Monday, August 29, 2016

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013

 2016 Aug 24. pii: S2214-109X(16)30168-1. doi: 10.1016/S2214-109X(16)30168-1. [Epub ahead of print]

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

Mokdad AHForouzanfar MHDaoud FEl Bcheraoui CMoradi-Lakeh MKhalil IAfshin ATuffaha MCharara RBarber RMWagner JCercy KKravitz H,Coates MMRobinson MEstep KSteiner CJaber SMokdad AAO'Rourke KFChew AKim PEl Razek MMAbdalla SAbd-Allah FAbraham JPAbu-Raddad LJAbu-Rmeileh NMAl-Nehmi AAAkanda ASAl Ahmadi HAl Khabouri MJAl Lami FHAl Rayess ZAAlasfoor DAlBuhairan FSAldhahri SF,Alghnam SAlhabib SAl-Hamad NAli RAli SDAlkhateeb MAlMazroa MAAlomari MAAl-Raddadi RAlsharif UAl-Sheyab NAlsowaidi SAl-Thani M,Altirkawi KAAmare ATAmini HAmmar WAnwari PAsayesh HAsghar RAssabri AMAssadi RBacha UBadawi ABakfalouni TBasulaiman MO,Bazargan-Hejazi SBedi NBhakta ARBhutta ZAAbdulhak AABoufous SBourne RRDanawi HDas JDeribew ADing ELDurrani AMElshrek Y,Ibrahim MEEshrati BEsteghamati AFaghmous IAFarzadfar FFeigl ABFereshtehnejad SMFilip IFischer FGankpé FGGinawi IGishu MDGupta R,Habash RMHafezi-Nejad NHamadeh RRHamdouni HHamidi SHarb HLHassanvand MSHedayati MTHeydarpour PHsairi MHusseini A,Jahanmehr NJha VJonas JBKaram NEKasaeian AKassa NAKaul AKhader YKhalifa SEKhan EAKhan GKhoja TKhosravi AKinfu YDefo BK,Balaji ALLunevicius RObermeyer CMMalekzadeh RMansourian MMarcenes WFarid HMMehari AMehio-Sibai AMemish ZAMensah GA,Mohammad KANahas ZNasher JTNawaz HNejjari CNisar MIOmer SBParsaeian MPeprah EKPervaiz APourmalek FQato DMQorbani M,Radfar ARafay ARahimi KRahimi-Movaghar VRahman SURai RKRana SMRao SRRefaat AHResnikoff SRoshandel GSaade GSaeedi MY,Sahraian MASaleh SSanchez-Riera LSatpathy MSepanlou SGSetegn TShaheen AShahraz SSheikhbahaei SShishani KSliwa KTavakkoli M,Terkawi ASUthman OAWesterman RYounis MZEl Sayed Zaki MZannad FRoth GAWang HNaghavi MVos TAl Rabeeah AALopez ADMurray CJ.

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.

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