The burden of disease in Saudi Arabia 1990-2017: results from the Global Burden of Disease Study 2017

Abstract

Background: Availability of data to assess the population health and provision and quality of health care in Saudi Arabia has been lacking. In 2010, Saudi Arabia began a major investment and transformation programme in the health-care sector. Here we assess the impact of this investment era on mortality, health loss, risk factors, and health-care services in the country.

Methods: We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to describe the levels and temporal patterns in deaths, health loss, risk factors, and health-care access and quality in the Saudi Arabian population during 1990-2010 (before the health-care investments and reform) and 2010-17 (during health-care investments and reform). We also compared patterns in health outcomes between these periods with those in the north Africa and the Middle East GBD region and the Gulf Cooperation Council countries.

Findings: Age-standardised mortality in Saudi Arabia decreased from 1990 to 2010 (annualised rate of change of -0·58%), and this decrease was further accelerated from 2010 to 2017 (-2·20%). The north Africa and the Middle East GBD region also had decreases in mortality during these periods, but for 2010-17 the decrease was not as low as in Saudi Arabia (-1·29%). Transport injuries decreased from third ranked cause of disability-adjusted life-years in 2010 to fifth ranked cause in 2017 in Saudi Arabia, below cardiovascular diseases (ranked first) and musculoskeletal disorders (ranked second). Years lived with disability (YLDs) due to mental disorders, substance use disorders, neoplasms, and neurological disorders consistently increased over the periods 1990-2010 and 2010-17. Between 1990 and 2017, attributable YLDs due to metabolic, behavioural, and environmental or occupational risk factors remained almost unchanged in Saudi Arabia, with high body-mass index, high fasting plasma glucose concentration, and drug use increasing across all age groups. Health-care Access and Quality (HAQ) Index levels increased in Saudi Arabia during this period with similar patterns to the rest of the Gulf Cooperation Council countries and the north Africa and the Middle East GBD region.

Interpretation: Decreases in mortality continued at greater rates in Saudi Arabia during the period of 2010-17 than in 1990-2010. HAQ Index levels have also improved. Public health policy makers in Saudi Arabia need to increase efforts to address preventable risk factors that are major contributors to the burden of ill health and disability.

Funding: Bill & Melinda Gates Foundation.

Figure 1

All-cause age-standardised mortality in Saudi Arabia, the other Gulf Cooperative Council Countries, and the north Africa and the Middle East GBD region, for both sexes, 1990–2017 The Gulf Cooperative Council countries are Saudi Arabia, Bahrain, Kuwait, Oman, Qatar, and the United Arab Emirates. GBD=Global Burden of Diseases, Injuries and Risk Factors study.

Figure 2

Proportional distribution of causes of death for 1990–2010 (A) and 2010–17 (B) in Saudi Arabia for all Level 2 GBD causes of death Causes of death that increased their proportional burden for the time period are coloured: blue rectangles are non-communicable disease; red rectangles are communicable, maternal, neonatal, and nutritional diseases; and green rectangles are injuries. The causes that remained stable or decreased are in grey. For more detail see the data visualisation tool. GBD=Global Burden of Diseases, Risk factors, and Injuries study. STIs=sexually transmitted infections.

Figure 3

Top-ranked Level 4 causes of age-standardised years lived with disability in both sexes in Saudi Arabia, the other Gulf Cooperation Council countries, and the north Africa and the Middle East GBD region for 1990 (A) and 2017 (B) Numbers are rankings, with colours indicating the scale from low (blue: below 17th) to high (red: first and second) rankings. For more detail see the data visualisation tool. GBD=Global Burden of Diseases, Injuries, and Risk Factors study.

Figure 4

Top 25 Level 2 causes of DALYs in Saudi Arabia for the periods 1990–2010 (A) and 2010–17 (B), both sexes Solid lines indicate increases and dashed lines indicate decreases in rank between periods. Significant changes are shown in bold. For more detail see the data visualisation tool. DALYs=disability-adjusted life-years

Figure 5

Top 20 Level 2 risk factors for all-cause YLDs in Saudi Arabia (A) and the north Africa and the Middle East GBD region (B) 1990–2017, both sexes Solid lines indicate increases and dashed lines indicate decreases in rank between periods. Significant changes are shown in bold. For more details see the data visualisation tool. BMI=body-mass index. GBD=Global Burden of Diseases, Injuries, and Risk Factors study. WaSH=water, sanitation, and hygiene. YLDs=years lived with disability.