Women’s Health in Saudi ArabiaPublished StudiesDr. Amr Jamal, MBBS, SBFM, ABFM, MRCGPAssistant Professor of Family MedicineMember of Women’s Health Research ChairKing Saud University, College of Medicine

Contents Demographic distribution Coronary artery disease Risk factors of coronary artery disease

Diabetes Mellitus Hypertension Hyperlipidemia Obesity Metabolic syndrome Physical inactivity Smoking

Osteoporosis

Kingdom’s Total Population

0 -

1

1 -

4

5 -

9

10 -

14

15 -

19

20 -

24

25 -

29

30 -

34

35 -

39

40 -

44

45 -

49

50 -

54

55 -

59

60 -

64

65 -

69

70 -

74

75 -

79

80+

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Females Maleshttp://www.cdsi.gov.sa/pdf/Detail_Census_1425.pdf

Females 10,121,022 (44.63% )Males 12,557,240 (55.37% )Total 22,678,262

Saudi Population

0 -

1

1 -

4

5 -

9

10 -

14

15 -

19

20 -

24

25 -

29

30 -

34

35 -

39

40 -

44

45 -

49

50 -

54

55 -

59

60 -

64

65 -

69

70 -

74

75 -

79

80+

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

http://www.cdsi.gov.sa/pdf/Detail_Census_1425.pdf

Saudi Females 8,239,970 (49.86% )Saudi Males 8,287,370 (50.14% )Total 16,527,340

Saudi Population With Disability

http://www.cdsi.gov.sa/pdf/Detail_Census_1425.pdf

Blind Deaf Deaf & Mute

Lost an Organ

Mentally Retarded

Paralysis Other

Female 5337 1082 6024 814 9720 10542 10510

Male 11670 1622 11558 2085 14892 19157 19583

2,500

7,500

12,500

17,500

22,500

Illiteracy

http://www.cdsi.gov.sa/pdf/Detail_Census_1425.pdf

1413H / 1992G 1425H / 2004G0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%

16.90%

8.20%

40.10%

21.20%

Male Female

National Studies

CADiSS Coronary Artery Disease in Saudis study A major national project designed to

look at CAD and its risk factors in Saudi population

Community-based national epidemiological health survey

Period: between 1995 and 2000 Age group: 30-70 years Participants: 17,232

Coronary Artery Disease

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

Male Female

overall prevalence of CAD obtained from this study is 5.5% in KSA

Variables found to be statistically significant risk factors in KSA: age male gender Urban residency body mass index (BMI) Hypertension current smoking fasting blood glucose fasting cholesterol and triglycerides

Al-Nozha, M. M., M. R. Arafah, et al. (2004). "Coronary artery disease in Saudi Arabia." Saudi Med J 25(9): 1165-71.

Diabetes Mellitus

DM0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Males Females

Prevalence of DM in KSA is 23.7%

age-adjusted prevalence for the year 2000 is 21.9%

27.9% of diabetic patients were unaware of having DM.Al-Nozha, M. M., M. A. Al-Maatouq, et al. (2004). "Diabetes mellitus in Saudi Arabia." Saudi Med J 25(11): 1603-10.

Hypertension28.60%

23.90%

Male Female

26.4% of the world’s adult population in 2000 had hypertension 26.6% of men 26.1% of women

hypertension at younger ages was higher in men than in women

but among older people (>60 years) it was higher in women

Increasing weight showed significant increase in prevalence of hypertension in a linear relationship

66.9% of hypertensive patients were unaware of having hypertension

Al-Nozha, M. M., M. Abdullah, et al. (2007). "Hypertension in Saudi Arabia." Saudi Med J 28(1): 77-84.

Hypertension Females had statistically significant

elevated systolic hypertension compared with males (P < 0.01).

However, if blood pressure = 140/90 mmHg is used as a criterion for hypertension definition, the prevalence among the latter age groups would be 20.4% for systolic and 25.9% for diastolic hypertension.

ISH was higher among females compared with males (2% vs.. 1.4%)

IDH was higher among males than females (4.4% vs.. 3.4%).

Al-Nozha, M. M., M. S. Ali, et al. (1997). "Arterial hypertension in Saudi Arabia." Ann Saudi Med 17(2): 170-4.

Hypertension There was a higher prevalence among

females compared to males in the 40-75 year age group in all regions, except in the highlands of Al Tail and Astir.

However, the difference was not statistically significant, except in Makah (25.9%, P<0.001)Al Shrike (22%, P<0.03).

Al-Nozha, M. M. and A. K. Oman (1998). "The prevalence of hypertension in different geographical regions of Saudi Arabia." Ann Saudi Med 18(5): 401-7.

Hyperlipedimia

HC HT0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

MaleFemale

Al-Nozha, M. M., M. R. Arafah, et al. (2008). "Hyperlipidemia in Saudi Arabia." Saudi Med J 29(2): 282-7.

mean cholesterol level = 5.4+/-1.52 mmol/l

mean triglycerides level = 1.8+/-1.29 mmol/l

Hypercholesterolemia the mean TCC for all female subjects was significantly

higher than for male subjects (4.24 versus 4 mmol/l)

There was a progressive increase in TCC with age, reaching a maximum at The fifth decade for males The sixth decade for female

There was a progressive increase in mean TCC with increasing BMI values for male and female subjects with higher values of mean TCC for female subjects for any

given BMI value. The prevalence of HC, 5.2-6.2 mmol/l was 9% and 11% for

all male and female subjects, respectively (P = 0.74), The prevalence of HC, > 6.2 mmol/l was 7% and 8% for

male and female subjectsal-Nuaim, A. R., K. al-Rubeaan, et al. (1996). "Prevalence of hypercholesterolemia in Saudi Arabia, epidemiological study." Int J Cardiol 54(1): 41-9.

Obesity

Overweight Obesity

42%

26%

32%

44%

Male FemaleAl-Nozha, M. M., Y. Y. Al-Mazrou, et al. (2005). "Obesity in Saudi Arabia." Saudi Med J 26(5): 824-9.

Normal28%

Overweight37%

Moderate Obesity32%

Severe Obesity3%

Obesity

Overweight Obesity

29%

16%

27%

24%

Male Femaleal-Nuaim, A. R., K. al-Rubeaan, et al. (1996). "High prevalence of overweight and obesity in Saudi Arabia." Int J Obes Relat Metab Disord 20(6): 547-52.

Overweight and obesity were more prevalent among:Female IlliterateHigh-incomeUrban

Metabolic Syndrome

Age a

djus

ted

prev

alen

ce o

f MS

Crude

pre

vale

nce

of M

S

Low H

DL am

ong

MS

37% 41%

75%

42% 42%

82%

Male Female

Presence of at least 3 of the following: abdominal obesity (waist

circumference): > 102 cm (40 inch) in male > 88 cm (35 inch) in female

Triglycerides ≥ 150 mg/dl (1.69 mmol/L)

HDL cholesterol < 40 mg/dl (1.03 mmol/L) in male < 50 mg/dl (1.29 mmol/L) in female,

blood pressure ≥ 130/85 mm Hg fasting glucose ≥ or = 110

mg/dl (6.1 mmol/L)Al-Nozha, M., A. Al-Khadra, et al. (2005). "Metabolic syndrome in Saudi Arabia." Saudi Med J 26(12): 1918-25.

Physical Inactivity

Inactivity

94% 98%

Male Female

Inactivity Increase with increasing age Decrease with increasing

education levels Highest in the Central region

(97%) Lowest in the southern

region (94%) Active individuals

exhibited lower values of BMI Lower values of WC

Al-Nozha, M. M., H. M. Al-Hazzaa, et al. (2007). "Prevalence of physical activity and inactivity among Saudis aged 30-70 years. A population-based cross-sectional study." Saudi Med J 28(4): 559-68.

Smoking

21%

1%

Male Female

Smoking prevalence was higher among: malemarrieduneducatedcertain occupations:

manual workers, businessmen, army officers, office workers

Jarallah, J. S., K. A. al-Rubeaan, et al. (1999). "Prevalence and determinants of smoking in three regions of Saudi Arabia." Tob Control 8(1): 53-6.

Osteoporosis

50-59

60-69

70-79

All age

42%

11%

5%

30%

33%

27%

22%

31%

24%

62%

74%

40%

Normal Osteopenia Osteoporosis El-Desouki, M. I. (2003). "Osteoporosis in postmenopausal Saudi women using dual x-ray bone densitometry." Saudi Med J 24(9): 953-6.

Osteoporosis Age range 20-79 years; 915 males and 1,065

females, in Jeddah area The prevalence of osteoporosis in Saudis

(50-79 years) at the lumbar spine Using the manufacturer's data: 38.3-47.7% Using Saudi reference data: 30.5-49.6%

In the lowest quartile of body weight Females: 25.6% Males: 15.5%

In the highest quartiles of body weight Females : 0.0% Males: 0.8%Ardawi, M. S., A. A. Maimany, et al. (2005). "Bone mineral density of the spine and femur in healthy

Saudis." Osteoporos Int 16(1): 43-55.

Osteoporosis

Ghannam, N. N., M. M. Hammami, et al. (1999). "Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation." Calcif Tissue Int 65(1): 23-8.

Vitamin D

25-35

≥ 50

70%

45%

30%

55%

Normal hypovitaminosis Al-Turki, H. A., M. Sadat-Ali, et al. (2008). "25-Hydoxyvitamin D levels among healthy Saudi Arabian women." Saudi Med J 29(12): 1765-8.