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; 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 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; 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

doi:10.1016/S2214-109X(16)30168-1

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

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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, …

The Lancet global health, Vol.4(10), pp.e704-e713

01/10/2016

DOI: https://doi.org/10.1016/S2214-109X(16)30168-1

PMCID: PMC6660972

PMID: 27568068

Abstract

Adult

Africa - epidemiology

Aged

Aged, 80 and over

Aging

Cardiovascular Diseases - epidemiology

Child

Child, Preschool

Diarrhea - epidemiology

Global Burden of Disease - trends

Humans

Infant

Infant, Newborn

Infection - epidemiology

Life Expectancy

Middle Aged

Middle East - epidemiology

Noncommunicable Diseases - epidemiology

Obesity - complications

Obesity - epidemiology

Quality-Adjusted Life Years

Risk Factors

Social Problems

Wounds and Injuries - epidemiology

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. 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. 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. 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. Bill & Melinda Gates Foundation.

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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
Creators - without role: Ali H Mokdad - University of Washington
Mohammad Hossein Forouzanfar - University of Washington
Farah Daoud - University of Washington
Charbel El Bcheraoui - University of Washington
Maziar Moradi-Lakeh
Ibrahim Khalil - University of Washington
Ashkan Afshin - University of Washington
Marwa Tuffaha - University of Washington
Raghid Charara - University of Washington
Ryan M Barber - University of Washington
Joseph Wagner - University of Washington
Kelly Cercy - University of Washington
Hannah Kravitz - University of Washington
Matthew M Coates - University of Washington
Margaret Robinson - University of Washington
Kara Estep - University of Washington
Caitlyn Steiner - University of Washington
Sara Jaber - University of Washington
Ali A Mokdad - The University of Texas Southwestern Medical Center
Kevin F O'Rourke - University of Washington
Adrienne Chew - University of Washington
Pauline Kim - University of Washington
Mohamed Magdy Abd El Razek - Aswan University
Safa Abdalla - Sudanese Public Health Consultancy Group, Solihull, UK
Foad Abd-Allah - Cairo University
Jerry P Abraham
Laith J Abu-Raddad - Weill Cornell Medical College in Qatar
Niveen M E Abu-Rmeileh - Birzeit University
Abdulwahab A Al-Nehmi - Ministry of Health, Sana'a, Yemen
Ali S Akanda - University of Rhode Island
Hanan Al Ahmadi - Majlis Al Shura, Riyadh, Saudi Arabia
Mazin J Al Khabouri - Ministry of Health, Muscat, Oman
Faris H Al Lami - University of Baghdad
Zulfa A Al Rayess - Evidence
Deena Alasfoor - Ministry of Health, Muscat, Oman
Fadia S AlBuhairan
Saleh F Aldhahri
Suliman Alghnam
Samia Alhabib - King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
Nawal Al-Hamad - Public Authority for Food and Nutrition, Kuwait
Raghib Ali - University of Oxford
Syed Danish Ali
Mohammad Alkhateeb - King Khalid University Hospital
Mohammad A AlMazroa - Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
Mahmoud A Alomari - Division of Physical Therapy, Department of Rehabilitation Sciences, Irbid, Jordan
Rajaa Al-Raddadi - Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
Ubai Alsharif - Charité - Universitätsmedizin Berlin
Nihaya Al-Sheyab - Maternal and Child Health Department, Irbid, Jordan
Shirina Alsowaidi - United Arab Emirates University
Mohamed Al-Thani - Supreme Council Of Health
Khalid A Altirkawi - King Saud University
Azmeraw T Amare
Heresh Amini
Walid Ammar - Ministry of Public Health, Beirut, Lebanon
Palwasha Anwari - Kabul, Afghanistan
Hamid Asayesh - EMERGENCY
Rana Asghar - Forum
Ali M Assabri - Sana'a University
Reza Assadi - Mashhad University of Medical Sciences
Umar Bacha - School of Health Sciences, University of Management and Technology, Lahore, Pakistan
Alaa Badawi - Public Health Agency of Canada, Toronto, ON, Canada
Talal Bakfalouni - Ministry of Health, Damascus, Syria
Mohammed O Basulaiman - Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
Shahrzad Bazargan-Hejazi - Charles R. Drew University of Medicine and Science
Neeraj Bedi - College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
Amit R Bhakta - National Institute of Mental Health, Montgomery Village, MD, USA
Zulfiqar A Bhutta
Aref A Bin Abdulhak - University of Iowa Hospitals and Clinics
Soufiane Boufous - UNSW Sydney
Rupert R A Bourne - Anglia Ruskin University
Hadi Danawi - Walden University
Jai Das - Department of Paediatrics and Child Health, Karachi, Pakistan
Amare Deribew
Eric L Ding - Harvard University
Adnan M Durrani - National Institutes of Health
Yousef Elshrek - University of Tripoli
Mohamed E Ibrahim - Cardiovascular Diseases Control and Prevention Program, Riyadh, Saudi Arabia
Babak Eshrati
Alireza Esteghamati - Tehran University of Medical Sciences
Imad A D Faghmous - London School of Hygiene & Tropical Medicine
Farshad Farzadfar - Tehran University of Medical Sciences
Andrea B Feigl - Harvard University
Seyed-Mohammad Fereshtehnejad - Karolinska Institutet
Irina Filip - Kaiser Permanente
Florian Fischer - Bielefeld University
Fortuné G Gankpé
Ibrahim Ginawi - University of Ha'il
Melkamu Dedefo Gishu
Rahul Gupta - West Virginia Bureau for Public Health, Charleston, WV, USA
Rami M Habash - Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
Nima Hafezi-Nejad - Tehran University of Medical Sciences
Randah R Hamadeh - Arabian Gulf University
Hayet Hamdouni - Direction des Soins de Santé de Base, Ministry of Health, Tunis, Tunisia
Samer Hamidi - Hamdan Bin Mohammed Smart University
Hilda L Harb - Ministry of Public Health, Beirut, Lebanon
Mohammad Sadegh Hassanvand - Tehran University of Medical Sciences
Mohammad T Hedayati - Department of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, Iran
Pouria Heydarpour - Tehran University of Medical Sciences
Mohamed Hsairi - Salah Azaiz Institute, Tunis, Tunisia
Abdullatif Husseini - Qatar University
Nader Jahanmehr - Shahid Beheshti University of Medical Sciences
Vivekanand Jha - University of Oxford
Jost B Jonas - Heidelberg
Nadim E Karam - University of Balamand
Amir Kasaeian
Nega Assefa Kassa - Haramaya University
Anil Kaul - Oklahoma State University Center for Health Sciences
Yousef Khader - Jordan University of Science and Technology
Shams Eldin A Khalifa - Supreme Council Of Health
Ejaz A Khan - Health Services Academy, Islamabad, Pakistan
Gulfaraz Khan - United Arab Emirates University
Tawfik Khoja - Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
Ardeshir Khosravi
Yohannes Kinfu - University of Canberra
Barthelemy Kuate Defo
Arjun Lakshmana Balaji - Indegene, Bangalore, India
Raimundas Lunevicius
Carla Makhlouf Obermeyer - American University of Beirut
Reza Malekzadeh - Tehran University of Medical Sciences
Morteza Mansourian - Iran University of Medical Sciences
Wagner Marcenes - Queen Mary University of London
Habibolah Masoudi Farid - State Welfare Organisation, Tehran, Iran
Alem Mehari - Howard University
Abla Mehio-Sibai - American University of Beirut
Ziad A Memish
George A Mensah - National Heart Lung and Blood Institute
Karzan A Mohammad - University of Salahaddin, Erbil, Iraq
Ziad Nahas - American University of Beirut
Jamal T Nasher - Ministry of Public Health and Population, Sana'a, Yemen
Haseeb Nawaz - Southern Illinois University, Springfield, IL, USA
Chakib Nejjari - Faculty
Muhammad Imran Nisar - Aga Khan University, Karachi, Pakistan
Saad B Omer - Emory University
Mahboubeh Parsaeian
Emmanuel K Peprah - National Heart Lung and Blood Institute
Aslam Pervaiz - Postgraduate Medical Institute, Lahore, Pakistan
Farshad Pourmalek - University of British Columbia
Dima M Qato - University of Illinois Urbana-Champaign
Mostafa Qorbani - Alborz University of Medical Sciences
Amir Radfar - A.T. Still University
Anwar Rafay - Contech
Kazem Rahimi - University of Oxford
Vafa Rahimi-Movaghar - Tehran University of Medical Sciences
Sajjad Ur Rahman - Hamad Medical Corporation
Rajesh K Rai - Society for Health and Demographic Surveillance, Suri, India
Saleem M Rana
Sowmya R Rao - Boston University School of Medicine
Amany H Refaat
Serge Resnikoff
Gholamreza Roshandel
Georges Saade
Mohammad Y Saeedi - Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
Mohammad Ali Sahraian - Tehran University of Medical Sciences
Shadi Saleh - American University of Beirut
Lidia Sanchez-Riera - Institut d'Investigació Biomédica de Bellvitge
Maheswar Satpathy - All India Institute of Medical Sciences
Sadaf G Sepanlou - Tehran University of Medical Sciences
Tesfaye Setegn - Bahir Dar University
Amira Shaheen - Department of Public Health, An-Najah University, Nablus, Palestine
Saeid Shahraz - Tufts Medical Center
Sara Sheikhbahaei - Tehran University of Medical Sciences
Kawkab Shishani - Washington State University Spokane
Karen Sliwa - University of Cape Town
Mohammad Tavakkoli - Westchester Medical Center
Abdullah S Terkawi
Olalekan A Uthman - University of Warwick
Ronny Westerman
Mustafa Z Younis - Jackson State University
Maysaa El Sayed Zaki - Mansoura University
Faiez Zannad
Gregory A Roth - University of Washington
Haidong Wang - University of Washington
Mohsen Naghavi - University of Washington
Theo Vos - University of Washington
Abdullah A Al Rabeeah - Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
Alan D Lopez
Christopher J L Murray - University of Washington
Publication Details: The Lancet global health, Vol.4(10), pp.e704-e713
Grant note: 203077 / Wellcome Trust
Identifiers: 9913468008331
Academic Unit: Alfaisal University; King Abdulaziz University; King Saud University; King Saud Bin Abdulaziz University for Health Sciences
Language: English
Resource Type: Journal article