Increasing Burden of Upper-Extremity Fractures in the Middle East and North Africa (MENA)

Abstract

Background: Upper-extremity fractures (UEFs) account for a large proportion of bone fractures and are costly to both health and the economy. The fracture burden in the Middle East and North Africa (MENA) is influenced by the region’s diverse cultural, economic, and political status. This study examined UEF epidemiology and causes across the MENA region and within the 21 MENA countries as categorized by the Global Burden of Disease (GBD) data set. Methods: On the basis of GBD data, this study evaluated the epidemiology of UEFs from 1990 to 2019. The causes of injuries, incidence, number of years of healthy life lost due to disability (YLD), and their association with the Socio-demographic Index (SDI) were obtained and calculated for males and females in all age groups. Results: From 1990 to 2019, the age-standardized incidence rate (ASIR) of UEFs in the MENA region increased by 2.33%, to 1,086.39 per 100,000 people, and the YLD rate increased 15.69%, to 9.17 per 100,000, opposing the global decreasing trends. Fractures of the radius and/or ulna had the highest ASIR (505.32 per 100,000) of all UEF types in 2019. The clavicle, scapula, and humerus had the highest increasing trend among the fracture sites. In 2019, Saudi Arabia had the highest ASIR of UEFs (2,296.93 per 100,000). Afghanistan had the highest age-standardized YLD rate due to UEFs (19.6 per 100,000) in 2019, with Syria (153.32%) and Iran (37.04%) experiencing the greatest increase and decrease, respectively, from 1990 to 2019. Falling was the leading cause of UEFs, accounting for 45.05% of incidence and 41.19% of YLD overall. Conclusions: Contrary to global trends, UEFs increased in the MENA region during the study period. Countries with higher fracture incidence and YLD should consider preventive and rehabilitation strategies.