文献： Ali H M,et al.The state of health in the Arab world, 1990—2010: an
analysis of the burden of diseases, injuries, and risk factors.The Lancet,
Early Online Publication, 20 January 2014.
アラブ連盟22カ国での疾病負担の経時変化を、世界の疾病負担研究（GBD）2010のデータから検証。死因第1位は2009年の下気道感染症から2010年の虚血性心疾患に変化した。精神疾患や糖尿病などの非感染性疾患による障害調整生命年（DALY）は1990年以降増加し、HIV感染による負担も特に低-中所得国で大きく増加した。
The state of health in the Arab world, 1990—2010: an analysis of the burden
of diseases, injuries, and risk factors
Prof Ali H Mokdad PhD a Corresponding AuthorEmail Address, Sara Jaber MD a,
Muna I Abdel Aziz PhD b, Fadia AlBuhairan MD c, Abduljabbar AlGhaithi MD d,
Nawal M AlHamad PhD e, Suad N Al-Hooti PhD f, Adel Al-Jasari MD d, Mohammad
A AlMazroa MD g, Ahmed Mohamed AlQasmi MD h, Shirina Alsowaidi MD i, Majed
Asad MD j, Charles Atkinson BS a, Alaa Badawi PhD k, Talal Bakfalouni MD l,
AbdelAziz Barkia PhD m, Stan Biryukov BS a, Charbel El Bcheraoui PhD a,
Farah Daoud BS a, Mohammad Hossein Forouzanfar MD a, Diego Gonzalez-Medina
BA a, Prof Randah R Hamadeh DPhil n, Mohamed Hsairi MD o, Seifeddin Saleh
Hussein MD j, Nadim Karam MD q, Shams Eldin Ali Hassan Khalifa MD p, Prof
Tawfik A M Khoja MD r, Faris Lami MD s, Katherine Leach-Kemon MPH a, Prof
Ziad A Memish MD g, Ali A Mokdad MD a, Mohsen Naghavi PhD a, Jamal Nasher MD
d, M Bassam Hijawi Qasem MD j, Mohammad Shuaib MD t, Al Anoud M Al Thani MD
p, Mohamed H Al Thani MD p, Mohammed Zamakhshary MD g, Prof Alan D Lopez PhD
u, Prof Christopher J L Murray MD a
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.
