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

Authors:
Dr. Rajaa Al-Raddadi, MD, ABCM, RICR, MMedED
Dr. Rajaa Al-Raddadi, MD, ABCM, RICR, MMedED
King Abdul Aziz university
Assistant professor
Jeddah, Makkah | Saudi Arabia
Talal Bakfalouni
Talal Bakfalouni
Johns Hopkins Medicine International
International Care Coordinator
Baltimore, MD | United States
Tesfaye Setegn
Tesfaye Setegn
University of Queensland
PhD Student
Brisbane, Queensland, | Australia
Dr Reza Malekzadeh, MD, AGAF
Dr Reza Malekzadeh, MD, AGAF
Digestive Oncology Research Center
professor
Gastroenterology
Tehran, Tehran | Iran (Islamic Republic of)
Ashkan Afshin, PhD
Ashkan Afshin, PhD
Ph.D Student of Health Education and Health Promotion at Iran University of Medical Sciences
Dr
kermanshah, Islamic | Iran (Islamic Republic of)
Mr Durrani A, FRCS(Plast)
Mr Durrani A, FRCS(Plast)
Addenbrooke's Hospital
Consultant Plastic Surgeon
Cambridge, Cambridgeshire | United Kingdom
Ali H Mokdad Mohammad Hossein Forouzanfar Farah Daoud Charbel El Bcheraoui Maziar Moradi-Lakeh Ibrahim Khalil 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 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 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 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 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 K 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 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

Lancet Glob Health 2016 10 25;4(10):e704-13. Epub 2016 Aug 25.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

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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Source
http://dx.doi.org/10.1016/S2214-109X(16)30168-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660972PMC
October 2016
144 Reads
25 Citations

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