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Lancet Glob Health. 2016 Oct;4(10):e704-13. doi: 10.1016/S2214-109X(16)30168-1. Epub 2016 Aug 25.

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Mokdad AH1, Forouzanfar MH2, Daoud F2, El Bcheraoui C2, Moradi-Lakeh M3, Khalil I2, Afshin A2, Tuffaha M2, Charara R2, Barber RM2, Wagner J2, Cercy K2, Kravitz H2, Coates MM2, Robinson M2, Estep K2, Steiner C2, Jaber S2, Mokdad AA4, O'Rourke KF2, Chew A2, Kim P2, El Razek MM5, Abdalla S6, Abd-Allah F7, Abraham JP8, Abu-Raddad LJ9, Abu-Rmeileh NM10, Al-Nehmi AA11, Akanda AS12, Al Ahmadi H13, Al Khabouri MJ14, Al Lami FH15, Al Rayess ZA16, Alasfoor D14, AlBuhairan FS17, Aldhahri SF18, Alghnam S19, Alhabib S20, Al-Hamad N21, Ali R22, Ali SD23, Alkhateeb M24, AlMazroa MA25, Alomari MA26, Al-Raddadi R25, Alsharif U27, Al-Sheyab N28, Alsowaidi S29, Al-Thani M30, Altirkawi KA31, Amare AT32, Amini H33, Ammar W34, Anwari P35, Asayesh H36, Asghar R37, Assabri AM38, Assadi R39, Bacha U40, Badawi A41, Bakfalouni T42, Basulaiman MO25, Bazargan-Hejazi S43, Bedi N44, Bhakta AR45, Bhutta ZA46, Bin Abdulhak AA47, Boufous S48, Bourne RR49, Danawi H50, Das J51, Deribew A52, Ding EL53, Durrani AM54, Elshrek Y55, Ibrahim ME56, Eshrati B57, Esteghamati A58, Faghmous IA59, Farzadfar F60, Feigl AB61, Fereshtehnejad SM62, Filip I63, Fischer F64, Gankpé FG65, Ginawi I66, Gishu MD67, Gupta R68, Habash RM25, Hafezi-Nejad N58, Hamadeh RR69, Hamdouni H70, Hamidi S71, Harb HL34, Hassanvand MS72, Hedayati MT73, Heydarpour P74, Hsairi M75, Husseini A76, Jahanmehr N77, Jha V78, Jonas JB79, Karam NE80, Kasaeian A81, Kassa NA82, Kaul A83, Khader Y84, Khalifa SE30, Khan EA85, Khan G86, Khoja T87, Khosravi A88, Kinfu Y89, Defo BK90, Balaji AL91, Lunevicius R92, Obermeyer CM93, Malekzadeh R94, Mansourian M95, Marcenes W96, Farid HM97, Mehari A98, Mehio-Sibai A99, Memish ZA100, Mensah GA101, Mohammad KA102, Nahas Z103, Nasher JT104, Nawaz H105, Nejjari C106, Nisar MI107, Omer SB108, Parsaeian M109, Peprah EK110, Pervaiz A111, Pourmalek F112, Qato DM113, Qorbani M114, Radfar A115, Rafay A116, Rahimi K22, Rahimi-Movaghar V117, Rahman SU118, Rai RK119, Rana SM120, Rao SR121, Refaat AH122, Resnikoff S123, Roshandel G124, Saade G125, Saeedi MY25, Sahraian MA74, Saleh S126, Sanchez-Riera L127, Satpathy M128, Sepanlou SG94, Setegn T129, Shaheen A130, Shahraz S131, Sheikhbahaei S58, Shishani K132, Sliwa K133, Tavakkoli M134, Terkawi AS135, Uthman OA136, Westerman R137, Younis MZ138, El Sayed Zaki M139, Zannad F140, Roth GA2, Wang H2, Naghavi M2, Vos T2, Al Rabeeah AA25, Lopez AD141, Murray CJ2.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mokdaa@uw.edu.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
4
Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
5
Aswan University Hospital, Aswan Faculty of Medicine, Aswan, Egypt.
6
Sudanese Public Health Consultancy Group, Solihull, UK.
7
Department of Neurology, Cairo University, Cairo, Egypt.
8
Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USA; Institute for Global Health, Harvard University, Boston, MA, USA.
9
Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar.
10
Institute of Community and Public Health, Birzeit University, Ramallah, Palestine.
11
Ministry of Health, Sana'a, Yemen.
12
University of Rhode Island, Kingston, RI, USA.
13
Majlis Al Shura, Riyadh, Saudi Arabia.
14
Ministry of Health, Muscat, Oman.
15
College of Medicine, University of Baghdad, Baghdad, Iraq.
16
The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia.
17
King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
18
King Saud University, Riyadh, Saudi Arabia; King Fahad Medical City, Riyadh, Saudi Arabia.
19
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
20
King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
21
Public Authority for Food and Nutrition, Kuwait.
22
University of Oxford, Oxford, UK.
23
University of London, London, UK; Institute and Faculty of Actuaries, Oxford, UK.
24
Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia.
25
Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.
26
Division of Physical Therapy, Department of Rehabilitation Sciences, Irbid, Jordan.
27
Charité Universitätsmedizin, Berlin, Germany.
28
Maternal and Child Health Department, Irbid, Jordan.
29
Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
30
Supreme Council of Health, Doha, Qatar.
31
King Saud University, Riyadh, Saudi Arabia.
32
Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia; College of Medicine and Health Sciences, Bahir Dar, Ethiopia.
33
Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
34
Ministry of Public Health, Beirut, Lebanon.
35
Kabul, Afghanistan.
36
Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran.
37
South Asian Public Health Forum, Islamabad, Pakistan.
38
Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
39
Mashhad University of Medical Sciences, Mashhad, Iran.
40
School of Health Sciences, University of Management and Technology, Lahore, Pakistan.
41
Public Health Agency of Canada, Toronto, ON, Canada.
42
Ministry of Health, Damascus, Syria.
43
Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
44
College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
45
National Institute of Mental Health, Montgomery Village, MD, USA.
46
Centre of Excellence in Women and Child Health, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
47
University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
48
Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia.
49
Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
50
Walden University, Minneapolis, MN, USA.
51
Department of Paediatrics and Child Health, Karachi, Pakistan.
52
Nuffield Department of Medicine, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
53
Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
54
National Institutes of Health, Montgomery Village, MD, USA.
55
Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya.
56
Cardiovascular Diseases Control and Prevention Program, Riyadh, Saudi Arabia.
57
Ministry of Health and Medical Education, Tehran, Iran; Arak University of Medical Sciences, Arak, Iran.
58
Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
59
London School of Hygiene & Tropical Medicine, London, UK.
60
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
61
Department of Global Health and Population, Harvard University, Boston, MA, USA.
62
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
63
Kaiser Permanente Psychiatry Residency Program, Fontana, CA, USA.
64
Bielefeld University, Bielefeld, Germany.
65
Leras Afrique, Cotonou, Benin; CHU Hassan II, Fez, Morocco.
66
College of Medicine, University of Hail, Hail, Saudi Arabia.
67
Haramaya University, Dira Dawa, Ethiopia; Kersa Health and Demographic Surveillance System, Harar, Ethiopia.
68
West Virginia Bureau for Public Health, Charleston, WV, USA.
69
Arabian Gulf University, Manama, Bahrain.
70
Direction des Soins de Santé de Base, Ministry of Health, Tunis, Tunisia.
71
Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.
72
Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
73
Department of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, Iran.
74
Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
75
Salah Azaiz Institute, Tunis, Tunisia.
76
Qatar University, Doha, Qatar.
77
School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
78
The George Institute for Global Health India, University of Oxford, New Delhi, India.
79
Ruprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany.
80
University of Balamand, Beirut, Lebanon.
81
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
82
Haramaya University, Harari, Ethiopia.
83
Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
84
Jordan University of Science and Technology, Irbid, Jordan.
85
Health Services Academy, Islamabad, Pakistan.
86
Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
87
Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.
88
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Ministry of Health and Medical Education, Tehran, Iran.
89
Centre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
90
Department of Demography and Public Health Research Institute, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
91
Indegene, Bangalore, India.
92
Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK.
93
Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
94
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
95
Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran.
96
Queen Mary University of London, London, UK.
97
State Welfare Organisation, Tehran, Iran.
98
Howard University College of Medicine, Washington, DC, USA.
99
Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
100
Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
101
Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Montgomery Village, MD, USA.
102
University of Salahaddin, Erbil, Iraq.
103
Medical Center, American University of Beirut, Beirut, Lebanon.
104
Ministry of Public Health and Population, Sana'a, Yemen.
105
Southern Illinois University, Springfield, IL, USA.
106
Faculty of Medicine, Fez, Morocco.
107
Aga Khan University, Karachi, Pakistan.
108
Emory University, Atlanta, GA, USA.
109
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
110
National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
111
Postgraduate Medical Institute, Lahore, Pakistan.
112
University of British Columbia, Vancouver, BC, Canada.
113
College of Pharmacy, University of Illinois, Chicago, IL, USA.
114
Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
115
A T Still University of Health Sciences, Kirksville, MO, USA.
116
Contech International Health Consultants, Lahore, Pakistan.
117
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
118
Hamad Medical Corporation, Doha, Qatar.
119
Society for Health and Demographic Surveillance, Suri, India.
120
Contech International Health Consultants, Lahore, Pakistan; Contech School of Public Health, Lahore, Pakistan.
121
Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
122
Walden University, Minneapolis, MN, USA; Suez Canal University, Ismailia, Egypt.
123
Brien Holden Vision Institute, University of New South Wales, Sydney, NSW, Australia; International Health and Development, Geneva, Switzerland.
124
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
125
Lebanese University, Beirut, Lebanon; Bellevue Medical Center, Mansourieh El Metn, Lebanon.
126
Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.
127
Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
128
All India Institute of Medical Sciences, New Delhi, India.
129
Bahir Dar University, Bahir Dar, Ethiopia.
130
Department of Public Health, An-Najah University, Nablus, Palestine.
131
Tufts Medical Center, Boston, MA, USA.
132
Washington State University, Spokane, WA, USA.
133
Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.
134
Westchester Medical Center, Valhalla, NY, USA.
135
Department of Anesthesiology, Riyadh, Saudi Arabia; Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA.
136
Warwick Medical School, University of Warwick, Coventry, UK.
137
Federal Institute for Population Research, Wiesbaden, Germany; German National Cohort Consortium, Heidelberg, Germany.
138
Jackson State University, Jackson, MS, USA.
139
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
140
Clinical Investigation Centre INSERM, Université de Lorraine, Vandoeuvre les Nancy, France; CHU de Nancy, Vandoeuvre les Nancy, France.
141
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.

Abstract

BACKGROUND:

The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.

METHODS:

GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically.

FINDINGS:

The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred.

INTERPRETATION:

Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.

FUNDING:

Bill & Melinda Gates Foundation.

Comment in

PMID:
27568068
PMCID:
PMC6660972
DOI:
10.1016/S2214-109X(16)30168-1
[Indexed for MEDLINE]
Free PMC Article

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