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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 Publisher Pubmed



Mokdad AH1 ; Forouzanfar MH1 ; Daoud F1 ; El Bcheraoui C1 ; Moradilakeh M1, 2 ; Khalil I1 ; Afshin A1 ; Tuffaha M1 ; Charara R1 ; Barber RM1 ; Wagner J1 ; Cercy K1 ; Kravitz H1 ; Coates MM1 Show All Authors
Authors
  1. Mokdad AH1
  2. Forouzanfar MH1
  3. Daoud F1
  4. El Bcheraoui C1
  5. Moradilakeh M1, 2
  6. Khalil I1
  7. Afshin A1
  8. Tuffaha M1
  9. Charara R1
  10. Barber RM1
  11. Wagner J1
  12. Cercy K1
  13. Kravitz H1
  14. Coates MM1
  15. Robinson M1
  16. Estep K1
  17. Steiner C1
  18. Jaber S1
  19. Mokdad AA4
  20. Orourke KF1
  21. Chew A1
  22. Kim P1
  23. El Razek MMA5
  24. Abdalla S6
  25. Abdallah F7
  26. Abraham JP8, 9
  27. Aburaddad LJ12
  28. Aburmeileh NME13
  29. Alnehmi AA14
  30. Akanda AS15
  31. Al Ahmadi H16
  32. Al Khabouri MJ17
  33. Al Lami FH18
  34. Al Rayess ZA19
  35. Alasfoor D17
  36. Albuhairan FS22, 23
  37. Aldhahri SF25, 27
  38. Alghnam S23, 28
  39. Alhabib S29
  40. Alhamad N30
  41. Ali R32
  42. Ali SD33, 34
  43. Alkhateeb M24
  44. Almazroa MA21
  45. Alomari MA35
  46. Alraddadi R21
  47. Alsharif U38
  48. Alsheyab N36
  49. Alsowaidi S39
  50. Althani M41
  51. Altirkawi KA25
  52. Amare AT42, 43
  53. Amini H45, 46, 47
  54. Ammar W48
  55. Anwari P49
  56. Asayesh H50
  57. Asghar R51
  58. Assabri AM52
  59. Assadi R53
  60. Bacha U54
  61. Badawi A55
  62. Bakfalouni T56
  63. Basulaiman MO21
  64. Bazarganhejazi S57
  65. Bedi N58
  66. Bhakta AR59
  67. Bhutta ZA62, 65
  68. Bin Abdulhak AA66
  69. Boufous S67
  70. Bourne RRA69
  71. Danawi H70
  72. Das J63
  73. Deribew A31, 71
  74. Ding EL11
  75. Durrani AM61
  76. Elshrek Y72
  77. Ibrahim ME20
  78. Eshrati B73, 74
  79. Esteghamati A75
  80. Faghmous IAD83
  81. Farzadfar F76
  82. Feigl AB10
  83. Fereshtehnejad SM86
  84. Filip I87
  85. Fischer F88
  86. Gankpe FG89, 90
  87. Ginawi I91
  88. Gishu MD92, 93
  89. Gupta R94
  90. Habash RM21
  91. Hafezinejad N75
  92. Hamadeh RR95
  93. Hamdouni H96
  94. Hamidi S97
  95. Harb HL48
  96. Hassanvand MS77
  97. Hedayati MT98
  98. Heydarpour P78
  99. Hsairi M99
  100. Husseini A100
  101. Jahanmehr N101
  102. Jha V102
  103. Jonas JB103
  104. Karam NE104
  105. Kasaeian A76, 79
  106. Kassa NA105
  107. Kaul A106
  108. Khader Y37
  109. Khalifa SEA41
  110. Khan EA107
  111. Khan G40
  112. Khoja T108
  113. Khosravi A76, 109
  114. Kinfu Y110
  115. Defo BK111, 112
  116. Balaji AL113
  117. Lunevicius R115, 116
  118. Obermeyer CM117
  119. Malekzadeh R80
  120. Mansourian M3
  121. Marcenes W121
  122. Farid HM122
  123. Mehari A123
  124. Mehiosibai A118
  125. Memish ZA21, 124
  126. Mensah GA60
  127. Mohammad KA125
  128. Nahas Z119
  129. Nasher JT126
  130. Nawaz H127
  131. Nejjari C128
  132. Nisar MI64
  133. Omer SB129
  134. Parsaeian M76, 81
  135. Peprah EK130
  136. Pervaiz A131
  137. Pourmalek F132
  138. Qato DM133
  139. Qorbani M134
  140. Radfar A135
  141. Rafay A136
  142. Rahimi K32
  143. Rahimimovaghar V82
  144. Rahman SU137
  145. Rai RK138
  146. Rana SM136, 139
  147. Rao SR140
  148. Refaat AH70, 141
  149. Resnikoff S68, 142
  150. Roshandel G80, 143
  151. Saade G144, 145
  152. Saeedi MY21
  153. Sahraian MA78
  154. Saleh S120
  155. Sanchezriera L146
  156. Satpathy M147
  157. Sepanlou SG80
  158. Setegn T44
  159. Shaheen A148
  160. Shahraz S149
  161. Sheikhbahaei S75
  162. Shishani K150
  163. Sliwa K151
  164. Tavakkoli M152
  165. Terkawi AS26, 153
  166. Uthman OA154
  167. Westerman R155, 156
  168. Younis MZ157
  169. El Sayed Zaki M158
  170. Zannad F84, 85
  171. Roth GA1
  172. Wang H1
  173. Naghavi M1
  174. Vos T1
  175. Al Rabeeah AA21
  176. Lopez AD1, 114
  177. Murray CJL1
Show Affiliations
Authors Affiliations
  1. 1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  2. 2. Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
  5. 5. Aswan University Hospital, Aswan Faculty of Medicine, Aswan, Egypt
  6. 6. Sudanese Public Health Consultancy Group, Solihull, United Kingdom
  7. 7. Department of Neurology, Cairo University, Cairo, Egypt
  8. 8. Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, United States
  9. 9. Institute for Global Health, Harvard University, Boston, MA, United States
  10. 10. Department of Global Health and Population, Harvard University, Boston, MA, United States
  11. 11. Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
  12. 12. Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
  13. 13. Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
  14. 14. Ministry of Health, Sana'a, Yemen
  15. 15. University of Rhode Island, Kingston, RI, United States
  16. 16. Majlis Al Shura, Riyadh, Saudi Arabia
  17. 17. Ministry of Health, Muscat, Oman
  18. 18. College of Medicine, University of Baghdad, Baghdad, Iraq
  19. 19. The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia
  20. 20. Cardiovascular Diseases Control and Prevention Program, Riyadh, Saudi Arabia
  21. 21. Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
  22. 22. King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  23. 23. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  24. 24. Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia
  25. 25. King Saud University, Riyadh, Saudi Arabia
  26. 26. Department of Anesthesiology, Riyadh, Saudi Arabia
  27. 27. King Fahad Medical City, Riyadh, Saudi Arabia
  28. 28. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
  29. 29. King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
  30. 30. Public Authority for Food and Nutrition, Kuwait
  31. 31. Nuffield Department of Medicine, Oxford, United Kingdom
  32. 32. University of Oxford, Oxford, United Kingdom
  33. 33. University of London, London, United Kingdom
  34. 34. Institute and Faculty of Actuaries, Oxford, United Kingdom
  35. 35. Division of Physical Therapy, Department of Rehabilitation Sciences, Irbid, Jordan
  36. 36. Maternal and Child Health Department, Irbid, Jordan
  37. 37. Jordan University of Science and Technology, Irbid, Jordan
  38. 38. Charite Universitatsmedizin, Berlin, Germany
  39. 39. Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
  40. 40. Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
  41. 41. Supreme Council of Health, Doha, Qatar
  42. 42. Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
  43. 43. College of Medicine and Health Sciences, Bahir Dar, Ethiopia
  44. 44. Bahir Dar University, Bahir Dar, Ethiopia
  45. 45. Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
  46. 46. Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
  47. 47. University of Basel, Basel, Switzerland
  48. 48. Ministry of Public Health, Beirut, Lebanon
  49. 49. Kabul, Afghanistan
  50. 50. Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran
  51. 51. South Asian Public Health Forum, Islamabad, Pakistan
  52. 52. Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
  53. 53. Mashhad University of Medical Sciences, Mashhad, Iran
  54. 54. School of Health Sciences, University of Management and Technology, Lahore, Pakistan
  55. 55. Public Health Agency of Canada, Toronto, ON, Canada
  56. 56. Ministry of Health, Damascus, Syrian Arab Republic
  57. 57. Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
  58. 58. College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
  59. 59. National Institute of Mental Health, Montgomery Village, MD, United States
  60. 60. Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Montgomery Village, MD, United States
  61. 61. National Institutes of Health, Montgomery Village, MD, United States
  62. 62. Centre of Excellence in Women and Child Health, Karachi, Pakistan
  63. 63. Department of Paediatrics and Child Health, Karachi, Pakistan
  64. 64. Aga Khan University, Karachi, Pakistan
  65. 65. Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
  66. 66. University of Iowa Hospitals and Clinics, Iowa City, IA, United States
  67. 67. Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia
  68. 68. Brien Holden Vision Institute, University of New South Wales, Sydney, NSW, Australia
  69. 69. Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom
  70. 70. Walden University, Minneapolis, MN, United States
  71. 71. KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
  72. 72. Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya
  73. 73. Ministry of Health and Medical Education, Tehran, Iran
  74. 74. Arak University of Medical Sciences, Arak, Iran
  75. 75. Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
  76. 76. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
  77. 77. Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
  78. 78. Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  79. 79. Hematology–Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  80. 80. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  81. 81. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  82. 82. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  83. 83. London School of Hygiene and Tropical Medicine, London, United Kingdom
  84. 84. Clinical Investigation Centre INSERM, Universite de Lorraine, Vandoeuvre les Nancy, France
  85. 85. CHU de Nancy, Vandoeuvre les Nancy, France
  86. 86. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
  87. 87. Kaiser Permanente Psychiatry Residency Program, Fontana, CA, United States
  88. 88. Bielefeld University, Bielefeld, Germany
  89. 89. Leras Afrique, Cotonou, Benin
  90. 90. CHU Hassan II, Fez, Morocco
  91. 91. College of Medicine, University of Hail, Hail, Saudi Arabia
  92. 92. Haramaya University, Dira Dawa, Ethiopia
  93. 93. Kersa Health and Demographic Surveillance System, Harar, Ethiopia
  94. 94. West Virginia Bureau for Public Health, Charleston, WV, United States
  95. 95. Arabian Gulf University, Manama, Bahrain
  96. 96. Direction des Soins de Sante de Base, Ministry of Health, Tunis, Tunisia
  97. 97. Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  98. 98. Department of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, Iran
  99. 99. Salah Azaiz Institute, Tunis, Tunisia
  100. 100. Qatar University, Doha, Qatar
  101. 101. School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  102. 102. The George Institute for Global Health India, University of Oxford, New Delhi, India
  103. 103. Ruprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany
  104. 104. University of Balamand, Beirut, Lebanon
  105. 105. Haramaya University, Harari, Ethiopia
  106. 106. Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
  107. 107. Health Services Academy, Islamabad, Pakistan
  108. 108. Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
  109. 109. Iranian Ministry of Health and Medical Education, Tehran, Iran
  110. 110. Centre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
  111. 111. Department of Demography and Public Health Research Institute, University of Montreal, Montreal, QC, Canada
  112. 112. Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
  113. 113. Indegene, Bangalore, India
  114. 114. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  115. 115. Aintree University Hospital National Health Service Foundation Trust, Liverpool, United Kingdom
  116. 116. School of Medicine, University of Liverpool, Liverpool, United Kingdom
  117. 117. Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  118. 118. Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  119. 119. Medical Center, American University of Beirut, Beirut, Lebanon
  120. 120. Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
  121. 121. Queen Mary University of London, London, United Kingdom
  122. 122. State Welfare Organisation, Tehran, Iran
  123. 123. Howard University College of Medicine, Washington, DC, United States
  124. 124. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  125. 125. University of Salahaddin, Erbil, Iraq
  126. 126. Ministry of Public Health and Population, Sana'a, Yemen
  127. 127. Southern Illinois University, Springfield, IL, United States
  128. 128. Faculty of Medicine, Fez, Morocco
  129. 129. Emory University, Atlanta, GA, United States
  130. 130. National Heart, Lung, and Blood Institute, Bethesda, MD, United States
  131. 131. Postgraduate Medical Institute, Lahore, Pakistan
  132. 132. University of British Columbia, Vancouver, BC, Canada
  133. 133. College of Pharmacy, University of Illinois, Chicago, IL, United States
  134. 134. Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
  135. 135. A T Still University of Health Sciences, Kirksville, MO, United States
  136. 136. Contech International Health Consultants, Lahore, Pakistan
  137. 137. Hamad Medical Corporation, Doha, Qatar
  138. 138. Society for Health and Demographic Surveillance, Suri, India
  139. 139. Contech School of Public Health, Lahore, Pakistan
  140. 140. Department of Surgery, Boston University School of Medicine, Boston, MA, United States
  141. 141. Suez Canal University, Ismailia, Egypt
  142. 142. International Health and Development, Geneva, Switzerland
  143. 143. Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
  144. 144. Lebanese University, Beirut, Lebanon
  145. 145. Bellevue Medical Center, Mansourieh El Metn, Lebanon
  146. 146. Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
  147. 147. All India Institute of Medical Sciences, New Delhi, India
  148. 148. Department of Public Health, An-Najah University, Nablus, Palestine
  149. 149. Tufts Medical Center, Boston, MA, United States
  150. 150. Washington State University, Spokane, WA, United States
  151. 151. Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
  152. 152. Westchester Medical Center, Valhalla, NY, United States
  153. 153. Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States
  154. 154. Warwick Medical School, University of Warwick, Coventry, United Kingdom
  155. 155. Federal Institute for Population Research, Wiesbaden, Germany
  156. 156. German National Cohort Consortium, Heidelberg, Germany
  157. 157. Jackson State University, Jackson, MS, United States
  158. 158. Faculty of Medicine, Mansoura University, Mansoura, Egypt

Source: The Lancet Global Health Published:2016


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. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
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