Tags

Type your tag names separated by a space and hit enter

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
Lancet Glob Health. 2016 10; 4(10):e704-13.LG

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GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods.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.

Authors+Show Affiliations

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mokdaa@uw.edu.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Aswan University Hospital, Aswan Faculty of Medicine, Aswan, Egypt.Sudanese Public Health Consultancy Group, Solihull, UK.Department of Neurology, Cairo University, Cairo, Egypt.Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USA; Institute for Global Health, Harvard University, Boston, MA, USA.Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar.Institute of Community and Public Health, Birzeit University, Ramallah, Palestine.Ministry of Health, Sana'a, Yemen.University of Rhode Island, Kingston, RI, USA.Majlis Al Shura, Riyadh, Saudi Arabia.Ministry of Health, Muscat, Oman.College of Medicine, University of Baghdad, Baghdad, Iraq.The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia.Ministry of Health, Muscat, Oman.King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.King Saud University, Riyadh, Saudi Arabia; King Fahad Medical City, Riyadh, Saudi Arabia.King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.Public Authority for Food and Nutrition, Kuwait.University of Oxford, Oxford, UK.University of London, London, UK; Institute and Faculty of Actuaries, Oxford, UK.Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia.Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.Division of Physical Therapy, Department of Rehabilitation Sciences, Irbid, Jordan.Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.Charité Universitätsmedizin, Berlin, Germany.Maternal and Child Health Department, Irbid, Jordan.Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.Supreme Council of Health, Doha, Qatar.King Saud University, Riyadh, Saudi Arabia.Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia; College of Medicine and Health Sciences, Bahir Dar, Ethiopia.Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.Ministry of Public Health, Beirut, Lebanon.Kabul, Afghanistan.Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran.South Asian Public Health Forum, Islamabad, Pakistan.Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.Mashhad University of Medical Sciences, Mashhad, Iran.School of Health Sciences, University of Management and Technology, Lahore, Pakistan.Public Health Agency of Canada, Toronto, ON, Canada.Ministry of Health, Damascus, Syria.Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.National Institute of Mental Health, Montgomery Village, MD, USA.Centre of Excellence in Women and Child Health, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.University of Iowa Hospitals and Clinics, Iowa City, IA, USA.Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia.Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, UK.Walden University, Minneapolis, MN, USA.Department of Paediatrics and Child Health, Karachi, Pakistan.Nuffield Department of Medicine, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.National Institutes of Health, Montgomery Village, MD, USA.Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya.Cardiovascular Diseases Control and Prevention Program, Riyadh, Saudi Arabia.Ministry of Health and Medical Education, Tehran, Iran; Arak University of Medical Sciences, Arak, Iran.Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.London School of Hygiene & Tropical Medicine, London, UK.Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.Department of Global Health and Population, Harvard University, Boston, MA, USA.Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.Kaiser Permanente Psychiatry Residency Program, Fontana, CA, USA.Bielefeld University, Bielefeld, Germany.Leras Afrique, Cotonou, Benin; CHU Hassan II, Fez, Morocco.College of Medicine, University of Hail, Hail, Saudi Arabia.Haramaya University, Dira Dawa, Ethiopia; Kersa Health and Demographic Surveillance System, Harar, Ethiopia.West Virginia Bureau for Public Health, Charleston, WV, USA.Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.Arabian Gulf University, Manama, Bahrain.Direction des Soins de Santé de Base, Ministry of Health, Tunis, Tunisia.Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.Ministry of Public Health, Beirut, Lebanon.Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.Department of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, Iran.Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.Salah Azaiz Institute, Tunis, Tunisia.Qatar University, Doha, Qatar.School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.The George Institute for Global Health India, University of Oxford, New Delhi, India.Ruprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany.University of Balamand, Beirut, Lebanon.Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.Haramaya University, Harari, Ethiopia.Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.Jordan University of Science and Technology, Irbid, Jordan.Supreme Council of Health, Doha, Qatar.Health Services Academy, Islamabad, Pakistan.Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Ministry of Health and Medical Education, Tehran, Iran.Centre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia.Department of Demography and Public Health Research Institute, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.Indegene, Bangalore, India.Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK.Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran.Queen Mary University of London, London, UK.State Welfare Organisation, Tehran, Iran.Howard University College of Medicine, Washington, DC, USA.Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Montgomery Village, MD, USA.University of Salahaddin, Erbil, Iraq.Medical Center, American University of Beirut, Beirut, Lebanon.Ministry of Public Health and Population, Sana'a, Yemen.Southern Illinois University, Springfield, IL, USA.Faculty of Medicine, Fez, Morocco.Aga Khan University, Karachi, Pakistan.Emory University, Atlanta, GA, USA.Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.National Heart, Lung, and Blood Institute, Bethesda, MD, USA.Postgraduate Medical Institute, Lahore, Pakistan.University of British Columbia, Vancouver, BC, Canada.College of Pharmacy, University of Illinois, Chicago, IL, USA.Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.A T Still University of Health Sciences, Kirksville, MO, USA.Contech International Health Consultants, Lahore, Pakistan.University of Oxford, Oxford, UK.Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.Hamad Medical Corporation, Doha, Qatar.Society for Health and Demographic Surveillance, Suri, India.Contech International Health Consultants, Lahore, Pakistan; Contech School of Public Health, Lahore, Pakistan.Department of Surgery, Boston University School of Medicine, Boston, MA, USA.Walden University, Minneapolis, MN, USA; Suez Canal University, Ismailia, Egypt.Brien Holden Vision Institute, University of New South Wales, Sydney, NSW, Australia; International Health and Development, Geneva, Switzerland.Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.Lebanese University, Beirut, Lebanon; Bellevue Medical Center, Mansourieh El Metn, Lebanon.Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.All India Institute of Medical Sciences, New Delhi, India.Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.Bahir Dar University, Bahir Dar, Ethiopia.Department of Public Health, An-Najah University, Nablus, Palestine.Tufts Medical Center, Boston, MA, USA.Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.Washington State University, Spokane, WA, USA.Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.Westchester Medical Center, Valhalla, NY, USA.Department of Anesthesiology, Riyadh, Saudi Arabia; Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA.Warwick Medical School, University of Warwick, Coventry, UK.Federal Institute for Population Research, Wiesbaden, Germany; German National Cohort Consortium, Heidelberg, Germany.Jackson State University, Jackson, MS, USA.Faculty of Medicine, Mansoura University, Mansoura, Egypt.Clinical Investigation Centre INSERM, Université de Lorraine, Vandoeuvre les Nancy, France; CHU de Nancy, Vandoeuvre les Nancy, France.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27568068

Citation

Mokdad, Ali H., et al. "Health in Times of Uncertainty in the Eastern Mediterranean Region, 1990-2013: a Systematic Analysis for the Global Burden of Disease Study 2013." The Lancet. Global Health, vol. 4, no. 10, 2016, pp. e704-13.
Mokdad AH, Forouzanfar MH, Daoud F, et al. Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Glob Health. 2016;4(10):e704-13.
Mokdad, A. H., Forouzanfar, M. H., Daoud, F., El Bcheraoui, C., Moradi-Lakeh, M., Khalil, I., Afshin, A., Tuffaha, M., Charara, R., Barber, R. M., Wagner, J., Cercy, K., Kravitz, H., Coates, M. M., Robinson, M., Estep, K., Steiner, C., Jaber, S., Mokdad, A. A., ... Murray, C. J. (2016). Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. Global Health, 4(10), e704-13. https://doi.org/10.1016/S2214-109X(16)30168-1
Mokdad AH, et al. Health in Times of Uncertainty in the Eastern Mediterranean Region, 1990-2013: a Systematic Analysis for the Global Burden of Disease Study 2013. Lancet Glob Health. 2016;4(10):e704-13. PubMed PMID: 27568068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. AU - Mokdad,Ali H, AU - Forouzanfar,Mohammad Hossein, AU - Daoud,Farah, AU - El Bcheraoui,Charbel, AU - Moradi-Lakeh,Maziar, AU - Khalil,Ibrahim, AU - Afshin,Ashkan, AU - Tuffaha,Marwa, AU - Charara,Raghid, AU - Barber,Ryan M, AU - Wagner,Joseph, AU - Cercy,Kelly, AU - Kravitz,Hannah, AU - Coates,Matthew M, AU - Robinson,Margaret, AU - Estep,Kara, AU - Steiner,Caitlyn, AU - Jaber,Sara, AU - Mokdad,Ali A, AU - O'Rourke,Kevin F, AU - Chew,Adrienne, AU - Kim,Pauline, AU - El Razek,Mohamed Magdy Abd, AU - Abdalla,Safa, AU - Abd-Allah,Foad, AU - Abraham,Jerry P, AU - Abu-Raddad,Laith J, AU - Abu-Rmeileh,Niveen M E, AU - Al-Nehmi,Abdulwahab A, AU - Akanda,Ali S, AU - Al Ahmadi,Hanan, AU - Al Khabouri,Mazin J, AU - Al Lami,Faris H, AU - Al Rayess,Zulfa A, AU - Alasfoor,Deena, AU - AlBuhairan,Fadia S, AU - Aldhahri,Saleh F, AU - Alghnam,Suliman, AU - Alhabib,Samia, AU - Al-Hamad,Nawal, AU - Ali,Raghib, AU - Ali,Syed Danish, AU - Alkhateeb,Mohammad, AU - AlMazroa,Mohammad A, AU - Alomari,Mahmoud A, AU - Al-Raddadi,Rajaa, AU - Alsharif,Ubai, AU - Al-Sheyab,Nihaya, AU - Alsowaidi,Shirina, AU - Al-Thani,Mohamed, AU - Altirkawi,Khalid A, AU - Amare,Azmeraw T, AU - Amini,Heresh, AU - Ammar,Walid, AU - Anwari,Palwasha, AU - Asayesh,Hamid, AU - Asghar,Rana, AU - Assabri,Ali M, AU - Assadi,Reza, AU - Bacha,Umar, AU - Badawi,Alaa, AU - Bakfalouni,Talal, AU - Basulaiman,Mohammed O, AU - Bazargan-Hejazi,Shahrzad, AU - Bedi,Neeraj, AU - Bhakta,Amit R, AU - Bhutta,Zulfiqar A, AU - Bin Abdulhak,Aref A, AU - Boufous,Soufiane, AU - Bourne,Rupert R A, AU - Danawi,Hadi, AU - Das,Jai, AU - Deribew,Amare, AU - Ding,Eric L, AU - Durrani,Adnan M, AU - Elshrek,Yousef, AU - Ibrahim,Mohamed E, AU - Eshrati,Babak, AU - Esteghamati,Alireza, AU - Faghmous,Imad A D, AU - Farzadfar,Farshad, AU - Feigl,Andrea B, AU - Fereshtehnejad,Seyed-Mohammad, AU - Filip,Irina, AU - Fischer,Florian, AU - Gankpé,Fortuné G, AU - Ginawi,Ibrahim, AU - Gishu,Melkamu Dedefo, AU - Gupta,Rahul, AU - Habash,Rami M, AU - Hafezi-Nejad,Nima, AU - Hamadeh,Randah R, AU - Hamdouni,Hayet, AU - Hamidi,Samer, AU - Harb,Hilda L, AU - Hassanvand,Mohammad Sadegh, AU - Hedayati,Mohammad T, AU - Heydarpour,Pouria, AU - Hsairi,Mohamed, AU - Husseini,Abdullatif, AU - Jahanmehr,Nader, AU - Jha,Vivekanand, AU - Jonas,Jost B, AU - Karam,Nadim E, AU - Kasaeian,Amir, AU - Kassa,Nega Assefa, AU - Kaul,Anil, AU - Khader,Yousef, AU - Khalifa,Shams Eldin A, AU - Khan,Ejaz A, AU - Khan,Gulfaraz, AU - Khoja,Tawfik, AU - Khosravi,Ardeshir, AU - Kinfu,Yohannes, AU - Defo,Barthelemy Kuate, AU - Balaji,Arjun Lakshmana, AU - Lunevicius,Raimundas, AU - Obermeyer,Carla Makhlouf, AU - Malekzadeh,Reza, AU - Mansourian,Morteza, AU - Marcenes,Wagner, AU - Farid,Habibolah Masoudi, AU - Mehari,Alem, AU - Mehio-Sibai,Abla, AU - Memish,Ziad A, AU - Mensah,George A, AU - Mohammad,Karzan A, AU - Nahas,Ziad, AU - Nasher,Jamal T, AU - Nawaz,Haseeb, AU - Nejjari,Chakib, AU - Nisar,Muhammad Imran, AU - Omer,Saad B, AU - Parsaeian,Mahboubeh, AU - Peprah,Emmanuel K, AU - Pervaiz,Aslam, AU - Pourmalek,Farshad, AU - Qato,Dima M, AU - Qorbani,Mostafa, AU - Radfar,Amir, AU - Rafay,Anwar, AU - Rahimi,Kazem, AU - Rahimi-Movaghar,Vafa, AU - Rahman,Sajjad Ur, AU - Rai,Rajesh K, AU - Rana,Saleem M, AU - Rao,Sowmya R, AU - Refaat,Amany H, AU - Resnikoff,Serge, AU - Roshandel,Gholamreza, AU - Saade,Georges, AU - Saeedi,Mohammad Y, AU - Sahraian,Mohammad Ali, AU - Saleh,Shadi, AU - Sanchez-Riera,Lidia, AU - Satpathy,Maheswar, AU - Sepanlou,Sadaf G, AU - Setegn,Tesfaye, AU - Shaheen,Amira, AU - Shahraz,Saeid, AU - Sheikhbahaei,Sara, AU - Shishani,Kawkab, AU - Sliwa,Karen, AU - Tavakkoli,Mohammad, AU - Terkawi,Abdullah S, AU - Uthman,Olalekan A, AU - Westerman,Ronny, AU - Younis,Mustafa Z, AU - El Sayed Zaki,Maysaa, AU - Zannad,Faiez, AU - Roth,Gregory A, AU - Wang,Haidong, AU - Naghavi,Mohsen, AU - Vos,Theo, AU - Al Rabeeah,Abdullah A, AU - Lopez,Alan D, AU - Murray,Christopher J L, Y1 - 2016/08/25/ PY - 2016/05/09/received PY - 2016/06/29/revised PY - 2016/07/11/accepted PY - 2016/8/29/entrez PY - 2016/8/29/pubmed PY - 2017/11/29/medline SP - e704 EP - 13 JF - The Lancet. Global health JO - Lancet Glob Health VL - 4 IS - 10 N2 - 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. SN - 2214-109X UR - https://www.unboundmedicine.com/medline/citation/27568068/Health_in_times_of_uncertainty_in_the_eastern_Mediterranean_region_1990_2013:_a_systematic_analysis_for_the_Global_Burden_of_Disease_Study_2013_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2214-109X(16)30168-1 DB - PRIME DP - Unbound Medicine ER -