Mokdad AH
Forouzanfar MH
Daoud F
El Bcheraoui C
Moradi-Lakeh M
Khalil I
Afshin A
Tuffaha M
Charara R
Barber RM
Wagner J
Cercy K
Kravitz H
Coates MM
Robinson M
Estep K
Steiner C
Jaber S
Mokdad AA
O'Rourke KF
Chew A
Kim P
El Razek MM
Abdalla S
Abd-Allah F
Abraham JP
Abu-Raddad LJ
Abu-Rmeileh NM
Al-Nehmi AA
Akanda AS
Al Ahmadi H
Al Khabouri MJ
Al Lami FH
Al Rayess ZA
Alasfoor D
AlBuhairan FS
Aldhahri SF
Alghnam S
Alhabib S
Al-Hamad N
Ali R
Ali SD
Alkhateeb M
AlMazroa MA
Alomari MA
Al-Raddadi R
Alsharif U
Al-Sheyab N
Alsowaidi S
Al-Thani M
Altirkawi KA
Amare AT
Amini H
Ammar W
Anwari P
Asayesh H
Asghar R
Assabri AM
Assadi R
Bacha U
Badawi A
Bakfalouni T
Basulaiman MO
Bazargan-Hejazi S
Bedi N
Bhakta AR
Bhutta ZA
Bin Abdulhak AA
Boufous S
Bourne RR
Danawi H
Das J
Deribew A
Ding EL
Durrani AM
Elshrek Y
Ibrahim ME
Eshrati B
Esteghamati A
Faghmous IA
Farzadfar F
Feigl AB
Fereshtehnejad SM
Filip I
Fischer F
Gankpe FG
Ginawi I
Gishu MD
Gupta R
Habash RM
Hafezi-Nejad N
Hamadeh RR
Hamdouni H
Hamidi S
Harb HL
Hassanvand MS
Hedayati MT
Heydarpour P
Hsairi M
Husseini A
Jahanmehr N
Jha V
Jonas JB
Karam NE
Kasaeian A
Kassa NA
Kaul A
Khader Y
Khalifa SE
Khan EA
Khan G
Khoja T
Khosravi A
Kinfu Y
Defo BK
Balaji AL
Lunevicius R
Obermeyer CM
Malekzadeh R
Mansourian M
Marcenes W
Farid HM
Mehari A
Mehio-Sibai A
Memish ZA
Mensah GA
Mohammad KA
Nahas Z
Nasher JT
Nawaz H
Nejjari C
Nisar MI
Omer SB
Parsaeian M
Peprah EK
Pervaiz A
Pourmalek F
Qato DM
Qorbani M
Radfar A
Rafay A
Rahimi K
Rahimi-Movaghar V
Rahman SU
Rai RK
Rana SM
Rao SR
Refaat AH
Resnikoff S
Roshandel G
Saade G
Saeedi MY
Sahraian MA
Saleh S
Sanchez-Riera L
Satpathy M
Sepanlou SG
Setegn T
Shaheen A
Shahraz S
Sheikhbahaei S
Shishani K
Sliwa K
Tavakkoli M
Terkawi AS
Uthman OA
Westerman R
Younis MZ
El Sayed Zaki M
Zannad F
Roth GA
Wang H
Naghavi M
Vos T
Al Rabeeah AA
Lopez AD
Murray CJ
Lancet Glob Health. 2016;4e704-13
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.
