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. and Forouzanfar, Mohammad Hossein and Daoud, Farah and El Bcheraoui, Charbel and Moradi-Lakeh, Maziar and Khalil, Ibrahim and Afshin, Ashkan and Tuffaha, Marwa and Charara, Raghid and Barber, Ryan M. and Wagner, Joseph and Cercy, Kelly and Kravitz, Hannah and Coates, Matthew M. and Robinson, Margaret and Estep, Kara and Steiner, Caitlyn and Jaber, Sara and Mokdad, Ali A. and O'Rourke, Kevin F. and Chew, Adrienne and Kim, Pauline and El Razek, Mohamed Magdy Abd and Abdalla, Safa and Abd-Allah, Foad 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 Alasfoor, Deena and AlBuhairan, Fadia S. and Aldhahri, Saleh F. and Alghnam, Suliman and Alhabib, Samia and Al-Hamad, Nawal and Ali, Raghib and Ali, Syed Danish and Alkhateeb, Mohammad and AlMazroa, Mohammad A. and Alomari, Mahmoud A. and Al-Raddadi, Rajaa and Alsharif, Ubai and Al-Sheyab, Nihaya and Alsowaidi, Shirina and Al-Thani, Mohamed and Altirkawi, Khalid A. and Amare, Azmeraw T. and Amini, Heresh and Ammar, Walid and Anwari, Palwasha and Asayesh, Hamid and Asghar, Rana and Assabri, Ali M. and Assadi, Reza and Bacha, Umar and Badawi, Alaa and Bakfalouni, Talal and Basulaiman, Mohammed O. and Bazargan-Hejazi, Shahrzad and Bedi, Neeraj and Bhakta, Amit R. and Bhutta, Zulfiqar A. and Bin Abdulhak, Aref A and Boufous, Soufiane and Bourne, Rupert R.A. and Danawi, Hadi and Das, Jai and Deribew, Amare and Ding, Eric L. and Durrani, Adnan M. and Elshrek, Yousef and Ibrahim, Mohamed E. and Eshrati, Babak and Esteghamati, Alireza and Faghmous, Imad A.D. and Farzadfar, Farshad and Feigl, Andrea B. and Fereshtehnejad, Seyed-Mohammad and Filip, Irina and Fischer, Florian and Gankpé, Fortuné G. and Ginawi, Ibrahim and Gishu, Melkamu Dedefo and Gupta, Rahul and Habash, Rami M. and Hafezi-Nejad, Nima and Hamadeh, Randah R. and Hamdouni, Hayet and Hamidi, Samer and Harb, Hilda L. and Hassanvand, Mohammad Sadegh and Hedayati, Mohammad T. and Heydarpour, Pouria and Hsairi, Mohamed and Husseini, Abdullatif and Jahanmehr, Nader and Jha, Vivekanand and Jonas, Jost B. and Karam, Nadim E. and Kasaeian, Amir and Kassa, Nega Assefa and Kaul, Anil and Khader, Yousef and Khalifa, Shams Eldin A. and Khan, Ejaz A. and Khan, Gulfaraz and Khoja, Tawfik and Khosravi, Ardeshir and Kinfu, Yohannes and Defo, Barthelemy Kuate and Balaji, Arjun Lakshmana and Lunevicius, Raimundas and Obermeyer, Carla Makhlouf and Malekzadeh, Reza and Mansourian, Morteza and Marcenes, Wagner and Farid, Habibolah Masoudi and Mehari, Alem and Mehio-Sibai, Abla and Memish, Ziad A and Mensah, George A. and Mohammad, Karzan A. and Nahas, Ziad and Nasher, Jamal T. and Nawaz, Haseeb and Nejjari, Chakib and Nisar, Muhammad Imran and Omer, Saad B. and Parsaeian, Mahboubeh and Peprah, Emmanuel K. and Pervaiz, Aslam and Pourmalek, Farshad and Qato, Dima M and Qorbani, Mostafa and Radfar, Amir and Rafay, Anwar and Rahimi, Kazem and Rahimi-Movaghar, Vafa and Rahman, Sajjad Ur and Rai, Rajesh K. and Rana, Saleem M. and Rao, Sowmya R. and Refaat, Amany H. and Resnikoff, Serge and Roshandel, Gholamreza and Saade, Georges and Saeedi, Mohammad Y. and Sahraian, Mohammad Ali and Saleh, Shadi and Sanchez-Riera, Lidia and Satpathy, Maheswar and Sepanlou, Sadaf G. and Setegn, Tesfaye and Shaheen, Amira and Shahraz, Saeid and Sheikhbahaei, Sara and Shishani, Kawkab and Sliwa, Karen and Tavakkoli, Mohammad and Terkawi, Abdullah S. and Uthman, Olalekan A. and Westerman, Ronny and Younis, Mustafa Z. and El Sayed Zaki, Maysaa and Zannad, Faiez and Roth, Gregory A. and Wang, Haidong and Naghavi, Mohsen and Vos, Theo and Al Rabeeah, Abdullah A. and Lopez, Alan D. and Murray, Christopher 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. ISSN 2214109X

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Summary 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.

Item Type: Journal Article
Faculty: Faculty of Medical Science
Depositing User: Ian Walker
Date Deposited: 27 Mar 2017 10:31
Last Modified: 30 Jun 2017 08:20

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