Trends in the burden of fire, heat, and hot substances in North Africa and the Middle East, 1990-2023: an analysis of the 2023 Global Burden of Disease Study.

BACKGROUND: Thermal injuries from fire, heat, and hot substances (FHHS) pose a significant public health challenge in North Africa and the Middle East (NAME). Comprehensive, long-term regional analyses, particularly those including the post-pandemic period, are limited. This study leverages Global Burden of Disease (GBD) 2023 data to provide a comprehensive assessment of the FHHS burden in the NAME region from 1990 to 2023, analyzing the distinct effects of age, period, and cohort to inform targeted interventions. METHODS: This study utilized FHHS data from the GBD 2023 for the 21 countries and territories of the NAME region. We analyzed trends in prevalence, incidence, mortality, and disability-adjusted life years (DALYs). The analysis employed joinpoint regression to identify temporal trend changes, decomposition analysis to isolate the effects of population growth, aging, and epidemiology, and an age-period-cohort model to delineate generational and age-specific risks. RESULTS: From 1990 to 2023, the age-standardized DALY rate for FHHS in NAME declined significantly (EAPC, - 2.6). Absolute prevalence increased in most countries, with increases exceeding 300% in Qatar and the United Arab Emirates. Joinpoint analysis identified an increase in ASIR during 2020-2023 (APC, 0.61%). Decomposition showed that population growth and ageing exerted upward pressure on absolute counts. For deaths, however, these positive demographic contributions were more than offset by favorable changes in age-specific epidemiological rates, resulting in a small net regional decline. CONCLUSION: From 1990 to 2023, NAME achieved substantial reductions in age-standardized DALY and death rates from FHHS. Population growth and ageing increased pressure on absolute prevalence and incidence, whereas improved age-specific epidemiological rates outweighed these pressures for deaths. The recent change in ASIR and the increasing burden in older age groups warrant continued surveillance and targeted prevention.