The Lancet Global Health (Oct 2016)
Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
- Prof. Ali H Mokdad, PhD,
- Mohammad Hossein Forouzanfar, PhD,
- Farah Daoud, BS,
- Charbel El Bcheraoui, PhD,
- Maziar Moradi-Lakeh, MD,
- Ibrahim Khalil, MD,
- Ashkan Afshin, DSc,
- Marwa Tuffaha, MD,
- Raghid Charara, MD,
- Ryan M Barber, BS,
- Joseph Wagner, BS,
- Kelly Cercy, BS,
- Hannah Kravitz, BS,
- Matthew M Coates, BA,
- Margaret Robinson, BA,
- Kara Estep, MPA,
- Caitlyn Steiner, MPH,
- Sara Jaber, MD,
- Ali A Mokdad, MD,
- Kevin F O'Rourke, MFA,
- Adrienne Chew, ND,
- Pauline Kim, BA,
- Mohamed Magdy Abd El Razek, MBBCh,
- Safa Abdalla, MD,
- Prof. Foad Abd-Allah, MD,
- Jerry P Abraham, MD,
- Laith J Abu-Raddad, PhD,
- Niveen M E Abu-Rmeileh, PhD,
- Abdulwahab A Al-Nehmi, MD,
- Ali S Akanda, PhD,
- Hanan Al Ahmadi, DrPH,
- Mazin J Al Khabouri, PhD,
- Faris H Al Lami, PhD,
- Zulfa A Al Rayess, ABFM,
- Deena Alasfoor, MSc,
- Fadia S AlBuhairan, MD,
- Saleh F Aldhahri, MD,
- Suliman Alghnam, PhD,
- Samia Alhabib, PhD,
- Nawal Al-Hamad, PhD,
- Raghib Ali, FRCP,
- Syed Danish Ali, BA,
- Mohammad Alkhateeb, RN,
- Mohammad A AlMazroa, MD,
- Mahmoud A Alomari, PhD,
- Rajaa Al-Raddadi, PhD,
- Ubai Alsharif, MPH,
- Nihaya Al-Sheyab, PhD,
- Shirina Alsowaidi, FRCPC,
- Mohamed Al-Thani, FRCPCH,
- Khalid A Altirkawi, MD,
- Azmeraw T Amare, MPH,
- Heresh Amini, MSPH,
- Walid Ammar, PhD,
- Palwasha Anwari, MD,
- Hamid Asayesh, PhD,
- Rana Asghar, MD,
- Prof. Ali M Assabri, PhD,
- Reza Assadi, PhD,
- Umar Bacha, PhM,
- Alaa Badawi, PhD,
- Talal Bakfalouni, MD,
- Mohammed O Basulaiman, PhD,
- Shahrzad Bazargan-Hejazi, PhD,
- Neeraj Bedi, MD,
- Amit R Bhakta, MD,
- Zulfiqar A Bhutta, PhD,
- Aref A Bin Abdulhak, MD,
- Soufiane Boufous, PhD,
- Rupert R A Bourne, FRCOphth,
- Hadi Danawi, PhD,
- Jai Das, MBA,
- Amare Deribew, PhD,
- Eric L Ding, ScD,
- Adnan M Durrani, MD,
- Yousef Elshrek, PhD,
- Mohamed E Ibrahim, MPhil,
- Babak Eshrati, PhD,
- Alireza Esteghamati, MD,
- Imad A D Faghmous, MPH,
- Farshad Farzadfar, MD,
- Andrea B Feigl, ScD,
- Seyed-Mohammad Fereshtehnejad, MD,
- Irina Filip, MD,
- Florian Fischer, MPH,
- Fortuné G Gankpé, MD,
- Ibrahim Ginawi, MD,
- Melkamu Dedefo Gishu, MS,
- Rahul Gupta, MD,
- Rami M Habash, MPH,
- Nima Hafezi-Nejad, MD,
- Prof. Randah R Hamadeh, DPhil,
- Hayet Hamdouni, PhD,
- Samer Hamidi, PhD,
- Hilda L Harb, MPH,
- Mohammad Sadegh Hassanvand, PhD,
- Mohammad T Hedayati, PhD,
- Pouria Heydarpour, MD,
- Prof. Mohamed Hsairi, MD,
- Abdullatif Husseini, PhD,
- Nader Jahanmehr, PhD,
- Prof. Vivekanand Jha, DM,
- Jost B Jonas, MD,
- Nadim E Karam, MD,
- Amir Kasaeian, PhD,
- Nega Assefa Kassa, PhD,
- Anil Kaul, MD,
- Prof. Yousef Khader, ScD,
- Shams Eldin A Khalifa, MSc,
- Ejaz A Khan, MPH,
- Gulfaraz Khan, PhD,
- Tawfik Khoja, FRCP,
- Ardeshir Khosravi, PhD,
- Yohannes Kinfu, PhD,
- Barthelemy Kuate Defo, PhD,
- Arjun Lakshmana Balaji, MPH,
- Raimundas Lunevicius, PhD,
- Prof. Carla Makhlouf Obermeyer, DSc,
- Reza Malekzadeh, MD,
- Morteza Mansourian, PhD,
- Prof. Wagner Marcenes, PhD,
- Habibolah Masoudi Farid, MD,
- Alem Mehari, MD,
- Abla Mehio-Sibai, PhD,
- Prof. Ziad A Memish, MD,
- George A Mensah, MD,
- Karzan A Mohammad, PhD,
- Prof. Ziad Nahas, MD,
- Jamal T Nasher, MSc,
- Haseeb Nawaz, MD,
- Prof. Chakib Nejjari, PhD,
- Muhammad Imran Nisar, MSc,
- Saad B Omer, PhD,
- Mahboubeh Parsaeian, PhD,
- Emmanuel K Peprah, PhD,
- Aslam Pervaiz, MHA,
- Farshad Pourmalek, PhD,
- Prof. Dima M Qato, PhD,
- Mostafa Qorbani, PhD,
- Amir Radfar, MD,
- Anwar Rafay, MS,
- Kazem Rahimi, DM,
- Vafa Rahimi-Movaghar, MD,
- Sajjad Ur Rahman, FRCPCH,
- Rajesh K Rai, MPH,
- Prof. Saleem M Rana, PhD,
- Sowmya R Rao, PhD,
- Amany H Refaat, PhD,
- Serge Resnikoff, MD,
- Gholamreza Roshandel, PhD,
- Georges Saade, MD,
- Mohammad Y Saeedi, PhD,
- Mohammad Ali Sahraian, MD,
- Shadi Saleh, PhD,
- Lidia Sanchez-Riera, PhD,
- Maheswar Satpathy, PhD,
- Sadaf G Sepanlou, MD,
- Tesfaye Setegn, MPH,
- Amira Shaheen, PhD,
- Saeid Shahraz, PhD,
- Sara Sheikhbahaei, MD,
- Kawkab Shishani, PhD,
- Prof. Karen Sliwa, PhD,
- Mohammad Tavakkoli, MD,
- Abdullah S Terkawi, MD,
- Olalekan A Uthman, PhD,
- Ronny Westerman, PhD,
- Mustafa Z Younis, DrPH,
- Prof. Maysaa El Sayed Zaki, PhD,
- Faiez Zannad, MD,
- Gregory A Roth, MD,
- Haidong Wang, PhD,
- Prof. Mohsen Naghavi, PhD,
- Prof. Theo Vos, PhD,
- Abdullah A Al Rabeeah, MBBS,
- Prof. Alan D Lopez, PhD,
- Prof. Christopher J L Murray, DPhil
Affiliations
- Prof. Ali H Mokdad, PhD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Mohammad Hossein Forouzanfar, PhD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Farah Daoud, BS
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Charbel El Bcheraoui, PhD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Maziar Moradi-Lakeh, MD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Ibrahim Khalil, MD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Ashkan Afshin, DSc
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Marwa Tuffaha, MD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Raghid Charara, MD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Ryan M Barber, BS
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Joseph Wagner, BS
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Kelly Cercy, BS
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Hannah Kravitz, BS
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Matthew M Coates, BA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Margaret Robinson, BA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Kara Estep, MPA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Caitlyn Steiner, MPH
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Sara Jaber, MD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Ali A Mokdad, MD
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Kevin F O'Rourke, MFA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Adrienne Chew, ND
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Pauline Kim, BA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Mohamed Magdy Abd El Razek, MBBCh
- Aswan University Hospital, Aswan Faculty of Medicine, Aswan, Egypt
- Safa Abdalla, MD
- Sudanese Public Health Consultancy Group, Solihull, UK
- Prof. Foad Abd-Allah, MD
- Department of Neurology, Cairo University, Cairo, Egypt
- Jerry P Abraham, MD
- Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USA
- Laith J Abu-Raddad, PhD
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
- Niveen M E Abu-Rmeileh, PhD
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
- Abdulwahab A Al-Nehmi, MD
- Ministry of Health, Sana'a, Yemen
- Ali S Akanda, PhD
- University of Rhode Island, Kingston, RI, USA
- Hanan Al Ahmadi, DrPH
- Majlis Al Shura, Riyadh, Saudi Arabia
- Mazin J Al Khabouri, PhD
- Ministry of Health, Muscat, Oman
- Faris H Al Lami, PhD
- College of Medicine, University of Baghdad, Baghdad, Iraq
- Zulfa A Al Rayess, ABFM
- The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia
- Deena Alasfoor, MSc
- Ministry of Health, Muscat, Oman
- Fadia S AlBuhairan, MD
- King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Saleh F Aldhahri, MD
- King Saud University, Riyadh, Saudi Arabia
- Suliman Alghnam, PhD
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Samia Alhabib, PhD
- King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
- Nawal Al-Hamad, PhD
- Public Authority for Food and Nutrition, Kuwait
- Raghib Ali, FRCP
- University of Oxford, Oxford, UK
- Syed Danish Ali, BA
- University of London, London, UK
- Mohammad Alkhateeb, RN
- Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia
- Mohammad A AlMazroa, MD
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
- Mahmoud A Alomari, PhD
- Division of Physical Therapy, Department of Rehabilitation Sciences, Irbid, Jordan
- Rajaa Al-Raddadi, PhD
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
- Ubai Alsharif, MPH
- Charité Universitätsmedizin, Berlin, Germany
- Nihaya Al-Sheyab, PhD
- Maternal and Child Health Department, Irbid, Jordan
- Shirina Alsowaidi, FRCPC
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Mohamed Al-Thani, FRCPCH
- Supreme Council of Health, Doha, Qatar
- Khalid A Altirkawi, MD
- King Saud University, Riyadh, Saudi Arabia
- Azmeraw T Amare, MPH
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Heresh Amini, MSPH
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Walid Ammar, PhD
- Ministry of Public Health, Beirut, Lebanon
- Palwasha Anwari, MD
- Kabul, Afghanistan
- Hamid Asayesh, PhD
- Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran
- Rana Asghar, MD
- South Asian Public Health Forum, Islamabad, Pakistan
- Prof. Ali M Assabri, PhD
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
- Reza Assadi, PhD
- Mashhad University of Medical Sciences, Mashhad, Iran
- Umar Bacha, PhM
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
- Alaa Badawi, PhD
- Public Health Agency of Canada, Toronto, ON, Canada
- Talal Bakfalouni, MD
- Ministry of Health, Damascus, Syria
- Mohammed O Basulaiman, PhD
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
- Shahrzad Bazargan-Hejazi, PhD
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Neeraj Bedi, MD
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
- Amit R Bhakta, MD
- National Institute of Mental Health, Montgomery Village, MD, USA
- Zulfiqar A Bhutta, PhD
- Centre of Excellence in Women and Child Health, Karachi, Pakistan
- Aref A Bin Abdulhak, MD
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Soufiane Boufous, PhD
- Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia
- Rupert R A Bourne, FRCOphth
- Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, UK
- Hadi Danawi, PhD
- Walden University, Minneapolis, MN, USA
- Jai Das, MBA
- Department of Paediatrics and Child Health, Karachi, Pakistan
- Amare Deribew, PhD
- Nuffield Department of Medicine, Oxford, UK
- Eric L Ding, ScD
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Adnan M Durrani, MD
- National Institutes of Health, Montgomery Village, MD, USA
- Yousef Elshrek, PhD
- Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya
- Mohamed E Ibrahim, MPhil
- Cardiovascular Diseases Control and Prevention Program, Riyadh, Saudi Arabia
- Babak Eshrati, PhD
- Ministry of Health and Medical Education, Tehran, Iran
- Alireza Esteghamati, MD
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Imad A D Faghmous, MPH
- London School of Hygiene & Tropical Medicine, London, UK
- Farshad Farzadfar, MD
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Andrea B Feigl, ScD
- Department of Global Health and Population, Harvard University, Boston, MA, USA
- Seyed-Mohammad Fereshtehnejad, MD
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Irina Filip, MD
- Kaiser Permanente Psychiatry Residency Program, Fontana, CA, USA
- Florian Fischer, MPH
- Bielefeld University, Bielefeld, Germany
- Fortuné G Gankpé, MD
- Leras Afrique, Cotonou, Benin
- Ibrahim Ginawi, MD
- College of Medicine, University of Hail, Hail, Saudi Arabia
- Melkamu Dedefo Gishu, MS
- Haramaya University, Dira Dawa, Ethiopia
- Rahul Gupta, MD
- West Virginia Bureau for Public Health, Charleston, WV, USA
- Rami M Habash, MPH
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
- Nima Hafezi-Nejad, MD
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Prof. Randah R Hamadeh, DPhil
- Arabian Gulf University, Manama, Bahrain
- Hayet Hamdouni, PhD
- Direction des Soins de Santé de Base, Ministry of Health, Tunis, Tunisia
- Samer Hamidi, PhD
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
- Hilda L Harb, MPH
- Ministry of Public Health, Beirut, Lebanon
- Mohammad Sadegh Hassanvand, PhD
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
- Mohammad T Hedayati, PhD
- Department of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, Iran
- Pouria Heydarpour, MD
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Prof. Mohamed Hsairi, MD
- Salah Azaiz Institute, Tunis, Tunisia
- Abdullatif Husseini, PhD
- Qatar University, Doha, Qatar
- Nader Jahanmehr, PhD
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Prof. Vivekanand Jha, DM
- The George Institute for Global Health India, University of Oxford, New Delhi, India
- Jost B Jonas, MD
- Ruprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany
- Nadim E Karam, MD
- University of Balamand, Beirut, Lebanon
- Amir Kasaeian, PhD
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Nega Assefa Kassa, PhD
- Haramaya University, Harari, Ethiopia
- Anil Kaul, MD
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Prof. Yousef Khader, ScD
- Jordan University of Science and Technology, Irbid, Jordan
- Shams Eldin A Khalifa, MSc
- Supreme Council of Health, Doha, Qatar
- Ejaz A Khan, MPH
- Health Services Academy, Islamabad, Pakistan
- Gulfaraz Khan, PhD
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Tawfik Khoja, FRCP
- Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
- Ardeshir Khosravi, PhD
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Yohannes Kinfu, PhD
- Centre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Barthelemy Kuate Defo, PhD
- Department of Demography and Public Health Research Institute, University of Montreal, Montreal, QC, Canada
- Arjun Lakshmana Balaji, MPH
- Indegene, Bangalore, India
- Raimundas Lunevicius, PhD
- Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK
- Prof. Carla Makhlouf Obermeyer, DSc
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Reza Malekzadeh, MD
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Morteza Mansourian, PhD
- Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
- Prof. Wagner Marcenes, PhD
- Queen Mary University of London, London, UK
- Habibolah Masoudi Farid, MD
- State Welfare Organisation, Tehran, Iran
- Alem Mehari, MD
- Howard University College of Medicine, Washington, DC, USA
- Abla Mehio-Sibai, PhD
- Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Prof. Ziad A Memish, MD
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
- George A Mensah, MD
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Montgomery Village, MD, USA
- Karzan A Mohammad, PhD
- University of Salahaddin, Erbil, Iraq
- Prof. Ziad Nahas, MD
- Medical Center, American University of Beirut, Beirut, Lebanon
- Jamal T Nasher, MSc
- Ministry of Public Health and Population, Sana'a, Yemen
- Haseeb Nawaz, MD
- Southern Illinois University, Springfield, IL, USA
- Prof. Chakib Nejjari, PhD
- Faculty of Medicine, Fez, Morocco
- Muhammad Imran Nisar, MSc
- Aga Khan University, Karachi, Pakistan
- Saad B Omer, PhD
- Emory University, Atlanta, GA, USA
- Mahboubeh Parsaeian, PhD
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Emmanuel K Peprah, PhD
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
- Aslam Pervaiz, MHA
- Postgraduate Medical Institute, Lahore, Pakistan
- Farshad Pourmalek, PhD
- University of British Columbia, Vancouver, BC, Canada
- Prof. Dima M Qato, PhD
- College of Pharmacy, University of Illinois, Chicago, IL, USA
- Mostafa Qorbani, PhD
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Amir Radfar, MD
- A T Still University of Health Sciences, Kirksville, MO, USA
- Anwar Rafay, MS
- Contech International Health Consultants, Lahore, Pakistan
- Kazem Rahimi, DM
- University of Oxford, Oxford, UK
- Vafa Rahimi-Movaghar, MD
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sajjad Ur Rahman, FRCPCH
- Hamad Medical Corporation, Doha, Qatar
- Rajesh K Rai, MPH
- Society for Health and Demographic Surveillance, Suri, India
- Prof. Saleem M Rana, PhD
- Contech International Health Consultants, Lahore, Pakistan
- Sowmya R Rao, PhD
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
- Amany H Refaat, PhD
- Walden University, Minneapolis, MN, USA
- Serge Resnikoff, MD
- Brien Holden Vision Institute, University of New South Wales, Sydney, NSW, Australia
- Gholamreza Roshandel, PhD
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Georges Saade, MD
- Lebanese University, Beirut, Lebanon
- Mohammad Y Saeedi, PhD
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
- Mohammad Ali Sahraian, MD
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Shadi Saleh, PhD
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Lidia Sanchez-Riera, PhD
- Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Maheswar Satpathy, PhD
- All India Institute of Medical Sciences, New Delhi, India
- Sadaf G Sepanlou, MD
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tesfaye Setegn, MPH
- Bahir Dar University, Bahir Dar, Ethiopia
- Amira Shaheen, PhD
- Department of Public Health, An-Najah University, Nablus, Palestine
- Saeid Shahraz, PhD
- Tufts Medical Center, Boston, MA, USA
- Sara Sheikhbahaei, MD
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Kawkab Shishani, PhD
- Washington State University, Spokane, WA, USA
- Prof. Karen Sliwa, PhD
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
- Mohammad Tavakkoli, MD
- Westchester Medical Center, Valhalla, NY, USA
- Abdullah S Terkawi, MD
- Department of Anesthesiology, Riyadh, Saudi Arabia
- Olalekan A Uthman, PhD
- Warwick Medical School, University of Warwick, Coventry, UK
- Ronny Westerman, PhD
- Federal Institute for Population Research, Wiesbaden, Germany
- Mustafa Z Younis, DrPH
- Jackson State University, Jackson, MS, USA
- Prof. Maysaa El Sayed Zaki, PhD
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Faiez Zannad, MD
- Clinical Investigation Centre INSERM, Université de Lorraine, Vandoeuvre les Nancy, France
- Gregory A Roth, MD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Haidong Wang, PhD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Prof. Mohsen Naghavi, PhD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Prof. Theo Vos, PhD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Abdullah A Al Rabeeah, MBBS
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
- Prof. Alan D Lopez, PhD
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Prof. Christopher J L Murray, DPhil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- DOI
- https://doi.org/10.1016/S2214-109X(16)30168-1
- Journal volume & issue
-
Vol. 4,
no. 10
pp. e704 – e713
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.
