Generating reliable evidence on the determinants of NCDs Dr. Raghib Ali MA MB BChir MPH MSc FRCP (UK) Director, Public Health Research Center, and Associate Research Professor, New York University Abu Dhabi. Visiting Research Fellow, University of Oxford.

Background Increasing life expectancy and changes in lifestyle in the populations of this region have led to a large and rapidly increasing burden of chronic diseases Non-Communicable Diseases (NCDs) already account for about 50% of the total burden of disease (mortality) in the Eastern Mediterranean Region but by 2030 this figure will be 80%. The rising incidence of NCDs in the region is mainly due to changes in environmental / lifestyle factors in genetically susceptible populations. Population health research is critical to understanding the relative importance of genes and environment in the aetiology of these diseases as well as discovering novel risk factors and biomarkers.

Background Unfortunately despite having nearly 400 million people, well-trained doctors, scientists and researchers in many of these countries there is limited experience in population health research. The total number of clinical studies currently being conducted in the EM region is much less than other WHO regions Collaborative research in the region is also very limited. The contribution of the region to the medical literature is also far below what should be achievable, given both the human and financial resources available in some countries, and again fares very poorly compared to other regions.

Cohort studies Long-term studies that can establish the causes of disease. Framingham Heart Study 5,000 - 1948 British Doctors Study 50,000 - 1951 UK Biobank 500,000 – 2008 More than 300 prospective cohorts, >90% in European origin populations

Middle Eastern Cohorts Turkish Adult Risk Factor Study - 1,500 participants, 1998 The Isfahan Cohort Study - 6,504 participants, 2001 The Golestan Cohort Study (oesophageal cancer) 50,000 participants, 2004 PURE UAE (Prospective Urban Rural Epidemiological) 1500 nationals, aged 35-70, 2006. Saudi biobank 200,000 - 100,000 family-based and 100,000 disease-specific group, 18+ Qatar biobank 60,000 Qatari nationals / long-term residents, 18+.

Deaths from Heart Disease

Prevalence of Type II Diabetes by country

Diabetes Increases the risk of premature death by 5 times Deaths from Heart disease 4 times Deaths from Kidney disease 20 times Responsible for one third of all deaths

#1 Risk Factor for Diabetes is Obesity Obesity increases risk of developing Diabetes 10 times And up to 40 times if very obese. Increases risk of: High blood pressure Heart disease Stroke Many cancers

The UAE Healthy Future Study

After 40 years of improvements, life expectancy in the UAE is falling.. Institute for Health Metrics and Evaluation. GBD Compare. Seattle, University of Washington, 2015

..likely to be secondary to the very high prevalence of Diabetes.. Hajat and Harrison, Prog Cardiovasc Dis, 2010

..itself secondary to the very high prevalence of Obesity But the UAE has much higher rates of IHD and Diabetes than the US with similar levels of obesity, suggesting other factors are also important…

The UAE Healthy Future Study Scope: Primarily interested in risk factors for Obesity, Diabetes and CVD in the first instance Both proximal (e.g. smoking, obesity, hypertension) and distal (i.e. socioeconomic) determinants. Also genetics, epigenetics and microbiome Sample: Population based recruitment of healthy volunteers 20,000 participants, aged 18 – 40 5000 participants recruited to date Link to electronic health records for key outcomes agreed Follow-up visits every 4 years Approach: Questionnaire, anthropometric measures and biological samples More accurate measures of diet and physical activity using new technologies

UAE Nationals Demographics UAE national population approx. 1 million Median age 19 85% aged less than 40 Approx. 500,000 aged 18 - 40.

After 10 years After 5 years 20,000 sample population at baseline After 10 years After 5 years

Study Timeline 2027-30 2021-26 2nd Follow-up visit 1st Follow-up visit 2016-21 Main Study Recruitment 2014-15 Pilot Study 2012-13 Planning

http://uaehealthyfuture.ae/

The First and Second Middle East Population Health Conference – Action Plan Create a network for NCD research involving Clinical Epidemiologists and Population Health researchers. Establish regional/country specific cohort studies and gather all in the region into a network of cohort studies Existing cohort studies can provide capacity building/ technical assistance to new and emerging cohorts Share analysis methodologies and pool data to look at outcomes in shorter timeframes Create common protocols, possible pooling of data Establish a core data set and allow for different levels of phenotyping based on country-specific needs Establish communication channels to share ideas and resources Funding available from Wellcome Trust Longitudinal Population Studies Fund

THANK YOU raghib.ali@nyu.edu