Health dynamics in war-torn Yemen: insights from 32 years of epidemiological data (1990-2021).

backgroundYemen is the poorest and war-torn country in the North Africa and Middle East region and lacks a comprehensive assessment of temporal trends in the overall disease burden, injuries, and disabilities at the country level; these insights are required to guide healthcare interventions and improve overall population health. We estimated the burden and temporal trends of diseases and their risk factors in Yemen between 1990 and 2021 using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021.

methodsIn this systematic analysis, we presented all-causes and cause-specific mortality rates, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), as well as the life expectancy at birth and health-adjusted life expectancy (HALE) using the standardized GBD methodology. Moreover, we compared the disease burden of Yemen with the top five war-torn countries based on the Global Peace Index (GPI) 2021, including Afghanistan, Syria, South Sudan, and Iraq.

resultsIn Yemen, the life expectancy at birth increased from 59.0 years (95% UI 56.4-61.8) in 1990 to 65.3 years (95% UI 62.2-67.9) in 2021. Between 1990 and 2021, the all-causes age-standardized mortality rate in Yemen decreased from 1471.7 deaths (95% UI 1268.4-1696.3) to 1347.2 deaths (95% UI 1097.5-1659.5). However, the age-standardized mortality rate caused by conflict and terrorism substantially increased from 1.9 deaths (95% UI 1.7-2.1) to 50.0 deaths (95% UI 45.5-55.0) between 2010 and 2021. In 2021, ischemic heart disease, COVID-19, stroke, hypertensive heart disease, conflict and terrorism, and neonatal disorders were leading causes of age-standardized mortality and YLLs rate. Dietary iron deficiency, low back pain, depressive disorders, headache disorders, anxiety disorders, and gynecological diseases were the leading causes of age-standardized YLDs rate in 2021. High blood pressure, high levels of low-density lipoprotein, smoking, low birth weight, and short gestations were the leading risk factors for age-standardized mortality in 2021. Yemen ranked 3rd in terms of high age-standardized all-causes deaths, YLLs, and lowest HALE at birth and lowest life expectancy at birth among the top five war-torn countries in 2021.

conclusionYemen must proportionately address the burden caused by non-communicable diseases, communicable, maternal, neonatal, and nutritional diseases, and conflict and terrorism. Prioritizing these areas will improve the overall population health and prevent premature mortality and disabilities.