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Increasing Burden of Lower-Extremity Fractures in the Middle East and North Africa (Mena) a 30-Year Epidemiological Analysis Publisher Pubmed



Hoveidaei AH1 ; Nakhostinansari A1 ; Heckmann ND2 ; Hosseiniasl SH3 ; Khonji MS4 ; Razi M5 ; Mahdaviani B1 ; Kistler NM2 ; Aiyer AA6
Authors
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Authors Affiliations
  1. 1. Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Orthopaedic Surgery, Keck School of Medicine, the University of Southern California, Los Angeles, CA, United States
  3. 3. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States

Source: Journal of Bone and Joint Surgery Published:2024


Abstract

Background: Lower-extremity fractures (LEFs) account for >30% of all skeletal injuries, contributing to the global health and economic burden. Fracture epidemiology in the Middle East and North Africa (MENA) region has been studied little. Health factors and disease epidemiology differ greatly among populations in MENA despite cultural, political, and economic similarities among the region’s countries. This study examined the epidemiology of LEFs and the need for rehabilitation in MENA from 1990 to 2019. Methods: We examined the epidemiology of fractures of the pelvis, hip, femur, patella, tibia, fibula, ankle, and foot bones using Global Burden of Disease (GBD) data. Fracture incidence, counts, and rates were measured for males and females across age groups in the 21 MENA countries as identified by the GBD data set. Associations between years of healthy life lost due to disability (YLD) resulting from fracture and the Socio-demographic Index (SDI) were analyzed. Results: In contrast to the global trend, the age-standardized incidence rate (ASIR) of LEFs in the MENA region increased by 4.57% from 1990 to 2019. In 2019, the highest ASIR among fractures was attributed to fractures of the patella, fibula, tibia, or ankle (434.36 per 100,000), most frequently occurring among those 20 to 24 years of age. In 2019, the highest ASIR of all fractures was noted in Saudi Arabia (2,010.56 per 100,000) and the lowest, in Sudan (523.29 per 100,000). The greatest increases from 1990 to 2019 in the ASIR of LEFs were noted in Yemen (132.39%), Syria (107.27%), and Afghanistan (94.47%), while the largest decreases were found in Kuwait (262.72%), Sudan (248.72%), and Iran (245.37%). In 2019, the YLD rate of LEFs had increased to 277.65 per 100,000, up from 235.55 per 100,000 in 1990. Conclusions: Between 1990 and 2019, LEFs increased in the MENA region. Violence, war, and road traffic accidents increased, leading to a high rate of fractures, especially among youth. Low bone-mineral density related to vitamin D deficiency has also been reported as a risk factor for fracture in the region. Regional health authorities should be informed of fracture patterns by this study. © 2024 Lippincott Williams and Wilkins. All rights reserved.
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