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, 4 (10), e704-13

Health in Times of Uncertainty in the Eastern Mediterranean Region, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013

Ali H Mokdad  1 Mohammad Hossein Forouzanfar  2 Farah Daoud  2 Charbel El Bcheraoui  2 Maziar Moradi-Lakeh  3 Ibrahim Khalil  2 Ashkan Afshin  2 Marwa Tuffaha  2 Raghid Charara  2 Ryan M Barber  2 Joseph Wagner  2 Kelly Cercy  2 Hannah Kravitz  2 Matthew M Coates  2 Margaret Robinson  2 Kara Estep  2 Caitlyn Steiner  2 Sara Jaber  2 Ali A Mokdad  4 Kevin F O'Rourke  2 Adrienne Chew  2 Pauline Kim  2 Mohamed Magdy Abd El Razek  5 Safa Abdalla  6 Foad Abd-Allah  7 Jerry P Abraham  8 Laith J Abu-Raddad  9 Niveen M E Abu-Rmeileh  10 Abdulwahab A Al-Nehmi  11 Ali S Akanda  12 Hanan Al Ahmadi  13 Mazin J Al Khabouri  14 Faris H Al Lami  15 Zulfa A Al Rayess  16 Deena Alasfoor  14 Fadia S AlBuhairan  17 Saleh F Aldhahri  18 Suliman Alghnam  19 Samia Alhabib  20 Nawal Al-Hamad  21 Raghib Ali  22 Syed Danish Ali  23 Mohammad Alkhateeb  24 Mohammad A AlMazroa  25 Mahmoud A Alomari  26 Rajaa Al-Raddadi  25 Ubai Alsharif  27 Nihaya Al-Sheyab  28 Shirina Alsowaidi  29 Mohamed Al-Thani  30 Khalid A Altirkawi  31 Azmeraw T Amare  32 Heresh Amini  33 Walid Ammar  34 Palwasha Anwari  35 Hamid Asayesh  36 Rana Asghar  37 Ali M Assabri  38 Reza Assadi  39 Umar Bacha  40 Alaa Badawi  41 Talal Bakfalouni  42 Mohammed O Basulaiman  25 Shahrzad Bazargan-Hejazi  43 Neeraj Bedi  44 Amit R Bhakta  45 Zulfiqar A Bhutta  46 Aref A Bin Abdulhak  47 Soufiane Boufous  48 Rupert R A Bourne  49 Hadi Danawi  50 Jai Das  51 Amare Deribew  52 Eric L Ding  53 Adnan M Durrani  54 Yousef Elshrek  55 Mohamed E Ibrahim  56 Babak Eshrati  57 Alireza Esteghamati  58 Imad A D Faghmous  59 Farshad Farzadfar  60 Andrea B Feigl  61 Seyed-Mohammad Fereshtehnejad  62 Irina Filip  63 Florian Fischer  64 Fortuné G Gankpé  65 Ibrahim Ginawi  66 Melkamu Dedefo Gishu  67 Rahul Gupta  68 Rami M Habash  25 Nima Hafezi-Nejad  58 Randah R Hamadeh  69 Hayet Hamdouni  70 Samer Hamidi  71 Hilda L Harb  34 Mohammad Sadegh Hassanvand  72 Mohammad T Hedayati  73 Pouria Heydarpour  74 Mohamed Hsairi  75 Abdullatif Husseini  76 Nader Jahanmehr  77 Vivekanand Jha  78 Jost B Jonas  79 Nadim E Karam  80 Amir Kasaeian  81 Nega Assefa Kassa  82 Anil Kaul  83 Yousef Khader  84 Shams Eldin A Khalifa  30 Ejaz A Khan  85 Gulfaraz Khan  86 Tawfik Khoja  87 Ardeshir Khosravi  88 Yohannes Kinfu  89 Barthelemy Kuate Defo  90 Arjun Lakshmana Balaji  91 Raimundas Lunevicius  92 Carla Makhlouf Obermeyer  93 Reza Malekzadeh  94 Morteza Mansourian  95 Wagner Marcenes  96 Habibolah Masoudi Farid  97 Alem Mehari  98 Abla Mehio-Sibai  99 Ziad A Memish  100 George A Mensah  101 Karzan A Mohammad  102 Ziad Nahas  103 Jamal T Nasher  104 Haseeb Nawaz  105 Chakib Nejjari  106 Muhammad Imran Nisar  107 Saad B Omer  108 Mahboubeh Parsaeian  109 Emmanuel K Peprah  110 Aslam Pervaiz  111 Farshad Pourmalek  112 Dima M Qato  113 Mostafa Qorbani  114 Amir Radfar  115 Anwar Rafay  116 Kazem Rahimi  22 Vafa Rahimi-Movaghar  117 Sajjad Ur Rahman  118 Rajesh K Rai  119 Saleem M Rana  120 Sowmya R Rao  121 Amany H Refaat  122 Serge Resnikoff  123 Gholamreza Roshandel  124 Georges Saade  125 Mohammad Y Saeedi  25 Mohammad Ali Sahraian  74 Shadi Saleh  126 Lidia Sanchez-Riera  127 Maheswar Satpathy  128 Sadaf G Sepanlou  94 Tesfaye Setegn  129 Amira Shaheen  130 Saeid Shahraz  131 Sara Sheikhbahaei  58 Kawkab Shishani  132 Karen Sliwa  133 Mohammad Tavakkoli  134 Abdullah S Terkawi  135 Olalekan A Uthman  136 Ronny Westerman  137 Mustafa Z Younis  138 Maysaa El Sayed Zaki  139 Faiez Zannad  140 Gregory A Roth  2 Haidong Wang  2 Mohsen Naghavi  2 Theo Vos  2 Abdullah A Al Rabeeah  25 Alan D Lopez  141 Christopher J L Murray  2
Affiliations

Health in Times of Uncertainty in the Eastern Mediterranean Region, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013

Ali H Mokdad et al. Lancet Glob Health.

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.

Conflict of interest statement

Declaration of interests

We declare no competing interests.

Figures

Figure 1
Figure 1. DALYs attributed to risk factors in countries of the eastern Mediterranean region, 1990 and 2013
DALYs=disability-adjusted life-years.
Figure 2
Figure 2. Projected versus observed life expectancy at birth of males in Egypt, Libya, Syria, Tunisia, and Yemen, 2000–13
GBD=Global Burden of Disease.
Figure 3
Figure 3. Projected versus observed life expectancy at birth of females in Egypt, Libya, Syria, Tunisia, and Yemen, 2000–13
GBD=Global Burden of Disease.

Comment in

  • Health in times of uncertainty.
    Lafta RK. Lafta RK. Lancet Glob Health. 2016 Oct;4(10):e666-7. doi: 10.1016/S2214-109X(16)30184-X. Epub 2016 Aug 25. Lancet Glob Health. 2016. PMID: 27568067 No abstract available.

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