dc.description.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systematic reviews and through the contribution of unpublished data sources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.
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