1. 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.

2. 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.

3. 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.

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

5. 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) nationals, aged 35-70, 2006.
Saudi biobank 200, ,000 family-based and 100,000 disease-specific group, 18+
Qatar biobank 60,000 Qatari nationals / long-term residents, 18+.

6. Deaths from Heart Disease

7. Prevalence of Type II Diabetes by country

8. 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

9. #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

10. The UAE Healthy Future Study

11. 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

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

14. ..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…

16. 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

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

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

19. Study Timeline
2nd Follow-up visit
1st Follow-up visit
Main Study Recruitment
Pilot Study
Planning

21. 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

22. THANK YOU