Published in PLOS One on 2026-08-31, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original study title: Prevalence, characteristics, and determinants of chest pain among physicians in the Middle East and North Africa: A multinational cross-sectional study
Original authors: Saadi M. Saleh, Weam Aldiban, Alaa Aljamala, Khaled Gadallah, Omar Habib, Mansour Algazar, Omar Abdalazeez, Safia Abdi, Noorulhuda Oudah, Hamza I. Alhamdan, Bushra M. Rageh, DARS Consortium, Rasha Shaker Eldesouky
Source: PLOS One • DOI 10.1371/journal.pone.0355946
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Physicians face substantial occupational, psychological, and cardiovascular risk factors predisposing them to chest pain, yet no large-scale study has examined this in the Middle East and North Africa (MENA). This study determined the prevalence, characteristics, and determinants of chest pain among MENA physicians.
This multinational cross-sectional study enrolled 6,224 physicians from 12 MENA countries (August–December 2023). Chest pain was classified using the Rose Angina Questionnaire. Anxiety and panic disorder were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Panic Disorder Screener (PADIS). Binary and multinomial logistic regression identified independent determinants.
Overall, 795 (12.8%) met criteria for definitive anginal pain and 2,836 (45.6%) for possible anginal pain. In the adjusted binary model, panic disorder was the strongest predictor (AOR = 2.76, 95% CI: 2.44–3.13), followed by physical comorbidities (AOR = 1.91), sleep deprivation (AOR = 1.61), female sex (AOR = 1.49), anxiety disorder (AOR = 1.38), and obesity (AOR = 1.30). All nicotine product categories were independently associated with chest pain. Multinomial analysis revealed stronger associations of panic disorder (AOR = 3.52) and tobacco use with definitive anginal pain, while electronic nicotine delivery system (ENDS) use was significant only for possible anginal pain. Middle-income country physicians had higher odds than those from high-income countries (AOR = 1.71).
Chest pain was highly prevalent among MENA physicians, and was strongly associated with panic disorder, anxiety, sleep deprivation, and nicotine product use. Integrated occupational health programmes addressing both psychological and cardiovascular risk are urgently needed.
Introduction
Chest pain is among the most clinically significant and diagnostically complex symptoms encountered in medical practice. It accounts for approximately 6–8% of all emergency department visits globally and represents a leading cause of unscheduled healthcare utilization [1,2]. While chest pain carries an important association with serious cardiovascular conditions — including acute coronary syndromes, stable angina pectoris, and aortic disease — the majority of chest pain presentations in community and outpatient settings are non-cardiac in origin, arising from gastrointestinal, musculoskeletal, pulmonary, or psychological causes [3–5]. This diagnostic complexity is compounded by the substantial overlap between cardiac and non-cardiac presentations, particularly in the context of anxiety disorders and panic disorder, which can produce chest pain that closely mimics classical angina both clinically and experientially [6,7].
The Middle East and North Africa (MENA) region presents a distinctive epidemiological context for cardiovascular disease. Cardiovascular events in this region occur at younger ages than in Western populations, driven by a rapidly increasing prevalence of cardiovascular risk factors including obesity, type 2 diabetes, dyslipidaemia, and tobacco use [8,9]. Despite this growing burden, population-level data on chest pain symptoms — as distinct from established cardiovascular disease endpoints — remain sparse, and the determinants of chest pain in this region are poorly characterised.
Reading this evidence
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© 2026 Saadi M. Saleh, Weam Aldiban, Alaa Aljamala, Khaled Gadallah, Omar Habib, Mansour Algazar, Omar Abdalazeez, Safia Abdi, Noorulhuda Oudah, Hamza I. Alhamdan, Bushra M. Rageh, DARS Consortium, Rasha Shaker Eldesouky. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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