Danger ahead: the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region, 1990-2015

Abstract

Objectives: The Eastern Mediterranean Region faces several health challenges at a difficult time with wars, unrest, and economic change.

Methods: We used the Global Burden of Disease 2015 study to present the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region from 1990 to 2015.

Results: Ischemic heart disease was the leading cause of death in the region in 2015, followed by cerebrovascular disease. Changes in total deaths ranged from a reduction of 25% for diarrheal diseases to an increase of about 42% for diabetes and tracheal, bronchus, and lung cancer. Collective violence and legal intervention increased by 850% during the time period. Diet was the leading risk factor for disability-adjusted life years (DALYs) for men compared to maternal malnutrition for females. Childhood undernutrition was the leading risk factor for DALYs in 1990 and 2005, but the second in 2015 after high blood pressure.

Conclusions: Our study shows that the region is facing several health challenges and calls for global efforts to stabilise the region and to address the current and future burden of disease.

Keywords: Burden of disease; Disability-adjusted life years; Eastern Mediterranean Region; Injuries; Risk factors.

Fig. 1

Eastern Mediterranean Region decomposition of changes in leading 30 causes of death due to population growth, population ageing, and changes in age-specific mortality rates, 2005–2015. Collective violence and legal intervention, which increased by 847%, was truncated for display purposes (Global Burden of Disease 2015 study, Eastern Mediterranean Region, 1990–2015)

Fig. 2

Leading 30 level 3 Eastern Mediterranean Region causes of disability-adjusted life-years (DALYs) for both sexes combined, 1990, 2005 and 2015. Causes are connected by arrows between time periods. Communicable, maternal, neonatal and nutritional causes are shown in red, non-communicable causes in blue and injuries in green. For the time period 1990–2005 and for 2005–2015, three measures of change are shown: percent change in the number of DALYs, percent change in the all-age DALY rate and percent change in the age-standardised DALY rate (Global Burden of Disease 2015 study, Eastern Mediterranean Region, 1990–2015)

Fig. 3

Leading ten Level 3 causes of Eastern Mediterranean Region age-specific disability-adjusted life-years (DALYs) in 2015. Each cause is coloured by the percentage change in age-specific DALY rate from 2005 to 2015. NN Preterm = neonatal preterm birth complications. NN Sepsis = neonatal sepsis and other neonatal infections. LRI = lower respiratory infections. Iron = iron-deficiency anaemia. HIV = HIV/AIDS. Back and neck = low back and neck pain. IHD = ischaemic heart disease. NN Enceph = neonatal encephalopathy due to birth asphyxia and trauma. Diarrhoea = diarrhoeal diseases. Skin = skin and subcutaneous diseases. Depression = depressive disorders. Stroke = cerebrovascular disease. Congenital = congenital anomalies. Diabetes = diabetes mellitus. COPD = chronic obstructive pulmonary disease. Alzheimer’s = Alzheimer’s disease and other dementias. PEM = protein-energy malnutrition. Conduct = conduct disorder. Sense = sense organ diseases. Other NN = other neonatal disorders. Intest inf = intestinal infectious diseases. Violence = interpersonal violence. NN Haemol = haemolytic disease and other neonatal jaundice. Anxiety = anxiety disorders. TB = tuberculosis. Lung C = lung, bronchial, and tracheal cancers. STD = sexually transmitted diseases excluding HIV. Haemog = haemoglobinopathies and haemolytic anaemias. CKD = chronic kidney disease. Other MSK = other musculoskeletal disorders. Drugs = drug use disorders. HTN HD = hypertensive heart disease. Whooping = whooping cough. Other UI = other unintentional injuries. War = collective violence and legal intervention. Cirrhosis Hep C = Cirrhosis and other chronic liver diseases due to hepatitis C. Other Cardio = Other cardiovascular and circulatory diseases. GBD = Global Burden of Disease (Global Burden of Disease 2015 study, Eastern Mediterranean Countries, 2005–2015)

Fig. 4

a Expected relationship between age-standardised years of life lost (YLL) and years lived with disability (YLD) rates per 100,000 and Sociodemographic index (SDI) and b all-age YLL and YLD rates (per 100,000) and SDI for 21 GBD Level 2 causes. These stacked curves represent the average relationship between SDI and each cause observed across the 22 Eastern Mediterranean Region countries in 2015. In each figure, the y-axis goes from lowest SDI to highest SDI. The left side shows rates for YLLs and the right side shows rates for YLDs; higher rates are further from the midline. The difference between (a) and (b) is the effect of shifts in population age structure expected with SDI. GBD = Global Burden of Disease (Global Burden of Disease 2015 study, Eastern Mediterranean Countries, 1990–2015)

Fig. 5

Eastern Mediterranean Region disability-adjusted life-years (DALYs) attributable to Level 2 risk factors for (a) men and (b) women in 2015 (Global Burden of Disease 2015 study, Eastern Mediterranean Countries, 1990–2015)

Fig. 6

Leading 30 level 3 Eastern Mediterranean Region risk factors for disability-adjusted life-years (DALYs) for both sexes combined, 1990, 2005, and 2015. Risks are connected by arrows between time periods. Behavioural risk factors are shown in red, environmental risks in blue and metabolic risks in green. For the time period 1990–2005 and for 2005–2015, three measures of change are shown: percent change in the number of DALYs, percent change in the all-age DALY rate and percent change in the age-standardised DALY rate. Statistically significant increases or decreases are shown in bold (p < 0.05) (Global Burden of Disease 2015 study, Eastern Mediterranean Region, 1990–2015)