EMR burden of Diseases Operation of Civil Registration, Vital Statistics and Identity Management Systems and the Production of Vital Statistics Reports, EMRO countries, Casablanca, Morocco 19-23 March 2018 Dr. Eman Aly MD PhD Dr. Eman Aly MD PhD

Introduction: Mortality data are the most relevant medical data to describe trend of diseases in the community Accurate and complete causes of death registration are required to represent the true burden of diseases CRVS – program in EMRO, is focusing on improving death/cause of death registration coverage and accurate identification of underlying cause of death, through; building capacity, close monitoring and evaluation of death registration systems at MS and provide technical support to overcome system issues Dr. Eman Aly MD PhD

Objective: Provide examples of cause specific mortality data analysis, including the Global burden of disease list, using the actual national resisted data Introduce output analysis of one of cause of death and data quality analysis software (ANACONDA) Identify the main data quality parameters (completeness and accuracy) Dr. Eman Aly MD PhD

Methodology: Calculation of proportion of causes of death using, the most recent mortality data available at, WHO global mortality data base, where data are cleaned in consultation with MS and uploaded The plan of analysis followed the classification of Global burden of disease list (20 causes), Analysis is done using STATA – 13 ANACONDA “Analysis of Cause of Death and data quality check tool”, is used to visualize the proportion of deaths and death rate per 100,000 by age group and sex Dr. Eman Aly MD PhD

Bahrain 2014 Completeness =83% GBD Cause category Freq. % Diabetes mellitus 474 17.59 Malignant neoplasms 279 10.36 Ill-defined diseases 265 9.84 Unintentional injuries 160 5.94 Endocrine disorders 93 3.45 Perinatal conditions 77 2.86 Congenital anomalies 65 2.41 Infectious and parasitic diseases 62 2.3 Neuropsychiatric conditions Genitourinary diseases 56 2.08 Respiratory diseases 54 2 Digestive diseases 53 1.97 Ill-defined injuries/accident 34 1.26 Respiratory infections 29 1.08 Intentional injuries 16 0.59 Musculoskeletal diseases 14 0.52 Other neoplasms 13 0.48 Skin diseases Nutritional deficiencies 9 0.33 Maternal conditions 0.07 Total 2,694 Dr. Eman Aly MD PhD

Bahrain 2014 Dr. Eman Aly MD PhD

Egypt 2014 Completeness =95% GBD Cause category Freq. % Cardiovascular diseases 253,152 47.66 Digestive diseases 58,460 11.01 Malignant neoplasms 32,864 6.19 Ill-defined diseases 30,736 5.79 Respiratory diseases 23,295 4.39 Genitourinary diseases 20,681 3.89 Diabetes mellitus 19,838 3.74 Unintentional injuries 19,515 3.67 Infectious and parasitic diseases 19,249 3.62 Respiratory infections 17,375 3.27 Endocrine disorders 9,335 1.76 Congenital anomalies 8,654 1.63 Neuropsychiatric conditions 6,240 1.17 Perinatal conditions 4,833 0.91 Other neoplasms 2,471 0.47 Nutritional deficiencies 1,258 0.24 Ill-defined injuries/accident 1,252 Intentional injuries 608 0.11 Maternal conditions 501 0.09 Skin diseases 409 0.08 Musculoskeletal diseases 314 0.06 Sense organ diseases 45 0.01 Oral conditions 30 Total 531,115 Dr. Eman Aly MD PhD

Egypt 2014 Completeness =95%

Iran 2014 Completeness =90% GBD Cause category Freq. % Cardiovascular diseases 114,013 41.99 Malignant neoplasms 35,882 13.21 Unintentional injuries 24,710 9.1 Ill-defined diseases 18,505 6.82 Respiratory diseases 10,317 3.8 Perinatal conditions 10,198 3.76 Diabetes mellitus 9,989 3.68 Neuropsychiatric conditions 6,731 2.48 Digestive diseases 6,622 2.44 Respiratory infections 5,572 2.05 Congenital anomalies 5,148 1.9 Genitourinary diseases 5,115 1.88 Infectious and parasitic diseases 4,973 1.83 Intentional injuries 4,822 1.78 Other neoplasms 2,450 0.9 Ill-defined injuries/accident 2,402 0.88 Endocrine disorders 2,046 0.75 Musculoskeletal diseases 807 0.3 Skin diseases 581 0.21 Nutritional deficiencies 373 0.14 Sense organ diseases 146 0.05 Maternal conditions 104 0.04 Oral conditions 26 Total 271,532 No data in age >75y Dr. Eman Aly MD PhD

Iran 2014 Dr. Eman Aly MD PhD

Iraq 2008 Completeness =75% GBD Cause category Freq. % Cardiovascular diseases 43,130 40.59 Unintentional injuries 11,020 10.37 Malignant neoplasms 7,907 7.44 Infectious and parasitic diseases 6,833 6.43 Ill-defined diseases 6,353 5.98 Perinatal conditions 5,651 5.32 Genitourinary diseases 5,197 4.89 Ill-defined injuries/accident 4,246 4 Diabetes mellitus 3,474 3.27 Intentional injuries 3,093 2.91 Respiratory infections 2,062 1.94 Respiratory diseases 1,866 1.76 Congenital anomalies 1,754 1.65 Neuropsychiatric conditions 1,460 1.37 Digestive diseases 1,214 1.14 Nutritional deficiencies 371 0.35 Endocrine disorders 323 0.3 Other neoplasms 114 0.11 Maternal conditions 63 0.06 Sense organ diseases 48 0.05 Musculoskeletal diseases 47 0.04 Skin diseases 27 0.03 Oral conditions 3 Total 106,256 No data in age >75y Dr. Eman Aly MD PhD

Iraq 2008 Dr. Eman Aly MD PhD

Jordan 2012 Completeness =65% GBD Cause category Freq. % Cardiovascular diseases 6,434 37.13 Malignant neoplasms 2,490 14.37 Diabetes mellitus 1,272 7.34 Unintentional injuries 1,042 6.01 Perinatal conditions 958 5.53 Congenital anomalies 747 4.31 Genitourinary diseases 544 3.14 Respiratory infections 535 3.09 Ill-defined diseases 512 2.95 Digestive diseases 499 2.88 Respiratory diseases 494 2.85 Ill-defined injuries/accident 456 2.63 Infectious and parasitic diseases 410 2.37 Neuropsychiatric conditions 303 1.75 Other neoplasms 194 1.12 Endocrine disorders 185 1.07 Intentional injuries 147 0.85 Musculoskeletal diseases 49 0.28 Maternal conditions 44 0.25 Nutritional deficiencies 7 0.04 Skin diseases Total 17,329 Dr. Eman Aly MD PhD

Jordan 2012 Dr. Eman Aly MD PhD

Kuwait 2014 Completeness =65% GBD Cause category Freq. % Cardiovascular diseases 2,273 38.32 Unintentional injuries 755 12.73 Malignant neoplasms 743 12.53 Respiratory infections 497 8.38 Infectious and parasitic diseases 383 6.46 Perinatal conditions 235 3.96 Congenital anomalies 221 3.73 Diabetes mellitus 127 2.14 Digestive diseases 107 1.8 Intentional injuries 103 1.74 Genitourinary diseases 93 1.57 Respiratory diseases 76 1.28 Ill-defined diseases 73 1.23 Neuropsychiatric conditions 63 1.06 Endocrine disorders 56 0.94 Ill-defined injuries/accident Other neoplasms 50 0.84 Musculoskeletal diseases 10 0.17 Maternal conditions 7 0.12 Skin diseases 3 0.05 Nutritional deficiencies 1 0.02 Total 5,932 Dr. Eman Aly MD PhD

Kuwait 2014 Completeness =65% Dr. Eman Aly MD PhD

Morocco 2012 Completeness =22% GBD Cause category Freq. % Ill-defined diseases 14,228 30.44 Cardiovascular diseases 9,103 19.47 Malignant neoplasms 4,041 8.64 Perinatal conditions 3,796 8.12 Diabetes mellitus 2,558 5.47 Ill-defined injuries/accident 2,062 4.41 Infectious and parasitic diseases 1,849 3.96 Unintentional injuries 1,609 3.44 Respiratory diseases 1,409 3.01 Genitourinary diseases 1,176 2.52 Digestive diseases 1,146 2.45 Neuropsychiatric conditions 1,032 2.21 Respiratory infections 921 1.97 Congenital anomalies 551 1.18 Endocrine disorders 366 0.78 Intentional injuries 270 0.58 Other neoplasms 213 0.46 Nutritional deficiencies 199 0.43 Maternal conditions 92 0.2 Musculoskeletal diseases 77 0.16 Skin diseases 42 0.09 Oral conditions 4 0.01 Total 46,744 Available Pop. data = 0-4 Dr. Eman Aly MD PhD

Morocco 2012 Dr. Eman Aly MD PhD

OPT 2014 GBD Cause category Freq. % Cardiovascular diseases 2,736 40.86 Malignant neoplasms 954 14.25 Diabetes mellitus 599 8.95 Perinatal conditions 346 5.17 Ill-defined diseases 306 4.57 Genitourinary diseases 264 3.94 Infectious and parasitic diseases 233 3.48 Respiratory diseases 221 3.3 Congenital anomalies 200 2.99 Digestive diseases 166 2.48 Unintentional injuries 157 2.34 Respiratory infections 140 2.09 Neuropsychiatric conditions 123 1.84 Ill-defined injuries/accident 100 1.49 Intentional injuries 79 1.18 Endocrine disorders 62 0.93 Maternal conditions 5 0.07 Musculoskeletal diseases 2 0.03 Nutritional deficiencies Other neoplasms 1 0.01 Total 6,696 Dr. Eman Aly MD PhD

OPT 2014 Dr. Eman Aly MD PhD

Oman 2012 Completeness=81% GBD Cause category Freq. % Ill-defined diseases 2,642 37.98 Cardiovascular diseases 1,398 20.1 Unintentional injuries 437 6.28 Infectious and parasitic diseases 386 5.55 Malignant neoplasms 313 4.5 Ill-defined injuries/accident 228 3.28 Respiratory diseases 217 3.12 Perinatal conditions 208 2.99 Diabetes mellitus 196 2.82 Respiratory infections 177 2.54 Congenital anomalies 155 2.23 Digestive diseases 154 2.21 Genitourinary diseases 152 2.19 Neuropsychiatric conditions 95 1.37 Endocrine disorders 94 1.35 Other neoplasms 26 0.37 Musculoskeletal diseases 21 0.3 Intentional injuries 19 0.27 Nutritional deficiencies 16 0.23 Skin diseases 13 0.19 Maternal conditions 6 0.09 Sense organ diseases 3 0.04 Total 6,956 Dr. Eman Aly MD PhD

Oman 2012 Dr. Eman Aly MD PhD

Qatar 2014 Completeness=67% GBD Cause category Freq. Percent Ill-defined diseases 666 28.18 Unintentional injuries 390 16.5 Cardiovascular diseases 372 15.74 Malignant neoplasms 250 10.58 Diabetes mellitus 135 5.71 Respiratory infections 75 3.17 Congenital anomalies 67 2.84 Intentional injuries Genitourinary diseases 65 2.75 Digestive diseases 60 2.54 Perinatal conditions 52 2.2 Infectious and parasitic diseases 47 1.99 Respiratory diseases 37 1.57 Endocrine disorders 32 1.35 Neuropsychiatric conditions 27 1.14 Ill-defined injuries/accident 11 0.47 Other neoplasms 4 0.17 Nutritional deficiencies 3 0.13 Skin diseases 2 0.08 Maternal conditions 1 0.04 Total 2,363 Dr. Eman Aly MD PhD

Qatar 2014 Dr. Eman Aly MD PhD

Saudi Arabia 2012 Completeness=36% GBD Cause category Freq. % Ill-defined diseases 13,681 29.99 ******************************* Cardiovascular diseases 8,216 18.01 ******************* Ill-defined injuries/accident 5,609 12.3 ************* Perinatal conditions 3,622 7.94 ******** Unintentional injuries 3,175 6.96 ******* Malignant neoplasms 2,026 4.44 ***** Genitourinary diseases 1,558 3.42 **** Infectious and parasitic diseases 1,488 3.26 *** Congenital anomalies 1,244 2.73 Respiratory infections 1,074 2.35 ** Diabetes mellitus 950 2.08 Digestive diseases 842 1.85 Respiratory diseases 833 1.83 Neuropsychiatric conditions 452 0.99 * Endocrine disorders 429 0.94 Skin diseases 179 0.39 Nutritional deficiencies 88 0.19 Intentional injuries 76 0.17 Maternal conditions 45 0.1 Musculoskeletal diseases 24 0.05 Other neoplasms 4 0.01 Sense organ diseases 2 Total 45,617 Dr. Eman Aly MD PhD

Syria 2010 GBD Cause category Freq. Percent Cardiovascular diseases 33,780 50.4 ******************************* Respiratory infections 9,185 13.7 ******** Malignant neoplasms 4,036 6.02 **** Respiratory diseases 3,008 4.49 *** Ill-defined diseases 2,828 4.22 Perinatal conditions 2,560 3.82 ** Unintentional injuries 2,049 3.06 Congenital anomalies 1,947 2.9 Digestive diseases 1,811 2.7 Infectious and parasitic diseases 1,777 2.65 Genitourinary diseases 982 1.47 * Ill-defined injuries/accident 808 1.21 Diabetes mellitus 751 1.12 Neuropsychiatric conditions 508 0.76 Endocrine disorders 489 0.73 Intentional injuries 245 0.37 Other neoplasms 132 0.2 Nutritional deficiencies 91 0.14 Maternal conditions 23 0.03 Skin diseases 11 0.02 Musculoskeletal diseases 6 0.01 Total 67,027 Dr. Eman Aly MD PhD

Tunisia 2013 Completeness=28% GBD Cause category Freq. % Cardiovascular diseases 5,670 26.46 Ill-defined diseases 3,822 17.83 Malignant neoplasms 3,109 14.51 Diabetes mellitus 1,705 7.96 Perinatal conditions 1,171 5.46 Respiratory diseases 858 4 Ill-defined injuries/accident 769 3.59 Infectious and parasitic diseases 691 3.22 Digestive diseases 594 2.77 Neuropsychiatric conditions 555 2.59 Congenital anomalies 519 2.42 Genitourinary diseases 467 2.18 Respiratory infections 452 2.11 Unintentional injuries 407 1.9 Endocrine disorders 333 1.55 Other neoplasms 145 0.68 Musculoskeletal diseases 50 0.23 Nutritional deficiencies 45 0.21 Maternal conditions 28 0.13 Intentional injuries 21 0.1 Skin diseases 20 0.09 Sense organ diseases 1 Total 21,432 Dr. Eman Aly MD PhD

Tunisia 2013 Dr. Eman Aly MD PhD

Key Findings! Using standardized data distribution for age group and the use of accurate ICD codes, reflect the actual burden of diseases and their epidemiological trends Cardiovascular disease comes on the top of the list, reflect the true epidemiologic evolution of NCDs and, also due the use of non specific diagnosis heart diseases (heart failure, cardiac arrest …etc) Ill-defined cause of death, which is representing the use of chapter IIIVX in ICD 10, also comes on the top of the list, indicating limited data quality and underlying cause of death identification Limited death and cause of death registration coverage, lower the confidence of the data analysis results Dr. Eman Aly MD PhD Dr. Eman Aly MD PhD