Elsevier

The Lancet

Volume 383, Issue 9914, 25–31 January 2014, Pages 309-320
The Lancet

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

https://doi.org/10.1016/S0140-6736(13)62189-3Get rights and content

Summary

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.

Findings

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.

Interpretation

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.

Funding

Bill & Melinda Gates Foundation.

Introduction

Geographically, the Arab world comprises 22 countries from north Africa to western Asia—ie, Algeria, Egypt, Bahrain, Comoros, Djibouti, Iraq, Jordan, Saudi Arabia, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, occupied Palestinian territory, Qatar, Yemen, Somalia, Sudan (including South Sudan), Syria, Tunisia, and the United Arab Emirates. These countries are the members of the League of Arab States.1 Each country has a unique set of historical, geopolitical, social, cultural, and economic characteristics,2 which determine its public health systems and the burden of disease and injury.

Countries bordering the Persian Gulf—eg, Saudi Arabia and the United Arab Emirates—have a rising burden of occupational and road injuries because of the high number of expatriates who migrate for job opportunities.3, 4 Non-communicable diseases have increased substantially in the Arab world, with varying prevalence between different populations.5, 6 Therefore, conclusions about the Arab world cannot be drawn from simple generalisations because they are likely to be misleading.2

The status of the health-care system in the Arab world has been reported previously.7 Public health systems are perceived as being non-productive and are low priority in national spending plans.8, 9 Despite the resources in some Arab countries, the development and performance of their public health systems are lower than expected, with a continued focus on treatment rather than prevention.9, 10 Progress in health care in the Arab world has been reported; however, it has been slow in some countries compared with others.7

In this study, we assess the burden of disease and injuries in the 22 Arab countries in 1990, 2005, and 2010 using data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010).11, 12, 13, 14, 15, 16, 17, 18

Section snippets

Overview

GBD 2010 was a comprehensive assessment of the burden of 291 diseases and injuries, 1060 disease sequelae, and 67 risk factors. Estimates of these were provided by age group, sex, and country for 1990, 2005, and 2010.11, 12, 13, 14, 15, 16, 17, 18 Health loss was assessed with a systemic analysis of all the available data, with the following metrics: mortality, causes of death, years of life lost due to premature mortality (YLLs), years of life lived with disability (YLDs), and

Results

In 2010, ischaemic heart disease was the leading cause of death in the Arab world (contributing to 14·3% of deaths; appendix p 1), whereas in 1990 it was ranked second (figure 1). From 1990 to 2010, the ranking of lower respiratory infections, diarrhoeal diseases, preterm birth complications, malaria, protein–energy malnutrition, tuberculosis, neonatal encephalopathy, meningitis, maternal disorders, and measles declined, whereas that for HIV/AIDS and neonatal sepsis increased (figure 1).

Discussion

The Arab world has made great progress in reducing the number of deaths from diseases and injuries and prolonging life. Over the past 20 years, it has succeeded in decreasing premature death and disability from most communicable, newborn, nutritional, and maternal causes with the exception of HIV/AIDS. Despite improvements, substantial burden of communicable, newborn, nutritional, and maternal causes persist in the Arab LICs. As far as we know, this study is the first in which the changes in

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