Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

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...

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Main Authors:	Prof. Ali H Mokdad, PhD, Mohammad Hossein Forouzanfar, PhD, Farah Daoud, BS, Charbel El Bcheraoui, PhD, Maziar Moradi-Lakeh, MD, Ibrahim Khalil, MD, Ashkan Afshin, DSc, Marwa Tuffaha, MD, Raghid Charara, MD, Ryan M Barber, BS, Joseph Wagner, BS, Kelly Cercy, BS, Hannah Kravitz, BS, Matthew M Coates, BA, Margaret Robinson, BA, Kara Estep, MPA, Caitlyn Steiner, MPH, Sara Jaber, MD, Ali A Mokdad, MD, Kevin F O'Rourke, MFA, Adrienne Chew, ND, Pauline Kim, BA, Mohamed Magdy Abd El Razek, MBBCh, Safa Abdalla, MD, Prof. Foad Abd-Allah, MD, Jerry P Abraham, MD, Laith J Abu-Raddad, PhD, Niveen M E Abu-Rmeileh, PhD, Abdulwahab A Al-Nehmi, MD, Ali S Akanda, PhD, Hanan Al Ahmadi, DrPH, Mazin J Al Khabouri, PhD, Faris H Al Lami, PhD, Zulfa A Al Rayess, ABFM, Deena Alasfoor, MSc, Fadia S AlBuhairan, MD, Saleh F Aldhahri, MD, Suliman Alghnam, PhD, Samia Alhabib, PhD, Nawal Al-Hamad, PhD, Raghib Ali, FRCP, Syed Danish Ali, BA, Mohammad Alkhateeb, RN, Mohammad A AlMazroa, MD, Mahmoud A Alomari, PhD, Rajaa Al-Raddadi, PhD, Ubai Alsharif, MPH, Nihaya Al-Sheyab, PhD, Shirina Alsowaidi, FRCPC, Mohamed Al-Thani, FRCPCH, Khalid A Altirkawi, MD, Azmeraw T Amare, MPH, Heresh Amini, MSPH, Walid Ammar, PhD, Palwasha Anwari, MD, Hamid Asayesh, PhD, Rana Asghar, MD, Prof. Ali M Assabri, PhD, Reza Assadi, PhD, Umar Bacha, PhM, Alaa Badawi, PhD, Talal Bakfalouni, MD, Mohammed O Basulaiman, PhD, Shahrzad Bazargan-Hejazi, PhD, Neeraj Bedi, MD, Amit R Bhakta, MD, Zulfiqar A Bhutta, PhD, Aref A Bin Abdulhak, MD, Soufiane Boufous, PhD, Rupert R A Bourne, FRCOphth, Hadi Danawi, PhD, Jai Das, MBA, Amare Deribew, PhD, Eric L Ding, ScD, Adnan M Durrani, MD, Yousef Elshrek, PhD, Mohamed E Ibrahim, MPhil, Babak Eshrati, PhD, Alireza Esteghamati, MD, Imad A D Faghmous, MPH, Farshad Farzadfar, MD, Andrea B Feigl, ScD, Seyed-Mohammad Fereshtehnejad, MD, Irina Filip, MD, Florian Fischer, MPH, Fortuné G Gankpé, MD, Ibrahim Ginawi, MD, Melkamu Dedefo Gishu, MS, Rahul Gupta, MD, Rami M Habash, MPH, Nima Hafezi-Nejad, MD, Prof. Randah R Hamadeh, DPhil, Hayet Hamdouni, PhD, Samer Hamidi, PhD, Hilda L Harb, MPH, Mohammad Sadegh Hassanvand, PhD, Mohammad T Hedayati, PhD, Pouria Heydarpour, MD, Prof. Mohamed Hsairi, MD, Abdullatif Husseini, PhD, Nader Jahanmehr, PhD, Prof. Vivekanand Jha, DM, Jost B Jonas, MD, Nadim E Karam, MD, Amir Kasaeian, PhD, Nega Assefa Kassa, PhD, Anil Kaul, MD, Prof. Yousef Khader, ScD, Shams Eldin A Khalifa, MSc, Ejaz A Khan, MPH, Gulfaraz Khan, PhD, Tawfik Khoja, FRCP, Ardeshir Khosravi, PhD, Yohannes Kinfu, PhD, Barthelemy Kuate Defo, PhD, Arjun Lakshmana Balaji, MPH, Raimundas Lunevicius, PhD, Prof. Carla Makhlouf Obermeyer, DSc, Reza Malekzadeh, MD, Morteza Mansourian, PhD, Prof. Wagner Marcenes, PhD, Habibolah Masoudi Farid, MD, Alem Mehari, MD, Abla Mehio-Sibai, PhD, Prof. Ziad A Memish, MD, George A Mensah, MD, Karzan A Mohammad, PhD, Prof. Ziad Nahas, MD, Jamal T Nasher, MSc, Haseeb Nawaz, MD, Prof. Chakib Nejjari, PhD, Muhammad Imran Nisar, MSc, Saad B Omer, PhD, Mahboubeh Parsaeian, PhD, Emmanuel K Peprah, PhD, Aslam Pervaiz, MHA, Farshad Pourmalek, PhD, Prof. Dima M Qato, PhD, Mostafa Qorbani, PhD, Amir Radfar, MD, Anwar Rafay, MS, Kazem Rahimi, DM, Vafa Rahimi-Movaghar, MD, Sajjad Ur Rahman, FRCPCH, Rajesh K Rai, MPH, Prof. Saleem M Rana, PhD, Sowmya R Rao, PhD, Amany H Refaat, PhD, Serge Resnikoff, MD, Gholamreza Roshandel, PhD, Georges Saade, MD, Mohammad Y Saeedi, PhD, Mohammad Ali Sahraian, MD, Shadi Saleh, PhD, Lidia Sanchez-Riera, PhD, Maheswar Satpathy, PhD, Sadaf G Sepanlou, MD, Tesfaye Setegn, MPH, Amira Shaheen, PhD, Saeid Shahraz, PhD, Sara Sheikhbahaei, MD, Kawkab Shishani, PhD, Prof. Karen Sliwa, PhD, Mohammad Tavakkoli, MD, Abdullah S Terkawi, MD, Olalekan A Uthman, PhD, Ronny Westerman, PhD, Mustafa Z Younis, DrPH, Prof. Maysaa El Sayed Zaki, PhD, Faiez Zannad, MD, Gregory A Roth, MD, Haidong Wang, PhD, Prof. Mohsen Naghavi, PhD, Prof. Theo Vos, PhD, Abdullah A Al Rabeeah, MBBS, Prof. Alan D Lopez, PhD, Prof. Christopher J L Murray, DPhil
Format:	Article
Language:	English
Published:	Elsevier 2016-10-01
Series:	The Lancet Global Health
Online Access:	http://www.sciencedirect.com/science/article/pii/S2214109X16301681

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author	Prof. Ali H Mokdad, PhD Mohammad Hossein Forouzanfar, PhD Farah Daoud, BS Charbel El Bcheraoui, PhD Maziar Moradi-Lakeh, MD Ibrahim Khalil, MD Ashkan Afshin, DSc Marwa Tuffaha, MD Raghid Charara, MD Ryan M Barber, BS Joseph Wagner, BS Kelly Cercy, BS Hannah Kravitz, BS Matthew M Coates, BA Margaret Robinson, BA Kara Estep, MPA Caitlyn Steiner, MPH Sara Jaber, MD Ali A Mokdad, MD Kevin F O'Rourke, MFA Adrienne Chew, ND Pauline Kim, BA Mohamed Magdy Abd El Razek, MBBCh Safa Abdalla, MD Prof. Foad Abd-Allah, MD Jerry P Abraham, MD Laith J Abu-Raddad, PhD Niveen M E Abu-Rmeileh, PhD Abdulwahab A Al-Nehmi, MD Ali S Akanda, PhD Hanan Al Ahmadi, DrPH Mazin J Al Khabouri, PhD Faris H Al Lami, PhD Zulfa A Al Rayess, ABFM Deena Alasfoor, MSc Fadia S AlBuhairan, MD Saleh F Aldhahri, MD Suliman Alghnam, PhD Samia Alhabib, PhD Nawal Al-Hamad, PhD Raghib Ali, FRCP Syed Danish Ali, BA Mohammad Alkhateeb, RN Mohammad A AlMazroa, MD Mahmoud A Alomari, PhD Rajaa Al-Raddadi, PhD Ubai Alsharif, MPH Nihaya Al-Sheyab, PhD Shirina Alsowaidi, FRCPC Mohamed Al-Thani, FRCPCH Khalid A Altirkawi, MD Azmeraw T Amare, MPH Heresh Amini, MSPH Walid Ammar, PhD Palwasha Anwari, MD Hamid Asayesh, PhD Rana Asghar, MD Prof. Ali M Assabri, PhD Reza Assadi, PhD Umar Bacha, PhM Alaa Badawi, PhD Talal Bakfalouni, MD Mohammed O Basulaiman, PhD Shahrzad Bazargan-Hejazi, PhD Neeraj Bedi, MD Amit R Bhakta, MD Zulfiqar A Bhutta, PhD Aref A Bin Abdulhak, MD Soufiane Boufous, PhD Rupert R A Bourne, FRCOphth Hadi Danawi, PhD Jai Das, MBA Amare Deribew, PhD Eric L Ding, ScD Adnan M Durrani, MD Yousef Elshrek, PhD Mohamed E Ibrahim, MPhil Babak Eshrati, PhD Alireza Esteghamati, MD Imad A D Faghmous, MPH Farshad Farzadfar, MD Andrea B Feigl, ScD Seyed-Mohammad Fereshtehnejad, MD Irina Filip, MD Florian Fischer, MPH Fortuné G Gankpé, MD Ibrahim Ginawi, MD Melkamu Dedefo Gishu, MS Rahul Gupta, MD Rami M Habash, MPH Nima Hafezi-Nejad, MD Prof. Randah R Hamadeh, DPhil Hayet Hamdouni, PhD Samer Hamidi, PhD Hilda L Harb, MPH Mohammad Sadegh Hassanvand, PhD Mohammad T Hedayati, PhD Pouria Heydarpour, MD Prof. Mohamed Hsairi, MD Abdullatif Husseini, PhD Nader Jahanmehr, PhD Prof. Vivekanand Jha, DM Jost B Jonas, MD Nadim E Karam, MD Amir Kasaeian, PhD Nega Assefa Kassa, PhD Anil Kaul, MD Prof. Yousef Khader, ScD Shams Eldin A Khalifa, MSc Ejaz A Khan, MPH Gulfaraz Khan, PhD Tawfik Khoja, FRCP Ardeshir Khosravi, PhD Yohannes Kinfu, PhD Barthelemy Kuate Defo, PhD Arjun Lakshmana Balaji, MPH Raimundas Lunevicius, PhD Prof. Carla Makhlouf Obermeyer, DSc Reza Malekzadeh, MD Morteza Mansourian, PhD Prof. Wagner Marcenes, PhD Habibolah Masoudi Farid, MD Alem Mehari, MD Abla Mehio-Sibai, PhD Prof. Ziad A Memish, MD George A Mensah, MD Karzan A Mohammad, PhD Prof. Ziad Nahas, MD Jamal T Nasher, MSc Haseeb Nawaz, MD Prof. Chakib Nejjari, PhD Muhammad Imran Nisar, MSc Saad B Omer, PhD Mahboubeh Parsaeian, PhD Emmanuel K Peprah, PhD Aslam Pervaiz, MHA Farshad Pourmalek, PhD Prof. Dima M Qato, PhD Mostafa Qorbani, PhD Amir Radfar, MD Anwar Rafay, MS Kazem Rahimi, DM Vafa Rahimi-Movaghar, MD Sajjad Ur Rahman, FRCPCH Rajesh K Rai, MPH Prof. Saleem M Rana, PhD Sowmya R Rao, PhD Amany H Refaat, PhD Serge Resnikoff, MD Gholamreza Roshandel, PhD Georges Saade, MD Mohammad Y Saeedi, PhD Mohammad Ali Sahraian, MD Shadi Saleh, PhD Lidia Sanchez-Riera, PhD Maheswar Satpathy, PhD Sadaf G Sepanlou, MD Tesfaye Setegn, MPH Amira Shaheen, PhD Saeid Shahraz, PhD Sara Sheikhbahaei, MD Kawkab Shishani, PhD Prof. Karen Sliwa, PhD Mohammad Tavakkoli, MD Abdullah S Terkawi, MD Olalekan A Uthman, PhD Ronny Westerman, PhD Mustafa Z Younis, DrPH Prof. Maysaa El Sayed Zaki, PhD Faiez Zannad, MD Gregory A Roth, MD Haidong Wang, PhD Prof. Mohsen Naghavi, PhD Prof. Theo Vos, PhD Abdullah A Al Rabeeah, MBBS Prof. Alan D Lopez, PhD Prof. Christopher J L Murray, DPhil
spellingShingle	Prof. Ali H Mokdad, PhD Mohammad Hossein Forouzanfar, PhD Farah Daoud, BS Charbel El Bcheraoui, PhD Maziar Moradi-Lakeh, MD Ibrahim Khalil, MD Ashkan Afshin, DSc Marwa Tuffaha, MD Raghid Charara, MD Ryan M Barber, BS Joseph Wagner, BS Kelly Cercy, BS Hannah Kravitz, BS Matthew M Coates, BA Margaret Robinson, BA Kara Estep, MPA Caitlyn Steiner, MPH Sara Jaber, MD Ali A Mokdad, MD Kevin F O'Rourke, MFA Adrienne Chew, ND Pauline Kim, BA Mohamed Magdy Abd El Razek, MBBCh Safa Abdalla, MD Prof. Foad Abd-Allah, MD Jerry P Abraham, MD Laith J Abu-Raddad, PhD Niveen M E Abu-Rmeileh, PhD Abdulwahab A Al-Nehmi, MD Ali S Akanda, PhD Hanan Al Ahmadi, DrPH Mazin J Al Khabouri, PhD Faris H Al Lami, PhD Zulfa A Al Rayess, ABFM Deena Alasfoor, MSc Fadia S AlBuhairan, MD Saleh F Aldhahri, MD Suliman Alghnam, PhD Samia Alhabib, PhD Nawal Al-Hamad, PhD Raghib Ali, FRCP Syed Danish Ali, BA Mohammad Alkhateeb, RN Mohammad A AlMazroa, MD Mahmoud A Alomari, PhD Rajaa Al-Raddadi, PhD Ubai Alsharif, MPH Nihaya Al-Sheyab, PhD Shirina Alsowaidi, FRCPC Mohamed Al-Thani, FRCPCH Khalid A Altirkawi, MD Azmeraw T Amare, MPH Heresh Amini, MSPH Walid Ammar, PhD Palwasha Anwari, MD Hamid Asayesh, PhD Rana Asghar, MD Prof. Ali M Assabri, PhD Reza Assadi, PhD Umar Bacha, PhM Alaa Badawi, PhD Talal Bakfalouni, MD Mohammed O Basulaiman, PhD Shahrzad Bazargan-Hejazi, PhD Neeraj Bedi, MD Amit R Bhakta, MD Zulfiqar A Bhutta, PhD Aref A Bin Abdulhak, MD Soufiane Boufous, PhD Rupert R A Bourne, FRCOphth Hadi Danawi, PhD Jai Das, MBA Amare Deribew, PhD Eric L Ding, ScD Adnan M Durrani, MD Yousef Elshrek, PhD Mohamed E Ibrahim, MPhil Babak Eshrati, PhD Alireza Esteghamati, MD Imad A D Faghmous, MPH Farshad Farzadfar, MD Andrea B Feigl, ScD Seyed-Mohammad Fereshtehnejad, MD Irina Filip, MD Florian Fischer, MPH Fortuné G Gankpé, MD Ibrahim Ginawi, MD Melkamu Dedefo Gishu, MS Rahul Gupta, MD Rami M Habash, MPH Nima Hafezi-Nejad, MD Prof. Randah R Hamadeh, DPhil Hayet Hamdouni, PhD Samer Hamidi, PhD Hilda L Harb, MPH Mohammad Sadegh Hassanvand, PhD Mohammad T Hedayati, PhD Pouria Heydarpour, MD Prof. Mohamed Hsairi, MD Abdullatif Husseini, PhD Nader Jahanmehr, PhD Prof. Vivekanand Jha, DM Jost B Jonas, MD Nadim E Karam, MD Amir Kasaeian, PhD Nega Assefa Kassa, PhD Anil Kaul, MD Prof. Yousef Khader, ScD Shams Eldin A Khalifa, MSc Ejaz A Khan, MPH Gulfaraz Khan, PhD Tawfik Khoja, FRCP Ardeshir Khosravi, PhD Yohannes Kinfu, PhD Barthelemy Kuate Defo, PhD Arjun Lakshmana Balaji, MPH Raimundas Lunevicius, PhD Prof. Carla Makhlouf Obermeyer, DSc Reza Malekzadeh, MD Morteza Mansourian, PhD Prof. Wagner Marcenes, PhD Habibolah Masoudi Farid, MD Alem Mehari, MD Abla Mehio-Sibai, PhD Prof. Ziad A Memish, MD George A Mensah, MD Karzan A Mohammad, PhD Prof. Ziad Nahas, MD Jamal T Nasher, MSc Haseeb Nawaz, MD Prof. Chakib Nejjari, PhD Muhammad Imran Nisar, MSc Saad B Omer, PhD Mahboubeh Parsaeian, PhD Emmanuel K Peprah, PhD Aslam Pervaiz, MHA Farshad Pourmalek, PhD Prof. Dima M Qato, PhD Mostafa Qorbani, PhD Amir Radfar, MD Anwar Rafay, MS Kazem Rahimi, DM Vafa Rahimi-Movaghar, MD Sajjad Ur Rahman, FRCPCH Rajesh K Rai, MPH Prof. Saleem M Rana, PhD Sowmya R Rao, PhD Amany H Refaat, PhD Serge Resnikoff, MD Gholamreza Roshandel, PhD Georges Saade, MD Mohammad Y Saeedi, PhD Mohammad Ali Sahraian, MD Shadi Saleh, PhD Lidia Sanchez-Riera, PhD Maheswar Satpathy, PhD Sadaf G Sepanlou, MD Tesfaye Setegn, MPH Amira Shaheen, PhD Saeid Shahraz, PhD Sara Sheikhbahaei, MD Kawkab Shishani, PhD Prof. Karen Sliwa, PhD Mohammad Tavakkoli, MD Abdullah S Terkawi, MD Olalekan A Uthman, PhD Ronny Westerman, PhD Mustafa Z Younis, DrPH Prof. Maysaa El Sayed Zaki, PhD Faiez Zannad, MD Gregory A Roth, MD Haidong Wang, PhD Prof. Mohsen Naghavi, PhD Prof. Theo Vos, PhD Abdullah A Al Rabeeah, MBBS Prof. Alan D Lopez, PhD Prof. Christopher J L Murray, DPhil 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
author_facet	Prof. Ali H Mokdad, PhD Mohammad Hossein Forouzanfar, PhD Farah Daoud, BS Charbel El Bcheraoui, PhD Maziar Moradi-Lakeh, MD Ibrahim Khalil, MD Ashkan Afshin, DSc Marwa Tuffaha, MD Raghid Charara, MD Ryan M Barber, BS Joseph Wagner, BS Kelly Cercy, BS Hannah Kravitz, BS Matthew M Coates, BA Margaret Robinson, BA Kara Estep, MPA Caitlyn Steiner, MPH Sara Jaber, MD Ali A Mokdad, MD Kevin F O'Rourke, MFA Adrienne Chew, ND Pauline Kim, BA Mohamed Magdy Abd El Razek, MBBCh Safa Abdalla, MD Prof. Foad Abd-Allah, MD Jerry P Abraham, MD Laith J Abu-Raddad, PhD Niveen M E Abu-Rmeileh, PhD Abdulwahab A Al-Nehmi, MD Ali S Akanda, PhD Hanan Al Ahmadi, DrPH Mazin J Al Khabouri, PhD Faris H Al Lami, PhD Zulfa A Al Rayess, ABFM Deena Alasfoor, MSc Fadia S AlBuhairan, MD Saleh F Aldhahri, MD Suliman Alghnam, PhD Samia Alhabib, PhD Nawal Al-Hamad, PhD Raghib Ali, FRCP Syed Danish Ali, BA Mohammad Alkhateeb, RN Mohammad A AlMazroa, MD Mahmoud A Alomari, PhD Rajaa Al-Raddadi, PhD Ubai Alsharif, MPH Nihaya Al-Sheyab, PhD Shirina Alsowaidi, FRCPC Mohamed Al-Thani, FRCPCH Khalid A Altirkawi, MD Azmeraw T Amare, MPH Heresh Amini, MSPH Walid Ammar, PhD Palwasha Anwari, MD Hamid Asayesh, PhD Rana Asghar, MD Prof. Ali M Assabri, PhD Reza Assadi, PhD Umar Bacha, PhM Alaa Badawi, PhD Talal Bakfalouni, MD Mohammed O Basulaiman, PhD Shahrzad Bazargan-Hejazi, PhD Neeraj Bedi, MD Amit R Bhakta, MD Zulfiqar A Bhutta, PhD Aref A Bin Abdulhak, MD Soufiane Boufous, PhD Rupert R A Bourne, FRCOphth Hadi Danawi, PhD Jai Das, MBA Amare Deribew, PhD Eric L Ding, ScD Adnan M Durrani, MD Yousef Elshrek, PhD Mohamed E Ibrahim, MPhil Babak Eshrati, PhD Alireza Esteghamati, MD Imad A D Faghmous, MPH Farshad Farzadfar, MD Andrea B Feigl, ScD Seyed-Mohammad Fereshtehnejad, MD Irina Filip, MD Florian Fischer, MPH Fortuné G Gankpé, MD Ibrahim Ginawi, MD Melkamu Dedefo Gishu, MS Rahul Gupta, MD Rami M Habash, MPH Nima Hafezi-Nejad, MD Prof. Randah R Hamadeh, DPhil Hayet Hamdouni, PhD Samer Hamidi, PhD Hilda L Harb, MPH Mohammad Sadegh Hassanvand, PhD Mohammad T Hedayati, PhD Pouria Heydarpour, MD Prof. Mohamed Hsairi, MD Abdullatif Husseini, PhD Nader Jahanmehr, PhD Prof. Vivekanand Jha, DM Jost B Jonas, MD Nadim E Karam, MD Amir Kasaeian, PhD Nega Assefa Kassa, PhD Anil Kaul, MD Prof. Yousef Khader, ScD Shams Eldin A Khalifa, MSc Ejaz A Khan, MPH Gulfaraz Khan, PhD Tawfik Khoja, FRCP Ardeshir Khosravi, PhD Yohannes Kinfu, PhD Barthelemy Kuate Defo, PhD Arjun Lakshmana Balaji, MPH Raimundas Lunevicius, PhD Prof. Carla Makhlouf Obermeyer, DSc Reza Malekzadeh, MD Morteza Mansourian, PhD Prof. Wagner Marcenes, PhD Habibolah Masoudi Farid, MD Alem Mehari, MD Abla Mehio-Sibai, PhD Prof. Ziad A Memish, MD George A Mensah, MD Karzan A Mohammad, PhD Prof. Ziad Nahas, MD Jamal T Nasher, MSc Haseeb Nawaz, MD Prof. Chakib Nejjari, PhD Muhammad Imran Nisar, MSc Saad B Omer, PhD Mahboubeh Parsaeian, PhD Emmanuel K Peprah, PhD Aslam Pervaiz, MHA Farshad Pourmalek, PhD Prof. Dima M Qato, PhD Mostafa Qorbani, PhD Amir Radfar, MD Anwar Rafay, MS Kazem Rahimi, DM Vafa Rahimi-Movaghar, MD Sajjad Ur Rahman, FRCPCH Rajesh K Rai, MPH Prof. Saleem M Rana, PhD Sowmya R Rao, PhD Amany H Refaat, PhD Serge Resnikoff, MD Gholamreza Roshandel, PhD Georges Saade, MD Mohammad Y Saeedi, PhD Mohammad Ali Sahraian, MD Shadi Saleh, PhD Lidia Sanchez-Riera, PhD Maheswar Satpathy, PhD Sadaf G Sepanlou, MD Tesfaye Setegn, MPH Amira Shaheen, PhD Saeid Shahraz, PhD Sara Sheikhbahaei, MD Kawkab Shishani, PhD Prof. Karen Sliwa, PhD Mohammad Tavakkoli, MD Abdullah S Terkawi, MD Olalekan A Uthman, PhD Ronny Westerman, PhD Mustafa Z Younis, DrPH Prof. Maysaa El Sayed Zaki, PhD Faiez Zannad, MD Gregory A Roth, MD Haidong Wang, PhD Prof. Mohsen Naghavi, PhD Prof. Theo Vos, PhD Abdullah A Al Rabeeah, MBBS Prof. Alan D Lopez, PhD Prof. Christopher J L Murray, DPhil
author_sort	Prof. Ali H Mokdad, PhD
title	Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
title_short	Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
title_full	Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
title_fullStr	Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
title_full_unstemmed	Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
title_sort	health in times of uncertainty in the eastern mediterranean region, 1990–2013: a systematic analysis for the global burden of disease study 2013
publisher	Elsevier
series	The Lancet Global Health
issn	2214-109X
publishDate	2016-10-01
description	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.
url	http://www.sciencedirect.com/science/article/pii/S2214109X16301681
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healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT abdulwahabaalnehmimd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT alisakandaphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT hananalahmadidrph healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mazinjalkhabouriphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT farishallamiphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT zulfaaalrayessabfm healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT deenaalasfoormsc 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healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT ranaasgharmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profalimassabriphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT rezaassadiphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT umarbachaphm healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT alaabadawiphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT talalbakfalounimd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mohammedobasulaimanphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT shahrzadbazarganhejaziphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT neerajbedimd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT amitrbhaktamd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT zulfiqarabhuttaphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT arefabinabdulhakmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT soufianeboufousphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT rupertrabournefrcophth healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT hadidanawiphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT jaidasmba healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT amarederibewphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT ericldingscd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT adnanmdurranimd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT yousefelshrekphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mohamedeibrahimmphil 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pouriaheydarpourmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profmohamedhsairimd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT abdullatifhusseiniphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT naderjahanmehrphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profvivekanandjhadm healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT jostbjonasmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT nadimekarammd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT amirkasaeianphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT negaassefakassaphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT anilkaulmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profyousefkhaderscd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT shamseldinakhalifamsc healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT ejazakhanmph healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT gulfarazkhanphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT tawfikkhojafrcp 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healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT rezamalekzadehmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mortezamansourianphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profwagnermarcenesphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT habibolahmasoudifaridmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT alemmeharimd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT ablamehiosibaiphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profziadamemishmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT georgeamensahmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT karzanamohammadphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profziadnahasmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT jamaltnashermsc healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT haseebnawazmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profchakibnejjariphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT muhammadimrannisarmsc healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT saadbomerphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mahboubehparsaeianphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT emmanuelkpeprahphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT aslampervaizmha healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT farshadpourmalekphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profdimamqatophd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mostafaqorbaniphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT amirradfarmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT anwarrafayms healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT kazemrahimidm healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT vafarahimimovagharmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT sajjadurrahmanfrcpch healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT rajeshkraimph healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profsaleemmranaphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT sowmyarraophd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT amanyhrefaatphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT sergeresnikoffmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT gholamrezaroshandelphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT georgessaademd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mohammadysaeediphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mohammadalisahraianmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT shadisalehphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT lidiasanchezrieraphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT maheswarsatpathyphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT sadafgsepanloumd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT tesfayesetegnmph healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT amirashaheenphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT saeidshahrazphd 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healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT mustafazyounisdrph healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profmaysaaelsayedzakiphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT faiezzannadmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT gregoryarothmd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT haidongwangphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profmohsennaghaviphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT proftheovosphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT abdullahaalrabeeahmbbs healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profalandlopezphd healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013 AT profchristopherjlmurraydphil healthintimesofuncertaintyintheeasternmediterraneanregion19902013asystematicanalysisfortheglobalburdenofdiseasestudy2013
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spelling	doaj-7c0d5b995ace4c40b99504c387157eeb2020-11-25T01:28:34ZengElsevierThe Lancet Global Health2214-109X2016-10-01410e704e71310.1016/S2214-109X(16)30168-1Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013Prof. Ali H Mokdad, PhD0Mohammad Hossein Forouzanfar, PhD1Farah Daoud, BS2Charbel El Bcheraoui, PhD3Maziar Moradi-Lakeh, MD4Ibrahim Khalil, MD5Ashkan Afshin, DSc6Marwa Tuffaha, MD7Raghid Charara, MD8Ryan M Barber, BS9Joseph Wagner, BS10Kelly Cercy, BS11Hannah Kravitz, BS12Matthew M Coates, BA13Margaret Robinson, BA14Kara Estep, MPA15Caitlyn Steiner, MPH16Sara Jaber, MD17Ali A Mokdad, MD18Kevin F O'Rourke, MFA19Adrienne Chew, ND20Pauline Kim, BA21Mohamed Magdy Abd El Razek, MBBCh22Safa Abdalla, MD23Prof. Foad Abd-Allah, MD24Jerry P Abraham, MD25Laith J Abu-Raddad, PhD26Niveen M E Abu-Rmeileh, PhD27Abdulwahab A Al-Nehmi, MD28Ali S Akanda, PhD29Hanan Al Ahmadi, DrPH30Mazin J Al Khabouri, PhD31Faris H Al Lami, PhD32Zulfa A Al Rayess, ABFM33Deena Alasfoor, MSc34Fadia S AlBuhairan, MD35Saleh F Aldhahri, MD36Suliman Alghnam, PhD37Samia Alhabib, PhD38Nawal Al-Hamad, PhD39Raghib Ali, FRCP40Syed Danish Ali, BA41Mohammad Alkhateeb, RN42Mohammad A AlMazroa, MD43Mahmoud A Alomari, PhD44Rajaa Al-Raddadi, PhD45Ubai Alsharif, MPH46Nihaya Al-Sheyab, PhD47Shirina Alsowaidi, FRCPC48Mohamed Al-Thani, FRCPCH49Khalid A Altirkawi, MD50Azmeraw T Amare, MPH51Heresh Amini, MSPH52Walid Ammar, PhD53Palwasha Anwari, MD54Hamid Asayesh, PhD55Rana Asghar, MD56Prof. Ali M Assabri, PhD57Reza Assadi, PhD58Umar Bacha, PhM59Alaa Badawi, PhD60Talal Bakfalouni, MD61Mohammed O Basulaiman, PhD62Shahrzad Bazargan-Hejazi, PhD63Neeraj Bedi, MD64Amit R Bhakta, MD65Zulfiqar A Bhutta, PhD66Aref A Bin Abdulhak, MD67Soufiane Boufous, PhD68Rupert R A Bourne, FRCOphth69Hadi Danawi, PhD70Jai Das, MBA71Amare Deribew, PhD72Eric L Ding, ScD73Adnan M Durrani, MD74Yousef Elshrek, PhD75Mohamed E Ibrahim, MPhil76Babak Eshrati, PhD77Alireza Esteghamati, MD78Imad A D Faghmous, MPH79Farshad Farzadfar, MD80Andrea B Feigl, ScD81Seyed-Mohammad Fereshtehnejad, MD82Irina Filip, MD83Florian Fischer, MPH84Fortuné G Gankpé, MD85Ibrahim Ginawi, MD86Melkamu Dedefo Gishu, MS87Rahul Gupta, MD88Rami M Habash, MPH89Nima Hafezi-Nejad, MD90Prof. Randah R Hamadeh, DPhil91Hayet Hamdouni, PhD92Samer Hamidi, PhD93Hilda L Harb, MPH94Mohammad Sadegh Hassanvand, PhD95Mohammad T Hedayati, PhD96Pouria Heydarpour, MD97Prof. Mohamed Hsairi, MD98Abdullatif Husseini, PhD99Nader Jahanmehr, PhD100Prof. Vivekanand Jha, DM101Jost B Jonas, MD102Nadim E Karam, MD103Amir Kasaeian, PhD104Nega Assefa Kassa, PhD105Anil Kaul, MD106Prof. Yousef Khader, ScD107Shams Eldin A Khalifa, MSc108Ejaz A Khan, MPH109Gulfaraz Khan, PhD110Tawfik Khoja, FRCP111Ardeshir Khosravi, PhD112Yohannes Kinfu, PhD113Barthelemy Kuate Defo, PhD114Arjun Lakshmana Balaji, MPH115Raimundas Lunevicius, PhD116Prof. Carla Makhlouf Obermeyer, DSc117Reza Malekzadeh, MD118Morteza Mansourian, PhD119Prof. Wagner Marcenes, PhD120Habibolah Masoudi Farid, MD121Alem Mehari, MD122Abla Mehio-Sibai, PhD123Prof. Ziad A Memish, MD124George A Mensah, MD125Karzan A Mohammad, PhD126Prof. Ziad Nahas, MD127Jamal T Nasher, MSc128Haseeb Nawaz, MD129Prof. Chakib Nejjari, PhD130Muhammad Imran Nisar, MSc131Saad B Omer, PhD132Mahboubeh Parsaeian, PhD133Emmanuel K Peprah, PhD134Aslam Pervaiz, MHA135Farshad Pourmalek, PhD136Prof. Dima M Qato, PhD137Mostafa Qorbani, PhD138Amir Radfar, MD139Anwar Rafay, MS140Kazem Rahimi, DM141Vafa Rahimi-Movaghar, MD142Sajjad Ur Rahman, FRCPCH143Rajesh K Rai, MPH144Prof. Saleem M Rana, PhD145Sowmya R Rao, PhD146Amany H Refaat, PhD147Serge Resnikoff, MD148Gholamreza Roshandel, PhD149Georges Saade, MD150Mohammad Y Saeedi, PhD151Mohammad Ali Sahraian, MD152Shadi Saleh, PhD153Lidia Sanchez-Riera, PhD154Maheswar Satpathy, PhD155Sadaf G Sepanlou, MD156Tesfaye Setegn, MPH157Amira Shaheen, PhD158Saeid Shahraz, PhD159Sara Sheikhbahaei, MD160Kawkab Shishani, PhD161Prof. Karen Sliwa, PhD162Mohammad Tavakkoli, MD163Abdullah S Terkawi, MD164Olalekan A Uthman, PhD165Ronny Westerman, PhD166Mustafa Z Younis, DrPH167Prof. Maysaa El Sayed Zaki, PhD168Faiez Zannad, MD169Gregory A Roth, MD170Haidong Wang, PhD171Prof. Mohsen Naghavi, PhD172Prof. Theo Vos, PhD173Abdullah A Al Rabeeah, MBBS174Prof. Alan D Lopez, PhD175Prof. Christopher J L Murray, DPhil176Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USADepartment of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAAswan University Hospital, Aswan Faculty of Medicine, Aswan, EgyptSudanese Public Health Consultancy Group, Solihull, UKDepartment of Neurology, Cairo University, Cairo, EgyptFamily Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USAInfectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, QatarInstitute of Community and Public Health, Birzeit University, Ramallah, PalestineMinistry of Health, Sana'a, YemenUniversity of Rhode Island, Kingston, RI, USAMajlis Al Shura, Riyadh, Saudi ArabiaMinistry of Health, Muscat, OmanCollege of Medicine, University of Baghdad, Baghdad, IraqThe Saudi Center for Evidence Based Healthcare, Riyadh, Saudi ArabiaMinistry of Health, Muscat, OmanKing Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaKing Saud University, Riyadh, Saudi ArabiaKing Abdullah International Medical Research Center, Riyadh, Saudi ArabiaKing Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi ArabiaPublic Authority for Food and Nutrition, KuwaitUniversity of Oxford, Oxford, UKUniversity of London, London, UKPediatric Department, King Khalid University Hospital, Riyadh, Saudi ArabiaKingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi ArabiaDivision of Physical Therapy, Department of Rehabilitation Sciences, Irbid, JordanKingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi ArabiaCharité Universitätsmedizin, Berlin, GermanyMaternal and Child Health Department, Irbid, JordanDepartment of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab EmiratesSupreme Council of Health, Doha, QatarKing Saud University, Riyadh, Saudi ArabiaDiscipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, AustraliaEnvironmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, IranMinistry of Public Health, Beirut, LebanonKabul, AfghanistanDepartment of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, IranSouth Asian Public Health Forum, Islamabad, PakistanFaculty of Medicine and Health Sciences, Sana'a University, Sana'a, YemenMashhad University of Medical Sciences, Mashhad, IranSchool of Health Sciences, University of Management and Technology, Lahore, PakistanPublic Health Agency of Canada, Toronto, ON, CanadaMinistry of Health, Damascus, SyriaKingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi ArabiaCharles R Drew University of Medicine and Science, Los Angeles, CA, USACollege of Public Health and Tropical Medicine, Jazan, Saudi ArabiaNational Institute of Mental Health, Montgomery Village, MD, USACentre of Excellence in Women and Child Health, Karachi, PakistanUniversity of Iowa Hospitals and Clinics, Iowa City, IA, USATransport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, AustraliaVision & Eye Research Unit, Anglia Ruskin University, Cambridge, UKWalden University, Minneapolis, MN, USADepartment of Paediatrics and Child Health, Karachi, PakistanNuffield Department of Medicine, Oxford, UKHarvard T H Chan School of Public Health, Harvard University, Boston, MA, USANational Institutes of Health, Montgomery Village, MD, USAFood Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, LibyaCardiovascular Diseases Control and Prevention Program, Riyadh, Saudi ArabiaMinistry of Health and Medical Education, Tehran, IranEndocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IranLondon School of Hygiene & Tropical Medicine, London, UKNon-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IranDepartment of Global Health and Population, Harvard University, Boston, MA, USADepartment of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, SwedenKaiser Permanente Psychiatry Residency Program, Fontana, CA, USABielefeld University, Bielefeld, GermanyLeras Afrique, Cotonou, BeninCollege of Medicine, University of Hail, Hail, Saudi ArabiaHaramaya University, Dira Dawa, EthiopiaWest Virginia Bureau for Public Health, Charleston, WV, USAKingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi ArabiaEndocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IranArabian Gulf University, Manama, BahrainDirection des Soins de Santé de Base, Ministry of Health, Tunis, TunisiaHamdan Bin Mohammed Smart University, Dubai, United Arab EmiratesMinistry of Public Health, Beirut, LebanonCenter for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, IranDepartment of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, IranMultiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IranSalah Azaiz Institute, Tunis, TunisiaQatar University, Doha, QatarSchool of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IranThe George Institute for Global Health India, University of Oxford, New Delhi, IndiaRuprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, GermanyUniversity of Balamand, Beirut, LebanonNon-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IranHaramaya University, Harari, EthiopiaOklahoma State University Center for Health Sciences, Tulsa, OK, USAJordan University of Science and Technology, Irbid, JordanSupreme Council of Health, Doha, QatarHealth Services Academy, Islamabad, PakistanDepartment of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab EmiratesHealth Ministers' Council for Cooperation Council States, Riyadh, Saudi ArabiaNon-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IranCentre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, AustraliaDepartment of Demography and Public Health Research Institute, University of Montreal, Montreal, QC, CanadaIndegene, Bangalore, IndiaAintree University Hospital National Health Service Foundation Trust, Liverpool, UKCenter for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, LebanonDigestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, IranQueen Mary University of London, London, UKState Welfare Organisation, Tehran, IranHoward University College of Medicine, Washington, DC, USADepartment of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, LebanonKingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi ArabiaCenter for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Montgomery Village, MD, USAUniversity of Salahaddin, Erbil, IraqMedical Center, American University of Beirut, Beirut, LebanonMinistry of Public Health and Population, Sana'a, YemenSouthern Illinois University, Springfield, IL, USAFaculty of Medicine, Fez, MoroccoAga Khan University, Karachi, PakistanEmory University, Atlanta, GA, USANon-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IranNational Heart, Lung, and Blood Institute, Bethesda, MD, USAPostgraduate Medical Institute, Lahore, PakistanUniversity of British Columbia, Vancouver, BC, CanadaCollege of Pharmacy, University of Illinois, Chicago, IL, USADepartment of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, IranA T Still University of Health Sciences, Kirksville, MO, USAContech International Health Consultants, Lahore, PakistanUniversity of Oxford, Oxford, UKSina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IranHamad Medical Corporation, Doha, QatarSociety for Health and Demographic Surveillance, Suri, IndiaContech International Health Consultants, Lahore, PakistanDepartment of Surgery, Boston University School of Medicine, Boston, MA, USAWalden University, Minneapolis, MN, USABrien Holden Vision Institute, University of New South Wales, Sydney, NSW, AustraliaDigestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IranLebanese University, Beirut, LebanonKingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi ArabiaMultiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Health Management and Policy, American University of Beirut, Beirut, LebanonInstitut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, SpainAll India Institute of Medical Sciences, New Delhi, IndiaDigestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IranBahir Dar University, Bahir Dar, EthiopiaDepartment of Public Health, An-Najah University, Nablus, PalestineTufts Medical Center, Boston, MA, USAEndocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IranWashington State University, Spokane, WA, USAFaculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South AfricaWestchester Medical Center, Valhalla, NY, USADepartment of Anesthesiology, Riyadh, Saudi ArabiaWarwick Medical School, University of Warwick, Coventry, UKFederal Institute for Population Research, Wiesbaden, GermanyJackson State University, Jackson, MS, USAFaculty of Medicine, Mansoura University, Mansoura, EgyptClinical Investigation Centre INSERM, Université de Lorraine, Vandoeuvre les Nancy, FranceInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAKingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi ArabiaInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USABackground: 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.http://www.sciencedirect.com/science/article/pii/S2214109X16301681

Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

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