Injury burden among adolescents and young adults aged 10-24 years in the Arab region, 1990-2023: a systematic analysis of the Global Burden of Disease Study 2023.

Abstract

Injuries are a leading cause of death and disability among adolescents and young people globally, but their burden has not been comprehensively characterised in the Arab region-a region shaped by rapid demographic change, socioeconomic disparities, and protracted conflict. We aimed to comprehensively characterise the injury burden by cause, age, sex, geographical location, and temporal trends among adolescents and young adults across the Arab region from 1990 to 2023, to inform evidence-based prevention strategies and policy development. This was a systematic analysis of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to assess injury burden among people aged 10-24 years across the Arab region (defined here as all 22 countries in the League of Arab States: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen) from 1990 to 2023. We analysed mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), with 95% uncertainty intervals (UIs), by sex, age group, country, and year. Injuries were examined across three levels of the GBD cause hierarchy: Level 1 (injuries as a broad cause group), Level 2 (transport injuries, unintentional injuries, and self-harm and interpersonal violence), and Level 3 (specific mechanisms, including conflict and terrorism, as well as road injuries). Correlations between DALY rates due to injury and the Socio-demographic Index (SDI) were assessed with Spearman's rank correlation. In 2023, injuries accounted for 79 624 (95% UI 73 305-86 869) deaths (57·3% [53·5-60·7] of all deaths) and 6·6 million (6·0-7·1) DALYs (32·0% [28·0-36·7] of total DALYs) among people aged 10-24 years in the Arab region. The mortality rate due to injury among people aged 10-24 years was 63·2 (95% UI 58·2-68·2) per 100 000 population and was substantially higher in males (94·5 [86·5-101·8] per 100 000) than females (30·1 [27·0-33·1] per 100 000). At Level 2, self-harm and interpersonal violence (31·3 [28·5-34·1] per 100 000) contributed the greatest mortality burden, followed by unintentional injuries (16·7 [14·3-19·2] per 100 000) and transport injuries (15·3 [11·6-18·7] per 100 000). At Level 3, conflict and terrorism (23·4 [95% UI 21·4-25·6] per 100 000) and road injuries (14·6 [10·9-18·0] per 100 000) were the leading causes of death. The injury burden increased markedly with age, with mortality rising from 30·7 (27·2-33·9) per 100 000 among those aged 10-14 years to 94·1 (86·8-101·7) per 100 000 among those aged 20-24 years, and was consistently higher in males than in females. YLL rates greatly exceeded YLD rates (4507·9 [4147·8-4860·2] per 100 000 vs 750·1 [561·6-988·7] per 100 000), indicating that the injury burden was predominantly driven by premature mortality. Between 1990 and 2023, mortality rates due to injury in the Arab region declined from 69·2 (62·5-76·7) per 100 000 to 63·2 (58·2-68·2) per 100 000, and YLL rates declined from 4986·1 (4498·4-5530·2) per 100 000 to 4507·9 (4147·8-4860·2) per 100 000, with reductions in transport and unintentional injuries offset by marked increases in self-harm and interpersonal violence, largely driven by conflict and terrorism. YLD rates remained stable (757·1 [566·6-1000·3] per 100 000 in 1990 vs 750·1 [561·6-988·7] per 100 000 in 2023). Substantial geographical inequalities were observed, with the highest mortality and DALY rates concentrated in conflict-affected settings, particularly Libya, Palestine, Somalia, Sudan, and Syria. DALY rates due to injury showed strong inverse correlations with SDI for self-harm and interpersonal violence, but weaker or non-significant correlations for transport injuries. Injuries are the leading cause of premature death among adolescents and young people in the Arab region, with the overall burden profoundly shaped by conflict and violence concentrated in conflict-affected settings. Targeted, context-sensitive prevention strategies and health-system investments are urgently needed across the region to reduce avoidable deaths and protect the health and future of the young population. Khalifa University of Science and Technology.