@article{22428,
  author = {Wang H. and Gupta R. and Vos T. and Sliwa K. and Robinson M. and Ali R. and Boufous S. and Murray C. and Jha V. and Farzadfar F. and Lopez A. and Barber R. and Abd-Allah F. and Abraham J. and Abu-Raddad L. and Abu-Rmeileh N. and Afshin A. and Alasfoor D. and Alhabib S. and Almazroa M. and Alsharif U. and Amare A. and Amini H. and Ammar W. and Anwari P. and Assadi R. and Badawi A. and Basulaiman M. and Bedi N. and Bhutta Z. and Bourne R. and Coates M. and Danawi H. and Ding E. and Eshrati B. and Esteghamati A. and Estep K. and Fereshtehnejad S. and Forouzanfar M. and Gankpe F. and Hafezi-Nejad N. and Hamadeh R. and Harb H. and Heydarpour P. and Hsairi M. and Husseini A. and Jonas J. and Kaul A. and Khalifa S. and Khan E. and Khan G. and Kinfu Y. and Defo B. and Lunevicius R. and Malekzadeh R. and Marcenes W. and Memish Z. and Mensah G. and Mohammad K. and Mokdad A. and Moradi-Lakeh M. and Naghavi M. and Nejjari C. and Nisar M. and Pervaiz A. and Pourmalek F. and Qato D. and Rafay A. and Rahman S. and Rana S. and Resnikoff S. and Roth G. and Saeedi M. and Sahraian M. and Satpathy M. and Sepanlou S. and Shaheen A. and Shahraz S. and Sheikhbahaei S. and Shishani K. and Steiner C. and Tavakkoli M. and Terkawi A. and Wagner J. and Westerman R. and Younis M. and Khabouri M. and Lami F. and Bakfalouni T. and Abdulhak A. and Durrani A. and Feigl A. and Hedayati M. and Karam N. and Balaji A. and Nahas Z. and Omer S. and Rahimi-Movaghar V. and Refaat A. and Sanchez-Riera L. and Daoud F. and C. Bcheraoui El and Khalil I. and Tuffaha M. and Charara R. and Cercy K. and Kravitz H. and Jaber S. and Mokdad A. and O'Rourke K. and Chew A. and Kim P. and Razek M. and Abdalla S. and Al-Nehmi A. and Akanda A. and H. Ahmadi Al and Rayess Z. and AlBuhairan F. and Aldhahri S. and Alghnam S. and Al-Hamad N. and Ali S. and Alkhateeb M. and Alomari M. and Al-Raddadi R. and Al-Sheyab N. and Alsowaidi S. and Al-Thani M. and Altirkawi K. and Asayesh H. and Asghar R. and Assabri A. and Bacha U. and Bazargan-Hejazi S. and Bhakta A. and Das J. and Deribew A. and Elshrek Y. and Ibrahim M. and Faghmous I. and Filip I. and Fischer F. and Ginawi I. and Gishu M. and Habash R. and Hamdouni H. and Hamidi S. and Hassanvand M. and Jahanmehr N. and Kasaeian A. and Kassa N. and Khader Y. and Khoja T. and Khosravi A. and Obermeyer C. and Mansourian M. and Farid H. and Mehari A. and Mehio-Sibai A. and Nasher J. and Nawaz H. and Parsaeian M. and Peprah E. and Qorbani M. and Radfar A. and Rai R. and Rao S. and Roshandel G. and Saade G. and Saleh S. and Setegn T. and Uthman O. and M. Zaki El and Zannad F. and Rabeeah A. and Rahimi K},
  title = {Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013},
  abstract = {<p>
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 &amp; Melinda Gates Foundation.
</p>
},
  year = {2016},
  journal = {Lancet Glob Health},
  edition = {2016/08/29},
  isbn = {2214-109X (Electronic)<br/>2214-109X (Linking)},
  note = {Mokdad, Ali H<br/>Forouzanfar, Mohammad Hossein<br/>Daoud, Farah<br/>El Bcheraoui, Charbel<br/>Moradi-Lakeh, Maziar<br/>Khalil, Ibrahim<br/>Afshin, Ashkan<br/>Tuffaha, Marwa<br/>Charara, Raghid<br/>Barber, Ryan M<br/>Wagner, Joseph<br/>Cercy, Kelly<br/>Kravitz, Hannah<br/>Coates, Matthew M<br/>Robinson, Margaret<br/>Estep, Kara<br/>Steiner, Caitlyn<br/>Jaber, Sara<br/>Mokdad, Ali A<br/>O'Rourke, Kevin F<br/>Chew, Adrienne<br/>Kim, Pauline<br/>El Razek, Mohamed Magdy Abd<br/>Abdalla, Safa<br/>Abd-Allah, Foad<br/>Abraham, Jerry P<br/>Abu-Raddad, Laith J<br/>Abu-Rmeileh, Niveen M E<br/>Al-Nehmi, Abdulwahab A<br/>Akanda, Ali S<br/>Al Ahmadi, Hanan<br/>Al Khabouri, Mazin J<br/>Al Lami, Faris H<br/>Al Rayess, Zulfa A<br/>Alasfoor, Deena<br/>AlBuhairan, Fadia S<br/>Aldhahri, Saleh F<br/>Alghnam, Suliman<br/>Alhabib, Samia<br/>Al-Hamad, Nawal<br/>Ali, Raghib<br/>Ali, Syed Danish<br/>Alkhateeb, Mohammad<br/>AlMazroa, Mohammad A<br/>Alomari, Mahmoud A<br/>Al-Raddadi, Rajaa<br/>Alsharif, Ubai<br/>Al-Sheyab, Nihaya<br/>Alsowaidi, Shirina<br/>Al-Thani, Mohamed<br/>Altirkawi, Khalid A<br/>Amare, Azmeraw T<br/>Amini, Heresh<br/>Ammar, Walid<br/>Anwari, Palwasha<br/>Asayesh, Hamid<br/>Asghar, Rana<br/>Assabri, Ali M<br/>Assadi, Reza<br/>Bacha, Umar<br/>Badawi, Alaa<br/>Bakfalouni, Talal<br/>Basulaiman, Mohammed O<br/>Bazargan-Hejazi, Shahrzad<br/>Bedi, Neeraj<br/>Bhakta, Amit R<br/>Bhutta, Zulfiqar A<br/>Abdulhak, Aref A Bin<br/>Boufous, Soufiane<br/>Bourne, Rupert R A<br/>Danawi, Hadi<br/>Das, Jai<br/>Deribew, Amare<br/>Ding, Eric L<br/>Durrani, Adnan M<br/>Elshrek, Yousef<br/>Ibrahim, Mohamed E<br/>Eshrati, Babak<br/>Esteghamati, Alireza<br/>Faghmous, Imad A D<br/>Farzadfar, Farshad<br/>Feigl, Andrea B<br/>Fereshtehnejad, Seyed-Mohammad<br/>Filip, Irina<br/>Fischer, Florian<br/>Gankpe, Fortune G<br/>Ginawi, Ibrahim<br/>Gishu, Melkamu Dedefo<br/>Gupta, Rahul<br/>Habash, Rami M<br/>Hafezi-Nejad, Nima<br/>Hamadeh, Randah R<br/>Hamdouni, Hayet<br/>Hamidi, Samer<br/>Harb, Hilda L<br/>Hassanvand, Mohammad Sadegh<br/>Hedayati, Mohammad T<br/>Heydarpour, Pouria<br/>Hsairi, Mohamed<br/>Husseini, Abdullatif<br/>Jahanmehr, Nader<br/>Jha, Vivekanand<br/>Jonas, Jost B<br/>Karam, Nadim E<br/>Kasaeian, Amir<br/>Kassa, Nega Assefa<br/>Kaul, Anil<br/>Khader, Yousef<br/>Khalifa, Shams Eldin A<br/>Khan, Ejaz A<br/>Khan, Gulfaraz<br/>Khoja, Tawfik<br/>Khosravi, Ardeshir<br/>Kinfu, Yohannes<br/>Defo, Barthelemy Kuate<br/>Balaji, Arjun Lakshmana<br/>Lunevicius, Raimundas<br/>Obermeyer, Carla Makhlouf<br/>Malekzadeh, Reza<br/>Mansourian, Morteza<br/>Marcenes, Wagner<br/>Farid, Habibolah Masoudi<br/>Mehari, Alem<br/>Mehio-Sibai, Abla<br/>Memish, Ziad A<br/>Mensah, George A<br/>Mohammad, Karzan A<br/>Nahas, Ziad<br/>Nasher, Jamal T<br/>Nawaz, Haseeb<br/>Nejjari, Chakib<br/>Nisar, Muhammad Imran<br/>Omer, Saad B<br/>Parsaeian, Mahboubeh<br/>Peprah, Emmanuel K<br/>Pervaiz, Aslam<br/>Pourmalek, Farshad<br/>Qato, Dima M<br/>Qorbani, Mostafa<br/>Radfar, Amir<br/>Rafay, Anwar<br/>Rahimi, Kazem<br/>Rahimi-Movaghar, Vafa<br/>Rahman, Sajjad Ur<br/>Rai, Rajesh K<br/>Rana, Saleem M<br/>Rao, Sowmya R<br/>Refaat, Amany H<br/>Resnikoff, Serge<br/>Roshandel, Gholamreza<br/>Saade, Georges<br/>Saeedi, Mohammad Y<br/>Sahraian, Mohammad Ali<br/>Saleh, Shadi<br/>Sanchez-Riera, Lidia<br/>Satpathy, Maheswar<br/>Sepanlou, Sadaf G<br/>Setegn, Tesfaye<br/>Shaheen, Amira<br/>Shahraz, Saeid<br/>Sheikhbahaei, Sara<br/>Shishani, Kawkab<br/>Sliwa, Karen<br/>Tavakkoli, Mohammad<br/>Terkawi, Abdullah S<br/>Uthman, Olalekan A<br/>Westerman, Ronny<br/>Younis, Mustafa Z<br/>El Sayed Zaki, Maysaa<br/>Zannad, Faiez<br/>Roth, Gregory A<br/>Wang, Haidong<br/>Naghavi, Mohsen<br/>Vos, Theo<br/>Al Rabeeah, Abdullah A<br/>Lopez, Alan D<br/>Murray, Christopher J L<br/>Lancet Glob Health. 2016 Aug 24. pii: S2214-109X(16)30168-1. doi: 10.1016/S2214-109X(16)30168-1.},
  language = {Eng},
}