A Longitudinal Study of Antimicrobial Resistance in the Eastern Mediterranean Region Using Global Burden Disease 2021 Estimates
1
Public Health, Qatar University, Doha, Qatar
Popul. Med. 2026;8(Supplement Supplement 1):A208
ABSTRACT
BACKGROUND:
Antimicrobial resistance (AMR) is a major global health threat, with particularly high mortality in the Eastern Mediterranean Region (EMR) where conflict, weak surveillance, and limited stewardship hinder effective response. Robust, comparable regional estimates of disease burden remain limited. The study aimed to investigate trends in AMR-attributable and AMR-associated death rates in 22 EMR countries, assess differences in disease burden by income level, and identify leading bacterial pathogens contributing to AMR-related mortality in the region.
METHODS:
We conducted a longitudinal ecological study using Global Burden of Disease (GBD) 2021 modeled estimates of AMR-attributable and AMR-associated death rates per 100,000 population by country, year, income level, and age (<5 and ≥5 years) during 2000-2021. Trend analysis using both graphs and annual percentage change (APC), proportional contribution of top six pathogens, and a generalized least squares panel-data regression were employed to quantify time trends and income-level disparities in AMR-attributable and AMR- associated death rates in the region.
RESULTS:
AMR-attributable and AMR-associated death rates declined overall, but large inequalities persisted. Year-on-year AMR-attributable and associated death rates were decreased by 10 and 35 deaths (per 1000 population), respectively. Low-income and mid-income countries had significantly higher AMR-attributable and associated death rates, compared to high-income countries. Conflict-affected settings (Somalia, Syria, Libya, Iraq, Palestine) showed extreme peaks and instability, whereas Gulf countries maintained low, stable rates. The six leading pathogens (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae) showed declining proportional contributions in AMR-attributable death rates among children <5 years but rising proportional burdens in those 5 years and older during the study period.
CONCLUSIONS:
AMR mortality in the EMR was decreasing but remained highly unequal and closely linked to income level, conflict, and age. Strengthening stewardship, laboratory capacity, and sustained surveillance especially in fragile settings are essential to further reduce AMR-related deaths.
Antimicrobial resistance (AMR) is a major global health threat, with particularly high mortality in the Eastern Mediterranean Region (EMR) where conflict, weak surveillance, and limited stewardship hinder effective response. Robust, comparable regional estimates of disease burden remain limited. The study aimed to investigate trends in AMR-attributable and AMR-associated death rates in 22 EMR countries, assess differences in disease burden by income level, and identify leading bacterial pathogens contributing to AMR-related mortality in the region.
METHODS:
We conducted a longitudinal ecological study using Global Burden of Disease (GBD) 2021 modeled estimates of AMR-attributable and AMR-associated death rates per 100,000 population by country, year, income level, and age (<5 and ≥5 years) during 2000-2021. Trend analysis using both graphs and annual percentage change (APC), proportional contribution of top six pathogens, and a generalized least squares panel-data regression were employed to quantify time trends and income-level disparities in AMR-attributable and AMR- associated death rates in the region.
RESULTS:
AMR-attributable and AMR-associated death rates declined overall, but large inequalities persisted. Year-on-year AMR-attributable and associated death rates were decreased by 10 and 35 deaths (per 1000 population), respectively. Low-income and mid-income countries had significantly higher AMR-attributable and associated death rates, compared to high-income countries. Conflict-affected settings (Somalia, Syria, Libya, Iraq, Palestine) showed extreme peaks and instability, whereas Gulf countries maintained low, stable rates. The six leading pathogens (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae) showed declining proportional contributions in AMR-attributable death rates among children <5 years but rising proportional burdens in those 5 years and older during the study period.
CONCLUSIONS:
AMR mortality in the EMR was decreasing but remained highly unequal and closely linked to income level, conflict, and age. Strengthening stewardship, laboratory capacity, and sustained surveillance especially in fragile settings are essential to further reduce AMR-related deaths.
| eISSN: | 2654-1459 |
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