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


RESULTS
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.


CONCLUSIONS
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.


BACKGROUND
Bill & Melinda Gates Foundation.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mokdaa@uw.edu.
Ali H
AH
Mokdad
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Sara
S
Jaber
Public Health Institute, Khartoum, Sudan.
Muna I Abdel
MI
Aziz
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Fadia
F
AlBuhairan
Ministry of Public Health and Population, Sana'a, Yemen.
Abduljabbar
A
AlGhaithi
Ministry of Health, Kuwait City, Kuwait.
Nawal M
NM
AlHamad
Kuwait Institute for Scientific Research, Kuwait City, Kuwait.
Suad N
SN
Al-Hooti
Ministry of Public Health and Population, Sana'a, Yemen.
Adel
A
Al-Jasari
Ministry of Health, Riyadh, Saudi Arabia.
Mohammad A
MA
AlMazroa
Ministry of Health, Muscat, Oman.
Ahmed Mohamed
AM
AlQasmi
United Arab Emirates University, Al Ain, United Arab Emirates.
Shirina
S
Alsowaidi
Ministry of Health, Amman, Jordan.
Majed
M
Asad
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Charles
C
Atkinson
Public Health Agency of Canada, Toronto, ON, Canada.
Alaa
A
Badawi
Ministry of Health, Damascus, Syria.
Talal
T
Bakfalouni
Ministry of Health, Rabat, Morocco.
AbdelAziz
A
Barkia
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Stan
S
Biryukov
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Charbel
C
El Bcheraoui
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Farah
F
Daoud
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Mohammad Hossein
MH
Forouzanfar
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Diego
D
Gonzalez-Medina
Arabian Gulf University, Al Manamah, Bahrain.
Randah R
RR
Hamadeh
National Institute of Public Health, Tunis, Tunisia.
Mohamed
M
Hsairi
Ministry of Health, Amman, Jordan.
Seifeddin Saleh
SS
Hussein
University of Balamand, Balamand, Lebanon.
Nadim
N
Karam
Supreme Council of Health, Doha, Qatar.
Shams Eldin Ali Hassan
SE
Khalifa
Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.
Tawfik A M
TA
Khoja
Baghdad College of Medicine, Baghdad, Iraq.
Faris
F
Lami
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Katherine
K
Leach-Kemon
Ministry of Health, Riyadh, Saudi Arabia.
Ziad A
ZA
Memish
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Ali A
AA
Mokdad
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Mohsen
M
Naghavi
Ministry of Public Health and Population, Sana'a, Yemen.
Jamal
J
Nasher
Ministry of Health, Amman, Jordan.
M Bassam Hijawi
MB
Qasem
Ministry of Health, Baghdad, Iraq.
Mohammad
M
Shuaib
Supreme Council of Health, Doha, Qatar.
Al Anoud M
AA
Al Thani
Supreme Council of Health, Doha, Qatar.
Mohamed H
MH
Al Thani
Ministry of Health, Riyadh, Saudi Arabia.
Mohammed
M
Zamakhshary
School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Alan D
AD
Lopez
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Christopher J L
CJ
Murray
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018643:Arab World; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D061213:Mortality, Premature / Q000639:trends; D017202:Myocardial Ischemia / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult