Burden of neurodegenerative diseases in the Eastern Mediterranean Region, 1990-2016: findings from the Global Burden of Disease Study 2016

BACKGROUND AND PURPOSE

The Eastern Mediterranean Region (EMR) is experiencing a demographic shift towards rapid aging at a time of political unrest. We aimed to estimate the burden of neurodegenerative disorders and its relationship with sociodemographic index in the EMR countries from 1990 to 2016.

METHODS

Using data from the Global Burden of Disease Study 2016, we calculated country-specific trends for prevalence, mortality, disability-adjusted life-years (DALY), years of life lost and years lived with disability (YLD) for Alzheimer's disease/other dementias and Parkinson's disease in the EMR during 1990-2016.

RESULTS

In the EMR, the age-standardized prevalence rate of Alzheimer's disease/other dementias and Parkinson's disease was estimated at 759.8/100 000 (95% uncertainty intervals, 642.9-899.9) and 87.1/100 000 (95% uncertainty intervals, 69.8-108.2) people in 2016, demonstrating 0.01% and 42.3% change from 1990, respectively. Neurodegenerative disorders contributed to 5.4% of total DALY and 4.6% of total YLD among the older EMR population (70 years of age or older in 2016). Age-standardized DALY due to Parkinson's disease were strongly correlated with the sociodemographic index level (r = 0.823, P < 0.001). The YLD:DALY ratio of neurodegenerative diseases declined during this period in the low-income but not the high-income EMR countries.

CONCLUSIONS

Our findings demonstrated an increasing trend in the burden of dementias and Parkinson's disease in most EMR countries between 1990 and 2016. With aging of the EMR populations, countries should target the modifiable risk factors of neurodegenerative diseases to control their increasing burden.

Hypertension and mortality in the Golestan Cohort Study: A prospective study of 50 000 adults in Iran

High blood pressure has been the second most important determinant of disease burden in Iran since the 1990s. Despite well-recognized evidence on the association of high blood pressure and mortality in other countries, this relationship has not been fully investigated in the demographic setting of Iran. The current study is the first large-scale longitudinal study of this association in Iran. Briefly, 50 045 subjects between 40 and 75 years of age have been recruited and followed. Blood pressure measurements were carried out at baseline. Causes of death were reported and verified by verbal autopsy throughout the follow-up period. The outcomes of interest were all-cause deaths and deaths due to ischemic heart disease (IHD) or stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs). A total of 46 674 subjects free from cardiovascular disease at baseline were analyzed. Absolute mortality rates increased along with increasing systolic or diastolic blood pressure above 120 and 80 mm Hg, respectively. Adjusted HRs (95% confidence intervals) for each 20 mm Hg increase in systolic blood pressure in all age groups were 1.18 (1.13-1.23) for all-cause mortality, 1.21 (1.13-1.31) for deaths due to IHD and 1.50 (1.39-1.63) for deaths due to stroke. Unadjusted and adjusted HRs were higher in younger subjects and decreased with increasing age of the participants. High blood pressure is a serious threat to the health of Iranians. The entire health-care system of Iran should be involved in a comprehensive action plan for controlling blood pressure.

Time Trends of Gastro-esophageal Reflux Disease (GERD) and Peptic Ulcer Disease (PUD) in Iran

BACKGROUND Epidemiology of diseases changes over time with changes in socio-economic status, culture and health care systems. Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are among the diseases whose epidemiology has changed over the past few decades in the west. Studies addressing the trend of GERD and PUD occurrence in Iran are lacking. We aimed to look at the time trends of GERD and PUD in a referral endoscopy clinic in Tehran, Iran. METHODS All patients with dyspeptic symptoms who underwent upper GI endoscopy from 1993 to 2005 (inclusive) in a tertiary outpatient GI referral center in Tehran were enrolled. Erosive esophagitis (EE, used as a proxy for GERD as a whole), PUD, rapid urease test (RUT) status and demographic characteristics were recorded from the endoscopy reports according to the year the endoscopy was performed. RESULTS Over a period of 13 years, 8,029 endoscopic examinations were performed. The most common endoscopic diagnosis was EE that occurred in 4,808 patients (59.8%) followed by duodenal ulcer in 2,188 (27.3%) and gastric ulcer in 88 (1.1%). Over 13 years (1995-2005), the proportion of EE increased from 14.1% in 1993 to 75.1% in 2005 among dyspeptic patients in this referral clinic. The proportion of each grade of GERD according to the Los Angeles classification was as follows: GERD-A 76.0%, GERD-B 20.9%, GERD-C 2.8% and GERD-D 0.3%. RUT positivity decreased from 71.4% to 9.5% during the study period. CONCLUSION This study shows a remarkable increase in EE with a concomitant decrease in PUD and RUT positivity among dyspeptic patients in Tehran over a decade. This change in trend is important for future health care planning.

A Population-based Seroepidemiological Study on Hepatitis E Virus in Iran

BACKGROUND Little is known about HEV seroprevalence and its determinants in Iran. Considering the fact that Iran is among the countries in which HEV infection is endemic, a large-scale population-based study in this regard is justified. METHODS This survey was conducted in 2006 in Tehran and Golestan Provinces, Iran. Stored sera of subjects were tested for serological markers of anti-HEV. The baseline data were recorded in structured questionnaires. Weighted seroprevalence and weighted logistic regression coefficients were calculated. RESULTS A total of 1423 samples were included. The overall seroprevalence in two provinces was 7.4%. Age with an odds ratio equal to 1.59 (95% CI: 1.26-2.02) and history of traditional phlebotomy with an odds ratio equal to 2.28 (95% CI: 1.13-4.60) were independent predictors of HEV seropositivity. CONCLUSION Considering the high rate of HEV seroprevalence in Iran, further studies on the cost-effectiveness of vaccination among vulnerable groups are mandatory.

Hepatocellular carcinoma in the world and the middle East

Hepatocellular carcinoma (HCC) is a major worldwide public health concern. Despite recent advances, there has been little success in improving the survival of HCC patients. Due to advances in diagnostic modalities and the increasing incidence of chronic viral hepatitis and nonalcoholic fatty liver disease (NAFLD), both of which are well known risk factors of HCC, the prevalence of HCC is increasing in developed countries and it is expected that this trend will continue in the future. In Middle Eastern countries the prevalence of this cancer is lower compared to sub-Saharan Africa and some Far East countries; however it is documented that the prevalence of this cancer in some parts of the Middle East is also increasing. In the current review, the prevalence and burden of this disease worldwide, particularly in Middle Eastern countries, and risk factors for HCC are discussed.