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, Mohammad Hossein Forouzanfar, Farah Daoud, Charbel El Bcheraoui, Maziar Moradi-Lakeh, Ibrahim Khalil, Ashkan Afshin, Marwa Tuffaha, Raghid Charara, Ryan M. Barber, Joseph Wagner, Kelly Cercy, Hannah Kravitz, Matthew M. Coates, Margaret Robinson, Kara Estep, Caitlyn Steiner, Sara Jaber, Ali A. Mokdad, Kevin F. O'Rourke & 157 others Adrienne Chew, Pauline Kim, Mohamed Magdy Abd El Razek, Safa Abdalla, Foad Abd-Allah, Jerry P. Abraham, Laith J. Abu-Raddad, Niveen M.E. Abu-Rmeileh, Abdulwahab A. Al-Nehmi, Ali S. Akanda, Hanan Al Ahmadi, Mazin J. Al Khabouri, Faris H. Al Lami, Zulfa A. Al Rayess, Deena Alasfoor, Fadia S. AlBuhairan, Saleh F. Aldhahri, Suliman Alghnam, Samia Alhabib, Nawal Al-Hamad, Raghib Ali, Syed Danish Ali, Mohammad Alkhateeb, Mohammad A. AlMazroa, Mahmoud A. Alomari, Rajaa Al-Raddadi, Ubai Alsharif, Nihaya Al-Sheyab, Shirina Alsowaidi, Mohamed Al-Thani, Khalid A. Altirkawi, Azmeraw T. Amare, Heresh Amini, Walid Ammar, Palwasha Anwari, Hamid Asayesh, Rana Asghar, Ali M. Assabri, Reza Assadi, Umar Bacha, Alaa Badawi, Talal Bakfalouni, Mohammed O. Basulaiman, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Amit R. Bhakta, Zulfiqar A. Bhutta, Aref A. Bin Abdulhak, Soufiane Boufous, Rupert R.A. Bourne, Hadi Danawi, Jai Das, Amare Deribew, Eric L. Ding, Adnan M. Durrani, Yousef Elshrek, Mohamed E. Ibrahim, Babak Eshrati, Alireza Esteghamati, Imad A.D. Faghmous, Farshad Farzadfar, Andrea B. Feigl, Seyed Mohammad Fereshtehnejad, Irina Filip, Florian Fischer, Fortuné G. Gankpé, Ibrahim Ginawi, Melkamu Dedefo Gishu, Rahul Gupta, Rami M. Habash, Nima Hafezi-Nejad, Randah R. Hamadeh, Hayet Hamdouni, Samer Hamidi, Hilda L. Harb, Mohammad Sadegh Hassanvand, Mohammad T. Hedayati, Pouria Heydarpour, Mohamed Hsairi, Abdullatif Husseini, Nader Jahanmehr, Vivekanand Jha, Jost B. Jonas, Nadim E. Karam, Amir Kasaeian, Nega Assefa Kassa, Anil Kaul, Yousef Khader, Shams Eldin A. Khalifa, Ejaz A. Khan, Gulfaraz Khan, Tawfik Khoja, Ardeshir Khosravi, Yohannes Kinfu, Barthelemy Kuate Defo, Arjun Lakshmana Balaji, Raimundas Lunevicius, Carla Makhlouf Obermeyer, Reza Malekzadeh, Morteza Mansourian, Wagner Marcenes, Habibolah Masoudi Farid, Alem Mehari, Abla Mehio-Sibai, Ziad A. Memish, George A. Mensah, Karzan A. Mohammad, Ziad Nahas, Jamal T. Nasher, Haseeb Nawaz, Chakib Nejjari, Muhammad Imran Nisar, Saad B. Omer, Mahboubeh Parsaeian, Emmanuel Peprah, Aslam Pervaiz, Farshad Pourmalek, Dima M. Qato, Mostafa Qorbani, Amir Radfar, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Sajjad Ur Rahman, Rajesh K. Rai, Saleem M. Rana, Sowmya R. Rao, Amany H. Refaat, Serge Resnikoff, Gholamreza Roshandel, Georges Saade, Mohammad Y. Saeedi, Mohammad Ali Sahraian, Shadi Saleh, Lidia Sanchez-Riera, Maheswar Satpathy, Sadaf G. Sepanlou, Tesfaye Setegn, Amira Shaheen, Saeid Shahraz, Sara Sheikhbahaei, Kawkab Shishani, Karen Sliwa, Mohammad Tavakkoli, Abdullah S. Terkawi, Olalekan A. Uthman, Ronny Westerman, Mustafa Z. Younis, Maysaa El Sayed Zaki, Faiez Zannad, Gregory A. Roth, Haidong Wang, Mohsen Naghavi, Theo Vos, Abdullah A. Al Rabeeah, Alan D. Lopez, Christopher J.L. Murray

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)e704-e713
JournalThe Lancet Global Health
Volume4
Issue number10
DOIs
StatePublished - Oct 1 2016

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Mediterranean Region
Quality-Adjusted Life Years
Uncertainty
Somalia
Health
Syria
Yemen
Djibouti
Life Expectancy
Libya
Afghanistan
Egypt
Population Growth
Myocardial Ischemia
Cause of Death
Wounds and Injuries
Bahrain
Qatar
Child Nutrition Disorders
United Arab Emirates

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mokdad, A. H., Forouzanfar, M. H., Daoud, F., El Bcheraoui, C., Moradi-Lakeh, M., Khalil, I., ... Murray, C. J. L. (2016). Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Global Health, 4(10), e704-e713. https://doi.org/10.1016/S2214-109X(16)30168-1

Health in times of uncertainty in the eastern Mediterranean region, 1990–2013 : a systematic analysis for the Global Burden of Disease Study 2013. / Mokdad, Ali H.; Forouzanfar, Mohammad Hossein; Daoud, Farah; El Bcheraoui, Charbel; Moradi-Lakeh, Maziar; Khalil, Ibrahim; Afshin, Ashkan; Tuffaha, Marwa; Charara, Raghid; Barber, Ryan M.; Wagner, Joseph; Cercy, Kelly; Kravitz, Hannah; Coates, Matthew M.; Robinson, Margaret; Estep, Kara; Steiner, Caitlyn; Jaber, Sara; Mokdad, Ali A.; O'Rourke, Kevin F.; Chew, Adrienne; Kim, Pauline; El Razek, Mohamed Magdy Abd; Abdalla, Safa; Abd-Allah, Foad; Abraham, Jerry P.; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M.E.; Al-Nehmi, Abdulwahab A.; Akanda, Ali S.; Al Ahmadi, Hanan; Al Khabouri, Mazin J.; Al Lami, Faris H.; Al Rayess, Zulfa A.; Alasfoor, Deena; AlBuhairan, Fadia S.; Aldhahri, Saleh F.; Alghnam, Suliman; Alhabib, Samia; Al-Hamad, Nawal; Ali, Raghib; Ali, Syed Danish; Alkhateeb, Mohammad; AlMazroa, Mohammad A.; Alomari, Mahmoud A.; Al-Raddadi, Rajaa; Alsharif, Ubai; Al-Sheyab, Nihaya; Alsowaidi, Shirina; Al-Thani, Mohamed; Altirkawi, Khalid A.; Amare, Azmeraw T.; Amini, Heresh; Ammar, Walid; Anwari, Palwasha; Asayesh, Hamid; Asghar, Rana; Assabri, Ali M.; Assadi, Reza; Bacha, Umar; Badawi, Alaa; Bakfalouni, Talal; Basulaiman, Mohammed O.; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Bhakta, Amit R.; Bhutta, Zulfiqar A.; Bin Abdulhak, Aref A.; Boufous, Soufiane; Bourne, Rupert R.A.; Danawi, Hadi; Das, Jai; Deribew, Amare; Ding, Eric L.; Durrani, Adnan M.; Elshrek, Yousef; Ibrahim, Mohamed E.; Eshrati, Babak; Esteghamati, Alireza; Faghmous, Imad A.D.; Farzadfar, Farshad; Feigl, Andrea B.; Fereshtehnejad, Seyed Mohammad; Filip, Irina; Fischer, Florian; Gankpé, Fortuné G.; Ginawi, Ibrahim; Gishu, Melkamu Dedefo; Gupta, Rahul; Habash, Rami M.; Hafezi-Nejad, Nima; Hamadeh, Randah R.; Hamdouni, Hayet; Hamidi, Samer; Harb, Hilda L.; Hassanvand, Mohammad Sadegh; Hedayati, Mohammad T.; Heydarpour, Pouria; Hsairi, Mohamed; Husseini, Abdullatif; Jahanmehr, Nader; Jha, Vivekanand; Jonas, Jost B.; Karam, Nadim E.; Kasaeian, Amir; Kassa, Nega Assefa; Kaul, Anil; Khader, Yousef; Khalifa, Shams Eldin A.; Khan, Ejaz A.; Khan, Gulfaraz; Khoja, Tawfik; Khosravi, Ardeshir; Kinfu, Yohannes; Defo, Barthelemy Kuate; Balaji, Arjun Lakshmana; Lunevicius, Raimundas; Obermeyer, Carla Makhlouf; Malekzadeh, Reza; Mansourian, Morteza; Marcenes, Wagner; Farid, Habibolah Masoudi; Mehari, Alem; Mehio-Sibai, Abla; Memish, Ziad A.; Mensah, George A.; Mohammad, Karzan A.; Nahas, Ziad; Nasher, Jamal T.; Nawaz, Haseeb; Nejjari, Chakib; Nisar, Muhammad Imran; Omer, Saad B.; Parsaeian, Mahboubeh; Peprah, Emmanuel; Pervaiz, Aslam; Pourmalek, Farshad; Qato, Dima M.; Qorbani, Mostafa; Radfar, Amir; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Sajjad Ur; Rai, Rajesh K.; Rana, Saleem M.; Rao, Sowmya R.; Refaat, Amany H.; Resnikoff, Serge; Roshandel, Gholamreza; Saade, Georges; Saeedi, Mohammad Y.; Sahraian, Mohammad Ali; Saleh, Shadi; Sanchez-Riera, Lidia; Satpathy, Maheswar; Sepanlou, Sadaf G.; Setegn, Tesfaye; Shaheen, Amira; Shahraz, Saeid; Sheikhbahaei, Sara; Shishani, Kawkab; Sliwa, Karen; Tavakkoli, Mohammad; Terkawi, Abdullah S.; Uthman, Olalekan A.; Westerman, Ronny; Younis, Mustafa Z.; El Sayed Zaki, Maysaa; Zannad, Faiez; Roth, Gregory A.; Wang, Haidong; Naghavi, Mohsen; Vos, Theo; Al Rabeeah, Abdullah A.; Lopez, Alan D.; Murray, Christopher J.L.

In: The Lancet Global Health, Vol. 4, No. 10, 01.10.2016, p. e704-e713.

Research output: Contribution to journalArticle

Mokdad, AH, Forouzanfar, MH, Daoud, F, El Bcheraoui, C, Moradi-Lakeh, M, Khalil, I, Afshin, A, Tuffaha, M, Charara, R, Barber, RM, Wagner, J, Cercy, K, Kravitz, H, Coates, MM, Robinson, M, Estep, K, Steiner, C, Jaber, S, Mokdad, AA, O'Rourke, KF, Chew, A, Kim, P, El Razek, MMA, Abdalla, S, Abd-Allah, F, Abraham, JP, Abu-Raddad, LJ, Abu-Rmeileh, NME, Al-Nehmi, AA, Akanda, AS, Al Ahmadi, H, Al Khabouri, MJ, Al Lami, FH, Al Rayess, ZA, Alasfoor, D, AlBuhairan, FS, Aldhahri, SF, Alghnam, S, Alhabib, S, Al-Hamad, N, Ali, R, Ali, SD, Alkhateeb, M, AlMazroa, MA, Alomari, MA, Al-Raddadi, R, Alsharif, U, Al-Sheyab, N, Alsowaidi, S, Al-Thani, M, Altirkawi, KA, Amare, AT, Amini, H, Ammar, W, Anwari, P, Asayesh, H, Asghar, R, Assabri, AM, Assadi, R, Bacha, U, Badawi, A, Bakfalouni, T, Basulaiman, MO, Bazargan-Hejazi, S, Bedi, N, Bhakta, AR, Bhutta, ZA, Bin Abdulhak, AA, Boufous, S, Bourne, RRA, Danawi, H, Das, J, Deribew, A, Ding, EL, Durrani, AM, Elshrek, Y, Ibrahim, ME, Eshrati, B, Esteghamati, A, Faghmous, IAD, Farzadfar, F, Feigl, AB, Fereshtehnejad, SM, Filip, I, Fischer, F, Gankpé, FG, Ginawi, I, Gishu, MD, Gupta, R, Habash, RM, Hafezi-Nejad, N, Hamadeh, RR, Hamdouni, H, Hamidi, S, Harb, HL, Hassanvand, MS, Hedayati, MT, Heydarpour, P, Hsairi, M, Husseini, A, Jahanmehr, N, Jha, V, Jonas, JB, Karam, NE, Kasaeian, A, Kassa, NA, Kaul, A, Khader, Y, Khalifa, SEA, Khan, EA, Khan, G, Khoja, T, Khosravi, A, Kinfu, Y, Defo, BK, Balaji, AL, Lunevicius, R, Obermeyer, CM, Malekzadeh, R, Mansourian, M, Marcenes, W, Farid, HM, Mehari, A, Mehio-Sibai, A, Memish, ZA, Mensah, GA, Mohammad, KA, Nahas, Z, Nasher, JT, Nawaz, H, Nejjari, C, Nisar, MI, Omer, SB, Parsaeian, M, Peprah, E, Pervaiz, A, Pourmalek, F, Qato, DM, Qorbani, M, Radfar, A, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Rahman, SU, Rai, RK, Rana, SM, Rao, SR, Refaat, AH, Resnikoff, S, Roshandel, G, Saade, G, Saeedi, MY, Sahraian, MA, Saleh, S, Sanchez-Riera, L, Satpathy, M, Sepanlou, SG, Setegn, T, Shaheen, A, Shahraz, S, Sheikhbahaei, S, Shishani, K, Sliwa, K, Tavakkoli, M, Terkawi, AS, Uthman, OA, Westerman, R, Younis, MZ, El Sayed Zaki, M, Zannad, F, Roth, GA, Wang, H, Naghavi, M, Vos, T, Al Rabeeah, AA, Lopez, AD & Murray, CJL 2016, 'Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013', The Lancet Global Health, vol. 4, no. 10, pp. e704-e713. https://doi.org/10.1016/S2214-109X(16)30168-1
Mokdad, Ali H. ; Forouzanfar, Mohammad Hossein ; Daoud, Farah ; El Bcheraoui, Charbel ; Moradi-Lakeh, Maziar ; Khalil, Ibrahim ; Afshin, Ashkan ; Tuffaha, Marwa ; Charara, Raghid ; Barber, Ryan M. ; Wagner, Joseph ; Cercy, Kelly ; Kravitz, Hannah ; Coates, Matthew M. ; Robinson, Margaret ; Estep, Kara ; Steiner, Caitlyn ; Jaber, Sara ; Mokdad, Ali A. ; O'Rourke, Kevin F. ; Chew, Adrienne ; Kim, Pauline ; El Razek, Mohamed Magdy Abd ; Abdalla, Safa ; Abd-Allah, Foad ; Abraham, Jerry P. ; Abu-Raddad, Laith J. ; Abu-Rmeileh, Niveen M.E. ; Al-Nehmi, Abdulwahab A. ; Akanda, Ali S. ; Al Ahmadi, Hanan ; Al Khabouri, Mazin J. ; Al Lami, Faris H. ; Al Rayess, Zulfa A. ; Alasfoor, Deena ; AlBuhairan, Fadia S. ; Aldhahri, Saleh F. ; Alghnam, Suliman ; Alhabib, Samia ; Al-Hamad, Nawal ; Ali, Raghib ; Ali, Syed Danish ; Alkhateeb, Mohammad ; AlMazroa, Mohammad A. ; Alomari, Mahmoud A. ; Al-Raddadi, Rajaa ; Alsharif, Ubai ; Al-Sheyab, Nihaya ; Alsowaidi, Shirina ; Al-Thani, Mohamed ; Altirkawi, Khalid A. ; Amare, Azmeraw T. ; Amini, Heresh ; Ammar, Walid ; Anwari, Palwasha ; Asayesh, Hamid ; Asghar, Rana ; Assabri, Ali M. ; Assadi, Reza ; Bacha, Umar ; Badawi, Alaa ; Bakfalouni, Talal ; Basulaiman, Mohammed O. ; Bazargan-Hejazi, Shahrzad ; Bedi, Neeraj ; Bhakta, Amit R. ; Bhutta, Zulfiqar A. ; Bin Abdulhak, Aref A. ; Boufous, Soufiane ; Bourne, Rupert R.A. ; Danawi, Hadi ; Das, Jai ; Deribew, Amare ; Ding, Eric L. ; Durrani, Adnan M. ; Elshrek, Yousef ; Ibrahim, Mohamed E. ; Eshrati, Babak ; Esteghamati, Alireza ; Faghmous, Imad A.D. ; Farzadfar, Farshad ; Feigl, Andrea B. ; Fereshtehnejad, Seyed Mohammad ; Filip, Irina ; Fischer, Florian ; Gankpé, Fortuné G. ; Ginawi, Ibrahim ; Gishu, Melkamu Dedefo ; Gupta, Rahul ; Habash, Rami M. ; Hafezi-Nejad, Nima ; Hamadeh, Randah R. ; Hamdouni, Hayet ; Hamidi, Samer ; Harb, Hilda L. ; Hassanvand, Mohammad Sadegh ; Hedayati, Mohammad T. ; Heydarpour, Pouria ; Hsairi, Mohamed ; Husseini, Abdullatif ; Jahanmehr, Nader ; Jha, Vivekanand ; Jonas, Jost B. ; Karam, Nadim E. ; Kasaeian, Amir ; Kassa, Nega Assefa ; Kaul, Anil ; Khader, Yousef ; Khalifa, Shams Eldin A. ; Khan, Ejaz A. ; Khan, Gulfaraz ; Khoja, Tawfik ; Khosravi, Ardeshir ; Kinfu, Yohannes ; Defo, Barthelemy Kuate ; Balaji, Arjun Lakshmana ; Lunevicius, Raimundas ; Obermeyer, Carla Makhlouf ; Malekzadeh, Reza ; Mansourian, Morteza ; Marcenes, Wagner ; Farid, Habibolah Masoudi ; Mehari, Alem ; Mehio-Sibai, Abla ; Memish, Ziad A. ; Mensah, George A. ; Mohammad, Karzan A. ; Nahas, Ziad ; Nasher, Jamal T. ; Nawaz, Haseeb ; Nejjari, Chakib ; Nisar, Muhammad Imran ; Omer, Saad B. ; Parsaeian, Mahboubeh ; Peprah, Emmanuel ; Pervaiz, Aslam ; Pourmalek, Farshad ; Qato, Dima M. ; Qorbani, Mostafa ; Radfar, Amir ; Rafay, Anwar ; Rahimi, Kazem ; Rahimi-Movaghar, Vafa ; Rahman, Sajjad Ur ; Rai, Rajesh K. ; Rana, Saleem M. ; Rao, Sowmya R. ; Refaat, Amany H. ; Resnikoff, Serge ; Roshandel, Gholamreza ; Saade, Georges ; Saeedi, Mohammad Y. ; Sahraian, Mohammad Ali ; Saleh, Shadi ; Sanchez-Riera, Lidia ; Satpathy, Maheswar ; Sepanlou, Sadaf G. ; Setegn, Tesfaye ; Shaheen, Amira ; Shahraz, Saeid ; Sheikhbahaei, Sara ; Shishani, Kawkab ; Sliwa, Karen ; Tavakkoli, Mohammad ; Terkawi, Abdullah S. ; Uthman, Olalekan A. ; Westerman, Ronny ; Younis, Mustafa Z. ; El Sayed Zaki, Maysaa ; Zannad, Faiez ; Roth, Gregory A. ; Wang, Haidong ; Naghavi, Mohsen ; Vos, Theo ; Al Rabeeah, Abdullah A. ; Lopez, Alan D. ; Murray, Christopher J.L. / Health in times of uncertainty in the eastern Mediterranean region, 1990–2013 : a systematic analysis for the Global Burden of Disease Study 2013. In: The Lancet Global Health. 2016 ; Vol. 4, No. 10. pp. e704-e713.
@article{f80a04d01fdd4c08a113fb99f38378b2,
title = "Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013",
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.",
author = "Mokdad, {Ali H.} and Forouzanfar, {Mohammad Hossein} and Farah Daoud and {El Bcheraoui}, Charbel and Maziar Moradi-Lakeh and Ibrahim Khalil and Ashkan Afshin and Marwa Tuffaha and Raghid Charara and Barber, {Ryan M.} and Joseph Wagner and Kelly Cercy and Hannah Kravitz and Coates, {Matthew M.} and Margaret Robinson and Kara Estep and Caitlyn Steiner and Sara Jaber and Mokdad, {Ali A.} and O'Rourke, {Kevin F.} and Adrienne Chew and Pauline Kim and {El Razek}, {Mohamed Magdy Abd} and Safa Abdalla and Foad Abd-Allah and Abraham, {Jerry P.} and Abu-Raddad, {Laith J.} and Abu-Rmeileh, {Niveen M.E.} and Al-Nehmi, {Abdulwahab A.} and Akanda, {Ali S.} and {Al Ahmadi}, Hanan and {Al Khabouri}, {Mazin J.} and {Al Lami}, {Faris H.} and {Al Rayess}, {Zulfa A.} and Deena Alasfoor and AlBuhairan, {Fadia S.} and Aldhahri, {Saleh F.} and Suliman Alghnam and Samia Alhabib and Nawal Al-Hamad and Raghib Ali and Ali, {Syed Danish} and Mohammad Alkhateeb and AlMazroa, {Mohammad A.} and Alomari, {Mahmoud A.} and Rajaa Al-Raddadi and Ubai Alsharif and Nihaya Al-Sheyab and Shirina Alsowaidi and Mohamed Al-Thani and Altirkawi, {Khalid A.} and Amare, {Azmeraw T.} and Heresh Amini and Walid Ammar and Palwasha Anwari and Hamid Asayesh and Rana Asghar and Assabri, {Ali M.} and Reza Assadi and Umar Bacha and Alaa Badawi and Talal Bakfalouni and Basulaiman, {Mohammed O.} and Shahrzad Bazargan-Hejazi and Neeraj Bedi and Bhakta, {Amit R.} and Bhutta, {Zulfiqar A.} and {Bin Abdulhak}, {Aref A.} and Soufiane Boufous and Bourne, {Rupert R.A.} and Hadi Danawi and Jai Das and Amare Deribew and Ding, {Eric L.} and Durrani, {Adnan M.} and Yousef Elshrek and Ibrahim, {Mohamed E.} and Babak Eshrati and Alireza Esteghamati and Faghmous, {Imad A.D.} and Farshad Farzadfar and Feigl, {Andrea B.} and Fereshtehnejad, {Seyed Mohammad} and Irina Filip and Florian Fischer and Gankp{\'e}, {Fortun{\'e} G.} and Ibrahim Ginawi and Gishu, {Melkamu Dedefo} and Rahul Gupta and Habash, {Rami M.} and Nima Hafezi-Nejad and Hamadeh, {Randah R.} and Hayet Hamdouni and Samer Hamidi and Harb, {Hilda L.} and Hassanvand, {Mohammad Sadegh} and Hedayati, {Mohammad T.} and Pouria Heydarpour and Mohamed Hsairi and Abdullatif Husseini and Nader Jahanmehr and Vivekanand Jha and Jonas, {Jost B.} and Karam, {Nadim E.} and Amir Kasaeian and Kassa, {Nega Assefa} and Anil Kaul and Yousef Khader and Khalifa, {Shams Eldin A.} and Khan, {Ejaz A.} and Gulfaraz Khan and Tawfik Khoja and Ardeshir Khosravi and Yohannes Kinfu and Defo, {Barthelemy Kuate} and Balaji, {Arjun Lakshmana} and Raimundas Lunevicius and Obermeyer, {Carla Makhlouf} and Reza Malekzadeh and Morteza Mansourian and Wagner Marcenes and Farid, {Habibolah Masoudi} and Alem Mehari and Abla Mehio-Sibai and Memish, {Ziad A.} and Mensah, {George A.} and Mohammad, {Karzan A.} and Ziad Nahas and Nasher, {Jamal T.} and Haseeb Nawaz and Chakib Nejjari and Nisar, {Muhammad Imran} and Omer, {Saad B.} and Mahboubeh Parsaeian and Emmanuel Peprah and Aslam Pervaiz and Farshad Pourmalek and Qato, {Dima M.} and Mostafa Qorbani and Amir Radfar and Anwar Rafay and Kazem Rahimi and Vafa Rahimi-Movaghar and Rahman, {Sajjad Ur} and Rai, {Rajesh K.} and Rana, {Saleem M.} and Rao, {Sowmya R.} and Refaat, {Amany H.} and Serge Resnikoff and Gholamreza Roshandel and Georges Saade and Saeedi, {Mohammad Y.} and Sahraian, {Mohammad Ali} and Shadi Saleh and Lidia Sanchez-Riera and Maheswar Satpathy and Sepanlou, {Sadaf G.} and Tesfaye Setegn and Amira Shaheen and Saeid Shahraz and Sara Sheikhbahaei and Kawkab Shishani and Karen Sliwa and Mohammad Tavakkoli and Terkawi, {Abdullah S.} and Uthman, {Olalekan A.} and Ronny Westerman and Younis, {Mustafa Z.} and {El Sayed Zaki}, Maysaa and Faiez Zannad and Roth, {Gregory A.} and Haidong Wang and Mohsen Naghavi and Theo Vos and {Al Rabeeah}, {Abdullah A.} and Lopez, {Alan D.} and Murray, {Christopher J.L.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/S2214-109X(16)30168-1",
language = "English (US)",
volume = "4",
pages = "e704--e713",
journal = "The Lancet Global Health",
issn = "2214-109X",
publisher = "Elsevier BV",
number = "10",

}

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 -