Health in times of uncertainty in the eastern Mediterranean region, 1990–2013

TY - JOUR

T1 - Health in times of uncertainty in the eastern Mediterranean region, 1990–2013

T2 - a systematic analysis for the Global Burden of Disease Study 2013

AU - Mokdad, Ali H.

AU - Forouzanfar, Mohammad Hossein

AU - Daoud, Farah

AU - El Bcheraoui, Charbel

AU - Moradi-Lakeh, Maziar

AU - Khalil, Ibrahim

AU - Afshin, Ashkan

AU - Tuffaha, Marwa

AU - Charara, Raghid

AU - Barber, Ryan M.

AU - Wagner, Joseph

AU - Cercy, Kelly

AU - Kravitz, Hannah

AU - Coates, Matthew M.

AU - Robinson, Margaret

AU - Estep, Kara

AU - Steiner, Caitlyn

AU - Jaber, Sara

AU - Mokdad, Ali A.

AU - O'Rourke, Kevin F.

AU - Chew, Adrienne

AU - Kim, Pauline

AU - El Razek, Mohamed Magdy Abd

AU - Abdalla, Safa

AU - Abd-Allah, Foad

AU - Abraham, Jerry P.

AU - Abu-Raddad, Laith J.

AU - Abu-Rmeileh, Niveen M.E.

AU - Al-Nehmi, Abdulwahab A.

AU - Akanda, Ali S.

AU - Al Ahmadi, Hanan

AU - Al Khabouri, Mazin J.

AU - Al Lami, Faris H.

AU - Al Rayess, Zulfa A.

AU - Alasfoor, Deena

AU - AlBuhairan, Fadia S.

AU - Aldhahri, Saleh F.

AU - Alghnam, Suliman

AU - Alhabib, Samia

AU - Al-Hamad, Nawal

AU - Ali, Raghib

AU - Ali, Syed Danish

AU - Alkhateeb, Mohammad

AU - AlMazroa, Mohammad A.

AU - Alomari, Mahmoud A.

AU - Al-Raddadi, Rajaa

AU - Alsharif, Ubai

AU - Al-Sheyab, Nihaya

AU - Alsowaidi, Shirina

AU - Al-Thani, Mohamed

AU - Altirkawi, Khalid A.

AU - Amare, Azmeraw T.

AU - Amini, Heresh

AU - Ammar, Walid

AU - Anwari, Palwasha

AU - Asayesh, Hamid

AU - Asghar, Rana

AU - Assabri, Ali M.

AU - Assadi, Reza

AU - Bacha, Umar

AU - Badawi, Alaa

AU - Bakfalouni, Talal

AU - Basulaiman, Mohammed O.

AU - Bazargan-Hejazi, Shahrzad

AU - Bedi, Neeraj

AU - Bhakta, Amit R.

AU - Bhutta, Zulfiqar A.

AU - Bin Abdulhak, Aref A.

AU - Boufous, Soufiane

AU - Bourne, Rupert R.A.

AU - Danawi, Hadi

AU - Das, Jai

AU - Deribew, Amare

AU - Ding, Eric L.

AU - Durrani, Adnan M.

AU - Elshrek, Yousef

AU - Ibrahim, Mohamed E.

AU - Eshrati, Babak

AU - Esteghamati, Alireza

AU - Faghmous, Imad A.D.

AU - Farzadfar, Farshad

AU - Feigl, Andrea B.

AU - Fereshtehnejad, Seyed Mohammad

AU - Filip, Irina

AU - Fischer, Florian

AU - Gankpé, Fortuné G.

AU - Ginawi, Ibrahim

AU - Gishu, Melkamu Dedefo

AU - Gupta, Rahul

AU - Habash, Rami M.

AU - Hafezi-Nejad, Nima

AU - Hamadeh, Randah R.

AU - Hamdouni, Hayet

AU - Hamidi, Samer

AU - Harb, Hilda L.

AU - Hassanvand, Mohammad Sadegh

AU - Hedayati, Mohammad T.

AU - Heydarpour, Pouria

AU - Hsairi, Mohamed

AU - Husseini, Abdullatif

AU - Jahanmehr, Nader

AU - Jha, Vivekanand

AU - Jonas, Jost B.

AU - Karam, Nadim E.

AU - Kasaeian, Amir

AU - Kassa, Nega Assefa

AU - Kaul, Anil

AU - Khader, Yousef

AU - Khalifa, Shams Eldin A.

AU - Khan, Ejaz A.

AU - Khan, Gulfaraz

AU - Khoja, Tawfik

AU - Khosravi, Ardeshir

AU - Kinfu, Yohannes

AU - Defo, Barthelemy Kuate

AU - Balaji, Arjun Lakshmana

AU - Lunevicius, Raimundas

AU - Obermeyer, Carla Makhlouf

AU - Malekzadeh, Reza

AU - Mansourian, Morteza

AU - Marcenes, Wagner

AU - Farid, Habibolah Masoudi

AU - Mehari, Alem

AU - Mehio-Sibai, Abla

AU - Memish, Ziad A.

AU - Mensah, George A.

AU - Mohammad, Karzan A.

AU - Nahas, Ziad

AU - Nasher, Jamal T.

AU - Nawaz, Haseeb

AU - Nejjari, Chakib

AU - Nisar, Muhammad Imran

AU - Omer, Saad B.

AU - Parsaeian, Mahboubeh

AU - Peprah, Emmanuel

AU - Pervaiz, Aslam

AU - Pourmalek, Farshad

AU - Qato, Dima M.

AU - Qorbani, Mostafa

AU - Radfar, Amir

AU - Rafay, Anwar

AU - Rahimi, Kazem

AU - Rahimi-Movaghar, Vafa

AU - Rahman, Sajjad Ur

AU - Rai, Rajesh K.

AU - Rana, Saleem M.

AU - Rao, Sowmya R.

AU - Refaat, Amany H.

AU - Resnikoff, Serge

AU - Roshandel, Gholamreza

AU - Saade, Georges

AU - Saeedi, Mohammad Y.

AU - Sahraian, Mohammad Ali

AU - Saleh, Shadi

AU - Sanchez-Riera, Lidia

AU - Satpathy, Maheswar

AU - Sepanlou, Sadaf G.

AU - Setegn, Tesfaye

AU - Shaheen, Amira

AU - Shahraz, Saeid

AU - Sheikhbahaei, Sara

AU - Shishani, Kawkab

AU - Sliwa, Karen

AU - Tavakkoli, Mohammad

AU - Terkawi, Abdullah S.

AU - Uthman, Olalekan A.

AU - Westerman, Ronny

AU - Younis, Mustafa Z.

AU - El Sayed Zaki, Maysaa

AU - Zannad, Faiez

AU - Roth, Gregory A.

AU - Wang, Haidong

AU - Naghavi, Mohsen

AU - Vos, Theo

AU - Al Rabeeah, Abdullah A.

AU - Lopez, Alan D.

AU - Murray, Christopher J.L.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

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U2 - 10.1016/S2214-109X(16)30168-1

DO - 10.1016/S2214-109X(16)30168-1

M3 - Article

VL - 4

SP - e704-e713

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

IS - 10

ER -