The Burden of Inflammatory Bowel Disease in Gulf Cooperation Council Countries from 1990 to 2021 with Forecasting Projections to 2030: A Global Burden of Disease Study

Interpreting mortality trends in the GCC countries: The healthy migrant effect

BackgroundBMI has been reported to be a major risk factor for the increased burden of several diseases. This study explores the burden of cancer linked to high body mass index (BMI) in Gulf Cooperation Council (GCC) countries and assesses the correlation with Socio-demographic Index (SDI).MethodUsing Global burden of disease (GBD) 2019 data, the authors quantified cancer burden through mortality, DALYs, age standardized mortality rate (ASMR), and age standardized DALYs rate (ASDR) across sexes, countries, cancer types, and years. Spearman’s correlation tested ASMR against SDI. The authors estimated 95% uncertainty limits (UIs) for population attribution fraction (PAFs).ResultsBetween 1990 and 2019, all six GCC countries showed increased number of the overall cancer-related deaths (398.73% in Bahrain to 1404.25% in United Arab Emirates), and DALYs (347.38% in Kuwait, to 1479.35% in United Arab Emirates) reflecting significant increasing in deaths, and burden cancer attributed to high BMI. In 2019, across GCC countries, pancreatic, uterine, and kidney cancer accounted for 87.91% of the total attributable deaths associated with high BMI in females, whereas in male, colon and rectum cancer alone accounted for 26% of all attributable deaths associated with high BMI.ConclusionThe study highlights the significant impact of high BMI on cancer burden in GCC countries. Moreover, the study identifies specific cancers, such as pancreatic, uterine, and kidney cancer in females, and colon and rectum cancer in males, as major contributors to attributable deaths, urging targeted prevention strategies at reducing weight and encouraging physical activity could greatly lessen the impact of diseases in the GCC countries.

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) Survey: Findings on the Burden of Sickle Cell Disease and Impact on the Quality of Life of Patients and Caregivers in Gulf Cooperation Council Countries

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) Survey: Perspectives of Physicians in Gulf Cooperation Council Countries on Sickle Cell Disease

The Gulf Cooperation Council (GCC) countries namely, Bahrain, Kuwait, Oman, Qatar, United Arab Emirates (UAE), and Saudi Arabia, have experienced unique demographic changes. The major population growth contributor in these countries is young migrants, which has led to a shift in the population age pyramid. Migrants constitute the vast proportion of GCC countries’ population reaching >80% in Qatar and UAE. Using Global Burden of Disease Study 2015 (GBD 2015) and United Nations data, for the GCC countries, we assessed the association between age-standardized mortality and population size trends with linear and polynomial regressions. In 1990–2015, all-cause age-standardized mortality was inversely proportional to national population size (p-values: 0.0001–0.0457). In Bahrain, Qatar, Oman, and Saudi Arabia, the highest annual decrease in mortality was observed when the annual population growth was the highest. In Qatar, all-cause age-specific mortality was inversely proportional to age-specific population size. This association was statistically significant among the 5–14 and 15–49 age groups, which have the largest population size. Cause-specific age-standardized mortality was also inversely proportional to population size. This association was statistically significant for half of the GBD 2015-defined causes of death such as “cirrhosis and other chronic liver diseases” and “HIV/AIDS and tuberculosis”. Remarkably, incoming migrants to Qatar have to be negative for HIV, hepatitis B and C, and tuberculosis. These results show that decline in mortality can be partly attributed to the increase in GCC countries’ population suggesting a healthy migrant effect that influences mortality rates. Consequently, benefits of health interventions and healthcare improvement are likely to be exaggerated in such countries hosting a substantial proportion of migrants compared with countries where migration is low. Researchers and policymakers should be cautious to not exclusively attribute decline in mortality within the GCC countries as a result of the positive effects of health interventions or healthcare improvement.

The prospective cohort Dialysis Outcomes and Practice Patterns Study (DOPPS) initiated data collection in national samples of hemodialysis (HD) units (total of 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in late 2012. Here, we report initial results regarding mineral bone disorders (MBDs) and its management in the GCC countries. Forty-one randomly selected HD facilities, treating >23 HD patients each, were sampled and represent care for >95% of GCC HD patients. Descriptive results for the GCC countries based on a random sample of 20-30 HD patients in each study facility. Initial results for the GCC are from 931 HD patients treated at 41 dialysis units (ranging from 1 unit in Bahrain to 21 in Saudi Arabia). Results are presented as weighted estimates, accounting for the sampling fraction in each unit. Baseline descriptive statistics (e.g., mean, median, or percentage), weighted by facility sampling fraction were calculated for the study sample. For analyses examining the percent of facility patients having (a) serum phosphorus >6.0 mg/dL or (b) parathyroid hormone (PTH) >600 pg/mL, analyses were restricted to facilities having at least 10 HD patients with a reported serum phosphorus or PTH measurement, respectively. Logistic regression analyses of the indicated binary outcomes were based on the use of generalized estimating equations and were adjusted for GCC country, patient age category (<45 years, 45-65 years, and >65 years old), sex, and whether the patient was diagnosed with diabetes mellitus. Logistic models accounted for clustering of patients within facilities, assuming an exchangeable working correlation matrix. Mean age of HD patients in the GCC countries was 53 years vs. 61-64 years in the three other DOPPS regions. MBD markers showed slightly lower mean serum Calcium in the GCC countries, similar mean serum phosphorus, and intermediate median PTH levels compared with the three other DOPPS regions. Among GCC countries, the country mean value of MBD markers ranged from 8.6-9.0 mg/dL for serum calcium, 4.4-5.4 mg/dL for serum phosphorus, whereas median PTH ranged from 163-389 pg/mL. Similar to other DOPPS regions, PTH was higher among patients who were younger or without diabetes, and serum phosphorus was lower with older age (P <0.001 for each). History of parathyroidectomy was lower in the GCC countries versus other regions but did not differ when adjusted for age and dialysis vintage. Among treatments used for managing MBD, the GCC countries showed one of the highest uses of cinacalcet (24%) and phosphorus binder use (81%), whereas intravenous Vitamin D use (24%) was slightly higher than that in EURANZ. A much larger fraction of HD patients in the GCC countries had a dialysate calcium bath ≥3.5 mEq/L (43%) versus 0-4% in the three other DOPPS regions. Although many aspects of MBD management and MBD marker achievement are similar in the GCC countries to that seen in other DOPPS study regions, large variability was seen across countries and facilities in the GCC. Mean serum calcium was lower in the GCC despite the much greater use of dialysate Ca of ~3.5 mEq/L which may be due to the relatively low use of vitamin D and higher cinacalcet use, meriting further study. Future work will focus on GCC facility HD practices and patient characteristics most strongly related to the achievement of MBD target levels and associated outcomes.

The prospective observational Dialysis Outcomes and Practice Patterns Study (DOPPS) was initiated in late 2012 in national samples of hemodialysis (HD) units (n = 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For many years, guidelines have recommended single pool Kt/V ≥1.2 as the minimum adequate dose for chronic HD patients. Here, we report initial DOPPS results regarding HD practices related to dialysis dose achievement in the GCC. A total of 928 adult HD patients were included in this analysis from 41 centers representing all six GCC countries. Baseline descriptive statistics (e.g., mean, standard deviation, median, interquartile range, or percentage) were calculated for the study sample. Results were weighted according to the fraction of HD patients sampled within each participating study site. Mean age varied between 51 years in Bahrain, Oman, and Saudi Arabia, 55 years in the United Arab Emirates (UAE) and Kuwait, and 62 years in Qatar. Mean body mass index (BMI) was the lowest in Oman patients (23.9 kg/m 2 , but the remaining GCC countries had mean BMIs of 25.7-28.9 kg/m 2 and substantial fractions of overweight patients. Median dialysis vintage ranged from 1.52 years in Kuwait to 3.52 years in Oman. Mean treatment time per session varied from 202 min in Saudi Arabia to 230 min in Qatar while mean blood flow rate (BFR) ranged between 267 mL/min in Oman and 310 mL/min in Saudi Arabia. Interdialytic weight gain varied considerably among GCC countries between 3.1 and 4.0 kg. Central venous catheter use was high among GCC countries, ranging from 29% in Oman to 56% in Kuwait, with other countries averaging 30-40% catheter use. Data were available only for 50-76% of patients in four GCC countries (Kuwait, Qatar, Saudi Arabia, and UAE) for calculating single pool Kt/V to indicate dialysis adequacy. When calculated for patients with vintage >1 year and dialyzing three times per week, mean single pool Kt/V was highest in Qatar and the UAE (1.50-1.51), intermediate in Kuwait (1.35), and lowest in Saudi Arabia (1.29). A higher risk of mortality was observed for patients having a single pool Kt/V <1.2 (vs. ≥1.2) [hazard ratio (HR) = 1.71, 95% confidence interval [CI]: 1.01-2.92]. Achievement of Kt/V in the GCC, although lower than in other DOPPS regions such as Europe/ANZ and North America, was similar to that in Japan. Japan and the GCC also share the practice of having a lower blood volume filtered per HD session per kg body weight. These findings suggest that increasing mean BFR and treatment time in the GCC, along with reducing catheter use, would substantially increase overall achievement of Kt/V >1.2 in the GCC, and hence, may improve survival. These mortality findings will need to be confirmed with up-coming GCC-DOPPS 6 analysis.

BackgroundAsthma control is influenced by multiple factors. These factors must be considered when appraising asthma interventions and their effectiveness in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates [UAE]). Based on published studies, the most prevalent asthma treatment in these countries are fixed dose combinations (FDC) of inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). This study is a rapid review of the literature on: (a) factors associated with asthma control in the GCC countries and (b) generalisability of ICS/LABA FDC effectiveness studies.MethodsTo review local factors associated with asthma control and, generalisability of published ICS/LABA FDC studies, two rapid reviews were conducted. Review 1 targeted literature pertaining to asthma control factors in GCC countries. Eligible studies were appraised, and clustering methodology used to summarise factors. Review 2 assessed ICS/LABA FDC studies in conditions close to actual clinical practice (i.e. effectiveness studies). Eligibility was determined by reviewing study characteristics. Evaluation of studies focused on randomised controlled trials (RCTs). In both reviews, initial (January 2018) and updated (November 2019) searches were conducted in EMBASE and PubMed databases. Eligible studies were appraised using the Critical Appraisal Skills Program (CASP) checklists.ResultsWe identified 51 publications reporting factors associated with asthma control. These publications reported studies conducted in Saudi Arabia (35), Qatar (5), Kuwait (5), UAE (3), Oman (1) and multiple countries (2). The most common factors associated with asthma control were: asthma-related education (13 articles), demographics (11articles), comorbidities (11 articles) and environmental exposures (11 articles). Review 2 identified 61 articles reporting ICS/LABA FDC effectiveness studies from countries outside of the GCC. Of these, six RCTs were critically appraised. The adequacy of RCTs in informing clinical practice varied when appraised against previously published criteria.ConclusionsAsthma-related education was the most recurring factor associated with asthma control in the GCC countries. Moreover, the generalisability of ICS/LABA FDC studies to this region is variable. Hence, asthma patients in the region, particularly those on ICS/LABA FDC, will continue to require physician review and oversight. While our findings provide evidence for local treatment guidelines, further research is required in GCC countries to establish the causal pathways through which asthma-related education influence asthma control for patients on ICS/LABA FDC therapy.

In general, foreign direct investments (FDIs) play a crucial role in driving a country's economic development, promoting diversification, and enhancing competitiveness. The Gulf Cooperation Council (GCC) countries, which heavily rely on the oil and gas sectors, are particularly vulnerable to fluctuations in commodity prices. However, these countries have recognized the imperative of economic diversification and have increasingly turned to inward FDIs to achieve it. By attracting capital, advanced technology, and expertise from foreign investors, FDIs enable the GCC countries to expand their economic base beyond the oil and gas sectors. This diversification not only creates employment opportunities but also fosters resilient economic growth, ultimately leading to an improvement in the living standards of the local population. This study investigates the macroeconomic and environmental factors that potentially attract foreign direct investment (FDI) inflows into the Gulf Cooperation Council (GCC) countries in the long run. Additionally, the study explores the causal relationship between these factors and FDI inflows. The panel autoregressive distributed lag (ARDL) approach to co-integration is the primary analytical technique used, utilizing long time-series data from six GCC countries, including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE) during the period 1990-2019. The empirical results indicate that, in the long run, almost all independent variables significantly influence FDI in GCC countries. Variables such as GDP growth (GDPG), inflation (INFL), carbon dioxide emissions (CO2), and urbanization (URB) are found to be highly significant (p≤0.01) in their impact on FDI. Moreover, unemployment (UNEMP) also positively and significantly influences FDI in these countries in the long run. Based on the key findings, strategies aimed at reducing persistently high unemployment rates, maintaining population growth, viewing FDI as a driver for GDP growth, and continuing with infrastructure development and urbanization are expected to attract more FDI inflows into GCC countries in the long run. Additionally, fostering both long-term economic incentives and creating a conducive business infrastructure for investors are vital for attracting inward FDI into any nation, including those in the GCC. This research would benefit various stakeholders, including governments, local businesses, investors, academia, and the local society, by providing valuable knowledge and informing decision-making processes related to economic development, diversification, and investment promotion.

Breast cancer incidence is increasing in the Gulf Cooperation Council (GCC) countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates. This study analysed geographical patterns, time trends, and age distribution of female breast cancer incidence among nationals and non-nationals in GCC countries. Available cancer registry data for 1979-2016 were retrieved for the GCC countries. Age-standardized rates (ASRs) per 100 000 women were calculated using the World standard population. Comparisons were made by calculating comparative incidence figures. From 1998 to 2012, incidence among nationals was highest in Bahrain (ASR 61.85), Kuwait (ASR 52.66), and Qatar (ASR 56.90) and lowest in Saudi Arabia (ASR 19.76), Oman (ASR 22.33), and United Arab Emirates (ASR 31.05). In the most recent period, data were available only in Qatar (2014-2016) and Saudi Arabia (2013-2015). Non-nationals and nationals in Qatar had higher incidence rates than in Saudi Arabia. Incidence among nationals in Qatar was at least twice that in Saudi Arabia (comparative incidence figure 2.32). Incidence among non-nationals in Qatar was 3 times higher than in Saudi Arabia. Among nationals in Kuwait, 10.8% of cases of breast cancer occurred in women aged < 40 years in 2008-2012, compared with 24.2% in non-nationals in Qatar in 2014-2016. Breast cancer incidence has increased over time among women in most GCC countries, likely reflecting the improvements in healthcare access and screening programmes. Nationals and non-nationals developed breast cancer at a younger age than women in other high-income countries. Increased screening uptake is still required in the region. Evidence-based, locally-informed interventions should be implemented to address risk factors specific to the nationals and non-nationals in the GCC countries.

Introduction and Study Aims:The underlying population of global regions varies widely and is a major determinant of regional cancer differences. The aims were to: (1) estimate the cancer burden in Gulf Cooperation Council (GCC) countries in 2040 for the ≥70 population and (2) assess the public health implications for this cancer increase.Methods:We used Global Cancer Observatory (GLOBOCAN) estimates of cancer incidence and mortality for people aged 70 years or more in GCC countries from 2018 to 2040 from the International Agency for Research on Cancer. For population growth, we used data for the same period from the Population Division of the United Nations Department of Economic and Social Affairs. From these, we calculated the predicted increase in the number of cancer cases and cancer deaths from 2018 to 2040 and the proportion of cases/deaths represented by those aged 70+ for the 2 time periods.Findings:In the GCC countries, the predicted number of newly diagnosed cancers and cancer deaths in the older population will increase by 465% and 462% respectively due to demographic changes—greater than other countries in the World Health Organization Eastern Mediterranean Region, or in countries of similar economic development. The largest predicted increases will be for Qatar and the United Arab Emirates. Based on the predicted population age, cancer burden among older people in the GCC countries will increase by approximately 460%.Conclusion:By the year 2040, the relationship between cancer and age will cause a 4- to 5-fold increase in the cancer burden in the GCC. These predictable changes will require additional planning and resources to provide appropriate healthcare.

In the GCC countries, date-palm sector is strategically important for the economic, social and environmental development. Therefore, markets globalization has had a huge impact on the comparative advantages of date exports from the GCC countries, highlighting a new range of necessary determinants for competitiveness of these countries on the international date palm date market. The current study is conducted in the framework of the “Development of sustainable date palm production systems in the GCC countries of the Arabian Peninsula” project funded by the Gulf Cooperation Council (GCC) and led by the International Center for Agricultural Research in the Dry Areas (ICARDA), and aims to provide updated estimates of competitiveness indicators of the GCC countries on the international market of date palm.The study starts by a summary description of updated figures concerning date’s production, yields, and consumption trends of the different GCC countries. This first part of the research paper also includes a presentation of the date trade matrix (destinations of exports and imports) of the considered countries. In a second part of this section, a set of competitiveness indicators were calculated to better reflect on the date trade balances performances of each of the GCC countries. The measures of competitiveness indicators conducted in this paper include: i) the Market Share (MS); ii) the Revealed Comparative Advantage (RCA); and iii) the Trade Balance Index (TBI). The Market share indicator was used to identify size advantages and the degree of specialization of a given country on the international market of a given commodity. The RCA has been defined as a measure of performance of international trade competitiveness of a given country for a given commodity. The TBI is used to analyze whether a country has specialization in export (as net-exporter) or in import (as net-importer) for a specific group of products. Data from both FAOSTAT and UN COMTRADE sources was used for the calculation of these indicators. Empirical findings show that GCC and North African countries are holding more than 70% of the international market of dates. The sum of market shares of the 6 GCC countries was about 30% of the international date market during 2015. This is showing that these countries together have strong potential for dominating the international date market. In terms of growth, it was clear that all GCC countries, including the least present on the international market are progressing quite positively with increasing shares from one year to another. In terms of RCA, the highest RCA value was recorded for Saudi Arabia (KSA). It was for about 43.5 in 2013, indicating that the country date export share for 2013 is 43.5% higher than its share in total world export of agricultural goods. Finally, TBI results show the existence of structural differences between KSA and UAE in terms of dates export and import patterns. These two countries are both the main players in date export in the GCC area. However, even though UAE is a net exporter of date palm, which its TBI is much lower than the TBI of KSA, showing that UAE is also importing a higher proportion of its exported dates compared to KSA. The date trade patterns among the GCC countries shows that there is a wide scope of coordination between the different trade strategies of these countries, through specialization and division of tasks. This can generate important opportunities for gaining more weight on the world market of dates.

To identify the primary risk factors contributing to stroke incidents and deaths, analyzing the trends and changes in regional stroke statistics between 1990 and 2021 in the Gulf Cooperation Council (GCC) countries. This longitudinal time trend study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, from June to August 2024. The data were recorded from the Institute for Health Metrics and Evaluation (IHME) and the Global Burden of Diseases (GBD) datasets. The incidence, mortality, and disability-adjusted life year (DALY) rates of stroke in the GCC countries, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE), and their association with environmental pollution, dietary, and metabolic risk factors were documented from 1990 to 2021. From 1990 to 2021, the GCC countries exhibited varied trends in stroke incidence, mortality and DALYs. The UAE had the highest stroke incidence rate in 2021 (106.01 per 100,000). The mortality rates due to stroke decreased in the GCC, except in Kuwait, where they increased by 14.4%. DALYs decreased in GCC countries, with the highest decline in Qatar (56%). Qatar experienced a 59.9% decrease in death rates and a 53.4% reduction in DALYs for hypertension. In GCC countries, hypertension, air pollution, and dietary factors are dominant risk factors for stroke, stroke-related deaths, and DALY rates. The UAE had the highest stroke incidence rate in 2021. However, mortality rates decreased in all GCC countries except Kuwait.

Oil prices and rapidly increasing urbanization could have a long-lasting impact on the environment in oil-abundant Gulf Cooperation Council (GCC) countries. Therefore, the environmental role of oil price, economic growth, and urbanization on CO2 emissions should be tested. The present study investigates the impact of oil price, economic growth, and urbanization on CO2 emissions in those countries, considering asymmetrical relationships. For this purpose, a nonlinear autoregressive distributive lag cointegration approach is applied in GCC countries during the 1980–2019 period, and cointegration is corroborated in all investigated models. Long-run results show that rising economic growth positively affects CO2 emissions in Kuwait, Oman, Qatar, and Saudi Arabia. Decreasing economic growth positively affects CO2 emissions in Bahrain, Kuwait, Qatar, and the United Arab Emirates (UAE). Moreover, the rising oil price has a positive impact on CO2 emissions and shows a scale effect in Oman, Qatar, and Saudi Arabia. Moreover, it has a negative effect and corroborates technique and composition effects in Kuwait and the UAE. Further, decreasing oil prices has a positive impact on CO2 emissions in Bahrain and has a negative effect in Kuwait and the UAE. Lastly, urbanization positively affects CO2 emissions in Bahrain, Oman, Qatar, and the UAE. Economic growth is found asymmetrical in all GCC countries, and the asymmetrical effect of oil price is also observed in all GCC countries except the UAE.

The aim of this research is to investigate various issues related to oil consumption and environmental impacts in the Gulf Cooperation Council (GCC) countries, in relation to population, climate change impacts, United Nations Sustainable Development Goals (UN’s SDGs), and ecological and carbon footprints. The GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) are almost entirely dependent on fossil energy sources (oil and natural gas) domestically, industrially, commercially, economically, and transportation-wise. Although the total population of the GCC countries is around 60 million, making up only 0.76% of the world’s population (8 billion), they do consume 5.15 million barrels per day (bbl/d) of oil, forming nearly 5.8% of the world’s daily consumption, which is around 88.4 million bbl/d as of 2021. Moreover, daily per capita consumption of oil in the GCC countries is about 0.09 barrels, while it is about 0.06 barrels in the USA. These figures indicate that the GCC’s countries combined and per capita, although not industrialized and small in population, consume large quantities of oil, compared to other countries of the world that are industrialized and/or densely populated, such as the USA, India, Japan, Russia, and Germany. The high rates of oil consumption in the GCC countries, associated with the highest per capita ecological and carbon footprints worldwide, have led to negative impacts on the environment, climate, and public health. The results of this work show that some of the GCC countries have the highest per capita ecological and carbon footprints. Thus, the GCC countries should effectively reduce their dependence on fossil energy sources and gradually replace them with renewable energy sources, especially photovoltaic (PV) solar energy. Furthermore, the statistics presented in this article and the outcomes reached uncover that the GCC countries lag behind with regard to various indicators of the UN’s SDGs. This implies the GCC countries are not taking adequate actions to encounter environmental problems, in order to fulfill some of the UN’s SDGs by 2030.