The state of health in the Arab world, 1990-2010: an analysis of the burden of diseases, injuries, and risk factors

Ali H Mokdad, Sara Jaber, Muna I Abdel Aziz, Fadia AlBuhairan, Abduljabbar AlGhaithi, Nawal M AlHamad, Suad N Al-Hooti, Adel Al-Jasari, Mohammad A AlMazroa, Ahmed Mohamed AlQasmi, Shirina Alsowaidi, Majed Asad, Charles Atkinson, Alaa Badawi, Talal Bakfalouni, AbdelAziz Barkia, Stan Biryukov, Charbel El Bcheraoui, Farah Daoud, Mohammad Hossein Forouzanfar, Diego Gonzalez-Medina, Randah R Hamadeh, Mohamed Hsairi, Seifeddin Saleh Hussein, Nadim Karam, Shams Eldin Ali Hassan Khalifa, Tawfik A M Khoja, Faris Lami, Katherine Leach-Kemon, Ziad A Memish, Ali A Mokdad, Mohsen Naghavi, Jamal Nasher, M Bassam Hijawi Qasem, Mohammad Shuaib, Al Anoud M Al Thani, Mohamed H Al Thani, Mohammed Zamakhshary, Alan D Lopez, Christopher J L Murray
Lancet 2014 January 25, 383 (9914): 309-20

BACKGROUND: The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010).

METHODS: We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010.

FINDINGS: Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases--especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis--increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place.

INTERPRETATION: Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world--although these disorders do still persist in LICs--whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed.

FUNDING: Bill & Melinda Gates Foundation.

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