Health and economic burden of seven environmental risk factors across Gulf Cooperation Council countries from 1990 to 2023

Gulf Cooperation Council (GCC) countries face high environmental exposures yet lack a comprehensive health economic assessment of environmental risk factors using current data. We estimated age-standardized death rates, disability-adjusted life years (DALYs), and health economic costs from seven environmental risk factors in six GCC countries for 1990 to 2023 using Global Burden of Disease (GBD) 2023 data. Economic burden was calculated using country-specific values of statistical life (VSL) from the WHO Health Economic Assessment Tool. Sensitivity analyses compared market exchange rate (MER) and purchasing power parity (PPP) valuations and DALY-based and mortality-only VSL approaches. In 2023, environmental risks were associated with 42,733 (95% UI: 31,970 to 54,069) premature deaths, 1,451,287 (95% UI: 1,100,311 to 1,828,133) DALYs, and $37.8 billion (MER) in economic costs, approximately 1.6% of combined GCC GDP. Ambient PM2.5 accounted for 56.9% of total burden ($21.6 billion). Age-standardized death rates declined 11% to 61% across countries from 1990 to 2023, with Saudi Arabia showing the smallest decline. Lead exposure ranked third (7652 deaths, $5.4 billion), reflecting a new direct cardiovascular pathway in GBD 2023. PPP-based valuation yielded $90.2 billion. Environmental risks cost the GCC $37.8 billion annually. PM2.5 reduction, heat adaptation, and lead biomonitoring are the highest-yield intervention targets.