenerativas [tesis
doctoral]. Granada: Universidad de Granada; 2022. Available from:
https://digibug.ugr.es/handle/10481/76834
23. World Health Rankings. Esclerosis múltiple. Tasa de muerte por país. 2024.
Available from:
https://www.sciencedirect.com/science/article/abs/pii/S1853002823000083
24. Prince M, Bryce R, Albanese E, et al. The global prevalence of dementia: a systematic
review and meta-analysis. Alzheimers Dement. 2013;9(1):63–75.e2.
doi:10.1016/j.jalz.2012.11.007. Available from:
https://www.sciencedirect.com/science/article/abs/pii/S1552526012025319
25. Tharwani ZH, Deepak FNU, Arshad MS, Zaheer S, Kumar R, Bhimani RK, et al.
Tendencias temporales de la enfermedad de Parkinson entre los adultos mayores en
los Estados Unidos desde 1999 hasta 2020: análisis retrospectivo de la base de datos
WONDER de los CDC. Parkinsonism Relat Disord. 2024 Oct;127:107110. Available
from: https://pubmed.ncbi.nlm.nih.gov/39180966/
26. Herdoíza JPM, Perero PSM, Toala LEA, Mercado ERI, Moreira-Vera DV.
Prevalencia de la enfermedad de Parkinson: Estudio puerta-a-puerta en la provincia
de Manabí-Ecuador. Rev Ecuat Neurol. 2017;26(1):23–6. Available from:
https://revecuatneurol.com/wp-content/uploads/2018/01/Prevalencia-Enfermedad-
Parkinson.-Prevalence-Parkinsons-Disease.pdf
27. Instituto Nacional de Estadística y Censos (INEC). Revista Código Científico. 2023.
Available from:
http://www.revistacodigocientifico.itslosandes.net/index.php/1/article/view/97
28. CIE-10. Formación continuada CIE-10: I Introducción historia y estructura general.
Available from:
https://www.researchgate.net/profile/Arturo-J-Martin-Vegue/publication/373556849
29. Matthews FE, Stephan BCM, Robinson L, et al. A two-decade dementia incidence
comparison from the cognitive function and ageing studies I and II. Nat Commun.
2016;7:11398. doi:10.1038/ncomms11398. Available from:
https://www.nature.com/articles/ncomms11398
30. World Health Organization Regional Office for Europe. European Detailed Mortality
Database [Internet]. Available from: https://www.who.int/europe/home?v=welcome
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
31. Organización Mundial de la Salud (OMS). Esclerosis múltiple. Datos y cifras. 2023.
Available from: https://www.who.int/es/news-room/fact-sheets/detail/multiple-
sclerosis
32. Multiple Sclerosis International Federation. Rising prevalence of multiple sclerosis
worldwide: Insights from the Atlas of MS, third edition. 2020. Available from:
https://pubmed.ncbi.nlm.nih.gov/33174475/
33. Global Burden of Disease Collaborative Network. Global Burden of Disease Study
2019 (GBD 2019); IHME, 2020. Available from:
https://ghdx.healthdata.org/record/ihme-data/gbd-2019-relative-risks
34. Llamosas-Falcón L, Sánchez-Díaz G, Gallego E, et al. A population-based study of
mortality due to muscular dystrophies across a 36-year period in Spain. Sci Rep.
2022;12:3750. doi:10.1038/s41598-022-07814-z. Available from:
https://www.nature.com/articles/s41598-022-07814-z
35. Salzberg DC, Mann JR, McDermott S, et al. Differences in race and ethnicity in
muscular dystrophy mortality rates for males under 40 years of age, 2006–2015.
Neuroepidemiology. 2018;50(3–4):201–6. doi:10.1159/000488244. Available from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8904487/
36. Centers for Disease Control and Prevention (CDC), NCHS. Widening gap in age at
muscular dystrophy–associated death between blacks and whites, 1986–2005.
Neurology. Available from: https://pubmed.ncbi.nlm.nih.gov/20837966/
37. World Health Organization. Parkinson Disease in Ecuador – Mortality Rate per
100 000. World Health Rankings. 2020. Available from:
https://www.worldlifeexpectancy.com/ecuador-parkinson-disease
38. Ribeiro SDM, Siqueira MT, Gurgel IGD, Diniz GTN. Temporal trend of mortality
due to Parkinson’s disease in older people in Brazil, 2002-2021. Rev Saude Publica.
2024;33:e2024532. Available from:
https://www.scielo.br/j/ress/a/5QDvK6pmY6sG6ZsT9jMWpns/?
format=html&lang=en
39. Olegini Vasconcellos PR, Rizzotto MLF, Taglietti M. Hospitalization and mortality
from Parkinson’s disease in Brazil from 2008 to 2020. Saúde Debate.
2023;47(137):196–206. Available from:
https://www.scielosp.org/article/sdeb/2023.v47n137/196-206/en/
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
40. Lima-Costa MF, et al. Prevalence, distribution and future projections of Parkinson
disease in Brazil: insights from the ELSI-Brazil cohort study. Lancet Reg Health Am.
2025;(xxxx):pp–pp. doi:10.1016/j.lana.2025.101046
41. Liu Y, Sheng W, Wang W, et al. Trends in Parkinson’s disease mortality in China
from 2004 to 2021: a joinpoint analysis. BMC Public Health. 2024;24:1234.
Available from:
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-18532-8
42. Martínez-Ramírez D, Rodríguez-Violante M, Velázquez-Ávila ES, et al. Trends in
Parkinson’s mortality in Mexico 2000–2020. Gac Sanit. 2024;38:102361. Available
from: https://www.sciencedirect.com/science/article/pii/S0213911124000086
43. Huang W, Goldberg RJ, Yarzebski J, Lessard D, Gore JM, Dalen JE. Time trends in
pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart
Assoc. 2020;9(21):e016784. Available from:
https://pubmed.ncbi.nlm.nih.gov/32809909/
44. Xia Y, Su L, Bai W, Hu Y, Zhao J, Li J, et al. Trends in pulmonary embolism
mortality rates by age group in the United States, 1999–2019. PLoS One.
2023;18(6):e0286560. Available from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12336653/
45. Zuin M, Bikdeli B, Davies J, Krishnathasan D, Rigatelli G, Roncon L, et al.
Contemporary trends in mortality related to high-risk pulmonary embolism in US
from 1999 to 2019. Thromb Res. 2023 Aug;228:72–80. Epub 2023 Jun 5. PMID:
37295022. Available from: https://pubmed.ncbi.nlm.nih.gov/37295022/
46. Alegre-Ayala J, Vela L, Fernández-Vázquez D, Navarro-López V, Macías-Macías Y,
Cano-de-la-Cuerda R. The impact of Parkinson's disease severity on performance of
activities of daily living: an observational study. Rev Neurol. 2023
Apr 16;76(8):249–55. doi:10.33588/rn.7608.2022263. PMID: 37046393;
PMCID: PMC10478137. Available from:
https://pubmed.ncbi.nlm.nih.gov/37046393/ Neurology
47. Jarman B, Aylin P. Death rates in England and Wales and the United States: variation
with age, sex, and race. BMJ. 2004 Dec 11;329(7479):1367. PMID: 15591562;
PMCID: PMC535447. Available from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC535447/
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
48. Hugentobler Schlickmann T, Somma Tessari M, Vendramini Borelli W, Alves
Marconi G, Magalhães Pereira G, Zimmer E, Noyce A, Fernández Mata I, de Mello
Rieder C, Teixeira-dos-Santos D, et al. Prevalence, distribution and future projections
of Parkinson disease in Brazil: insights from the ELSI-Brazil cohort study. Lancet
Reg Health Am. 2025;(en prensa): pp–pp. Available from:
https://www.sciencedirect.com/science/article/pii/S2667193X25000560?
ssrnid=4897344&dgcid=SSRN_redirect_SD
49. Wang S, Shuai J, Juan W, et al. Trends in Parkinson’s disease mortality in China from
2004 to 2021: a joinpoint analysis. BMC Public Health. 2024;24:1234. Available
from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-
18532-8
50. Yeverino-Gutiérrez ML, González-González MR, González-Santiago O. Trends in
Parkinson’s mortality in Mexico 2000-2020. Gac Sanit. 2024;38:102361.
doi:10.1016/j.gaceta.2024.102361. Available from:
https://www.gacetasanitaria.org/es-trends-in-parkinson39s-mortality-in-articulo-
S0213911124000086?utm_source=chatgpt.com
51. Huang W, Goldberg RJ, Yarzebski J, Lessard D, Gore JM, Dalen JE. Time trends in
pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart
Assoc. 2020;9(21):e016784. doi:10.1161/JAHA.120.016784. Available from:
https://pubmed.ncbi.nlm.nih.gov/32809909/
52. Martin K, Molsberry R, Cuttica M, et al. Trends in pulmonary embolism mortality
rates by age group in the United States, 1999–2019. PLoS One.
2023;18(6):e0286560. doi:10.1371/journal.pone.0286560. Available from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12336653/
53. Omidi M, Krishna V, Bandyopadhyay D, Jha S, Khan A, Qureshi W, et al.
Contemporary trends in mortality related to high-risk pulmonary embolism in the
United States from 1999 to 2019. Thromb Res. 2023;225:10–15.
doi:10.1016/j.thromres.2023.05.015
54. Llamosas-Falcón L, Sánchez-Díaz G, Gallego E, Villaverde-Hueso A, Arias-Merino
G, Posada de la Paz M, Alonso-Ferreira V. A population-based study of mortality due
to muscular dystrophies across a 36-year period in Spain. Sci Rep. 2022 Mar
8;12(1):3750. doi:10.1038/s41598-022-07814-z. PMID: 35260676;
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
PMCID: PMC8904487. Available from: https://www.nature.com/articles/s41598-
022-07814-z
55. Fedeli U, Schievano E. Increasing mortality related to Parkinson’s disease among
men in Northern Italy. Parkinsonism Relat Disord. 2017 Jul;40:47–50.
doi:10.1016/j.parkreldis.2017.04.008. Epub 2017 Apr 12. PMID: 28416129.
Available from:
https://www.sciencedirect.com/science/article/abs/pii/S1353802017301402
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or
financial relationships.
Copyright and Originality Statement
The authors affirm that this investigation has not been previously published in print or
electronic format, nor submitted to any other journal for consideration. In accordance with
the publication policies of the Revista Panamericana de Salud Pública / Pan American
Journal of Public Health (RPSP/PAJPH), the manuscript will remain exclusively under
review by RPSP/PAJPH until a final editorial decision is reached.
Ethical Considerations
This study was conducted in accordance with the ethical principles outlined in the
Declaration of Helsinki and adhered to national and institutional research ethics guidelines.
Participation was voluntary, and informed consent was obtained electronically from all
students prior to data collection. Confidentiality and anonymity of participants were strictly
maintained throughout the study.
Funding
This research received no external funding.
Declaration of Conflicting Interests
The authors declare that there are no conflicts of interest in relation to the research presented
in this manuscript.
Data Availability Statement
Mortality due to Neurodegenerative Diseases in Ecuadorian Adults: a Descriptive Analysis
Rev. Hosp. Psiq. Hab. Volumen 22 | 2025 | Publicación continua
Esta obra está bajo licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
Anonymized data that support the findings of this study may be made available from the
corresponding author upon reasonable request.
Contribuciones de autoría
José Alejandro Valdevila Figueira: participó en la conceptualización, el análisis formal, la
metodología, la redacción del borrador original y la redacción, revisión y edición.
María Alejandra Espinosa de los Monteros Andrade: participó en la conceptualización, la
curación de datos, el análisis formal, la investigación, la metodología, la validación, la
visualización, la redacción del borrador original y la redacción, revisión y edición.
Xavier Rodrigo Yambay-Bautista: participó en la curación de datos, el análisis formal, la
investigación, la utilización del software, la visualización y la redacción, revisión y edición.
Rocío Valdevila Santiesteban: participó en la redacción, borrador original y la redacción,
revisión y edición.
Indira Dayana Carvajal Parra: participó en la investigación, la metodología, la validación
y la redacción, revisión y edición.
Pedro Martínez-Suarez: participó en la metodología, la supervisión, la validación, el
manejo de recursos y la redacción, revisión y edición.
María José Pico Cucalon: participó en la conceptualización, la curación de datos, la
investigación, la visualización, la redacción, borrador original y la redacción, `evisión y
edición.
