Noncommunicable Diseases and Hospital Utilization in Kuwait: A Generalizable Approach Using the World Health Survey.

BACKGROUND: Kuwait and countries in the Arabian Gulf region face an alarming prevalence of noncommunicable diseases (NCDs) that strain their health systems and threaten their economies. To quantify a key dimension of the burden, we estimated the risk of hospital utilization in Kuwait associated with diagnoses of the most prevalent NCDs, excluding cancer, using a generalizable approach suitable for cross-country disease burden comparisons and assessments of prevention effectiveness. METHODS: The study analyzed responses from a nationally representative sample of 2,165 individuals with self-reported hospital admissions over 12 months and NCD diagnoses from the World Health Survey in Kuwait in 2010. Hospital utilization rates were examined for individuals diagnosed with hypertension, diabetes mellitus, asthma, chronic lung condition, heart disease, and stroke rates and adjusted for demographic and socioeconomic factors. Count regressions were used to estimate the association between individual NCDs while adjusting for other covariates. RESULTS: Using negative binomial regressions, we found that hypertension, the most common NCD in Kuwait, was associated with 75% higher hospital utilization. In addition, heart disease was associated with a 495% increase in hospital utilization rates after adjusting for potential confounders. Many other demographic, socioeconomic, and behavioral characteristics confounded the sizable increase in the risk of hospital admissions associated with NCDs. CONCLUSIONS: We estimated the substantial burden on curative services associated with NCDs in Kuwait through a standardized approach to compare hospital utilization rates associated with various NCDs; this approach is generalizable to more than 70 countries that participated in the World Health Survey.

Ambient exposure of O3 and NO2 and associated health risk in Kuwait.

Ozone (O3) and nitrogen dioxide (NO2), indissoluble air pollutants in the atmosphere, have been confirmed in various parts of the world to have detrimental health effects on humans. Currently, such information is lacking in Kuwait. The objectives of this study are to investigate the spatial and temporal variations of O3 and NO2 concentrations in Kuwait during a 4-year period (2014-2017) and to quantify the associated short- and long-term health effects, including all-cause, respiratory, and cardiovascular mortalities and morbidities during the same study period. Exposure assessment showed that the annual levels (22.5-26.4 ppb), SOMO35, and the 8-hour 4-year mean (38 ppb) of O3 were very low and below the World Health Organization (WHO) (50 ppb) and Kuwaiti (70 ppb) regulatory limits. The annual mean levels of NO2 ranged from 30.3 to 43.8 ppb and were significantly higher than both WHO and Kuwait limits (21 ppb). As expected, O3 and NO2 levels showed opposing trends, with higher concentrations of NO2 recorded in early morning and mid-evening, during autumn and winter, and during Saturdays (the so-called weekend effect). Health effects indicated high respiratory diseases due to short-term exposure to NO2. Contrary to the western countries' pollution levels, Kuwait showed lower O3 and higher NO2 levels. There is potential for substantial health improvements in Kuwait by reducing NO2 pollution through stringent control measures of stationary and mobile sources.

Exposure levels of air pollution (PM2.5) and associated health risk in Kuwait.

It is well established that respiratory and cardiovascular mortality and morbidity rates are associated with poor air quality as measured by high concentrations of fine particulate matter such as PM2.5 parameters. Since such information is lacking for the State of Kuwait, this study examined the exposure levels of PM2.5 and the associated health risk as evaluated by five mortality measures embodied in ischemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease and acute lower respiratory infection as well as two morbidity outcomes related to both cardiovascular and respiratory diseases. The measurement models utilized in this investigation followed the WHO guidelines. Over a span of a four-year period (2014-2017), the annual PM2.5 concentration levels ranged from 38.0 µg/m3 to 75.2 µg/m3. In general, exposure levels tended to fluctuate throughout the day with the higher levels recorded during rush hours (early morning and early evening), weekends (particularly Saturdays), and summer (i.e., August and September). The highest number of excess cases and attributable proportions of premature mortalities were related to ischemic heart disease and stroke at 352 (95% CI 275-426) and 70.8% (95% CI 39.7-85.2), respectively. In general, respiratory diseases showed a higher number of excess cases and attributable proportions than cardiovascular diseases. Relative to other findings on the global stage, the results emanating from Kuwait are emerging on the higher side. The study outcomes suggest that control strategies are in dire need to bend the pollution levels in Kuwait.