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Title: Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Authors: 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
Karam, Nadim E.
Affiliations: Faculty of Health Sciences 
Issue Date: 2016-01-01
Publisher: National Library of Medicine
Part of: The Lancet Global Health
Volume: 4
Issue: 10
Start page: e704
End page: e713
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.
DOI: 10.1016/S2214-109X(16)30168-1
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Department of Public Health

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