Epidemiological patterns and spatiotemporal analysis of cardiovascular disease mortality in Iran: Development of public health strategies and policies.

BACKGROUND: Cardiovascular diseases (CVD) stand out as the leading cause of mortality, and the mortality rate attributed to this disease is notably elevated in Iran. Consequently, dedicated studies on CVD become imperative. METHODS: This cross-sectional study utilized data from the death registration system of the Ministry of Health, Treatment and Medical Education of Iran. In this study, the statistical population of all people who died due to CVD in Iran were18,146, 21,945, and 24,352 individuals in the years 2017, 2018, and 2019, respectively. The primary objective is to conduct a spatiotemporal analysis of CVD mortality spatiotemporally using GIS-based methodologies. To achieve this, CVD mortality data at the township level for the years 2017, 2018, and 2019 in Iran are subjected to spatial statistical tests, including Anselin Local Moran's I and Hot Spot Analysis (Getis-Ord Gi*), as well as analytical techniques such as Mean Center (MC), (SD), and (GIS). RESULTS: The study identified a rising trend in cardiovascular disease-related deaths in Iran, reaching (46.36% females and 53.64 males), (45.39% females and 54.61% males) and (45.67% females and 54.33% males) individuals in the years 2017, 2018, and 2019, respectively. Throughout this period, the mortality rate was higher among men, with the elderly showing the highest mortality. Notably, distinct hotspots of cardiovascular disease mortality emerged in the western, southern, and eastern regions of Iran. These findings emphasize the importance of targeted interventions and further investigation into the contributing factors in these specific geographic areas. CONCLUSION: Geographic factors are identified as significant contributors to an elevated risk of cardiovascular disease mortality. Our study, shedding light on the spatial dynamics of the disease, offers valuable insights for decision-makers. The findings can contribute to the formulation of effective strategies and policies, aligning with a Holistic Cardiovascular Health Strategy, Gender-Based Healthcare Policies, and Spatial Planning and Environmental Policies.

A prospective cohort study protocol: monitoring and surveillance of adverse events following heterologous booster doses of Oxford AstraZeneca COVID-19 vaccine in previous recipients of two doses of Sinopharm or Sputnik V vaccines in Iran.

BACKGROUND: Regarding the paucity of evidence on the side effects of the booster dose of Oxford AstraZeneca vaccine in vaccinated people with Sinopharm or Sputnik V, we aimed to set up a cohort event monitoring (CEM) study to capture adverse events occurring in individuals who will receive the booster doses of AstraZeneca (either the first or second booster dose) following being vaccinated with Sinopharm or sputnik V vaccines in Iran. METHODS: The present study is an active COVID-19 vaccine safety surveillance through an observational prospective cohort study that will be conducted in vaccination centers in Iran. The study will be conducted in twelve provinces of Iran. Study sites are vaccination centers where the AstraZeneca vaccine is administered to the cohort population. The study population includes all individuals who have received two doses of Sinopharm or Sputnik V vaccines and either the first or second booster dose of AstraZeneca according to the national guidelines for immunization in Iran in 2023. We are planning to include 30,000 eligible people in this study. Each individual will be followed up for 13 weeks after either the first or second booster dose of the AstraZeneca vaccine. Furthermore, convenience sampling is used to include participants in the present study. Participation in the study will be strictly voluntary. DISCUSSION: With the planned study we will provide a valid epidemiological evidence to improve the understanding of the safety of the booster dose of the AstraZeneca and to better evaluate the effectiveness of public health interventions. This could help policy makers in managing the COVID-19 pandemic according to scientific evidence.

Willingness to pay for a COVID-19 vaccine and its associated determinants in Iran.

Introduction: Understanding the individuals' willingness to pay (WTP) for the COVID-19 vaccine could help design policy interventions to control the COVID-19 pandemic. This study aimed to estimate the individuals' willingness to pay (WTP) for a COVID-19 vaccine and to identify its associated determinants. Methods: A cross-sectional survey was conducted on 526 Iranian adults using a web-based questionnaire. A double-bounded contingent valuation approach was used to estimate WTP for the COVID-19 vaccine. The parameters of the model were estimated based on the maximum likelihood method. Results: A considerable proportion of participants (90.87%) were willing to pay for a COVID-19 vaccine. Based on our discrete choice model, the estimated mean WTP for a COVID-19 vaccine was US$ 60.13 (CI: 56.80-63.46; p < 0.01). Having a higher perceived risk of being contaminated with COVID-19, higher average monthly income, higher education level, pre-existence of chronic diseases, previous experience of vaccination, and belonging to higher age groups were significant determinants associated with WTP for COVID-19 vaccination. Conclusion: The present study indicates a relatively high WTP and acceptance of a COVID-19 vaccine among the Iranian population. Average monthly income, risk perception, education level, the preexistence of chronic disease, and previous vaccination experience increased the likelihood of WTP for a vaccine. Subsidizing the COVID-19 vaccine for the low-income population and raising risk perception among the population should be considered in formulating vaccine-related interventions.

Measurement and Decomposition of Socioeconomic Inequality in Metabolic Syndrome: A Cross-sectional Analysis of the RaNCD Cohort Study in the West of Iran.

OBJECTIVES: Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran. METHODS: This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middle-aged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CIn) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants. RESULTS: The proportion of MetS in the sample was 41.1%. The CIn of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%). CONCLUSIONS: Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.

Decomposing socioeconomic disparity in the utilization of screening mammography: A cross-sectional analysis from the RaNCD cohort study.

We aimed to examine the degree of socioeconomic inequality in screening mammography among Kurdish women of Iran. Data from the Ravansar Non-Communicable Diseases (RaNCD) Cohort Study were used. A total of 3,219 women aged 35-65 years were studied. The concentration index (CIn) was used to measure the magnitude of socioeconomic-related inequalities in screening mammography. Decomposition analysis was employed to calculate the contribution of each explanatory variable to the observed inequality. The participation rate for screening mammography was 19.7%. The CIn of screening mammography was 0.142 (95% CI: 0.0197, 0.0656), indicating that screening mammography is more concentrated among high-SES women. Socioeconomic status, education level and area of residence were the main contributors to the observed inequality, respectively. We found a pro-rich inequality in screening mammography among Iranian Kurdish women. For mitigating socioeconomic inequality in screening mammography policymakers should focus more on the poor and rural communities.

Socioeconomic disparities in using rehabilitation services among Iranian adults with disabilities: a decomposition analysis.

BACKGROUND: Persons with disabilities (PWD) generally experience various barriers in using health care compared to the general population, and these problems are more worsened for those with disabilities in lower socioeconomic status. The study aimed to estimate socioeconomic inequality in using rehabilitation services (URS) in adults with disabilities in Iran. METHODS: This cross-sectional study was conducted at a national level in Iran. 786 PWD (aged 18 years and older) participated in the study between September and December 2020. Socioeconomic-related inequality in URS was estimated by the Concentration Index (C). The C was decomposed to identify factors explaining the variability within the socioeconomic inequality in URS. RESULTS: In the present study 8.10% (N = 61) of the study population used rehabilitation services during the past three months. In this study, the value of the C was estimated 0.25 (p-value = 0.025) that shows URS was unequally distributed, and concentrated among the higher SES groups. The results of decomposition analysis indicated that the wealth index was the largest contributor (94.22%) to the observed socioeconomic inequalities in URS among PWD. Following the wealth index, Age and marital status were the major contributors to the unequal distribution of URS among the study population. CONCLUSIONS: Our findings revealed that socioeconomic inequality in using rehabilitation services was concentrated among well-off PWD. Accordingly, rehabilitation financing through appropriate mechanisms for individuals with low SES is suggested.

Investigating Global Spatial Patterns of Diarrhea-Related Mortality in Children Under Five.

Objective: Investigating the trends of child diarrhea-related mortality (DRM) is crucial to tracking and monitoring the progress of its prevention and control efforts worldwide. This study explores the spatial patterns of diarrhea-related mortality in children under five for monitoring and designing effective intervention programs. Methods: The data used in this study was obtained from the World Health Organization (WHO) public dataset that contained data from 195 countries from the year 2000 to 2017. This dataset contained 13,541,989 DRM cases. The worldwide spatial pattern of DRM was analyzed at the country level utilizing geographic information system (GIS) software. Moran's I, Getis-Ord Gi, Mean center, and Standard Deviational Ellipse (SDE) techniques were used to conduct the spatial analysis. Results: The spatial pattern of DRM was clustered all across the world during the study period from 2000 to 2017. The results revealed that Asian and African countries had the highest incidence of DRM worldwide. The findings from the spatial modeling also revealed that the focal point of death from diarrhea was mainly in Asian countries until 2010, and this focus shifted to Africa in 2011. Conclusion: DRM is common among children who live in Asia and Africa. These concentrations may also be due to differences in knowledge, attitude, and practices regarding diarrhea. Through GIS analysis, the study was able to map the distribution of DRM in temporal and spatial dimensions and identify the hotspots of DRM across the globe.

Socioeconomic inequalities in prevalence, awareness, treatment and control of hypertension: evidence from the PERSIAN cohort study.

BACKGROUND: Elevated blood pressure is associated with cardiovascular disease, stroke and chronic kidney disease. In this study, we examined the socioeconomic inequality and its related factors in prevalence, Awareness, Treatment and Control (ATC) of hypertension (HTN) in Iran. METHOD: The study used data from the recruitment phase of The Prospective Epidemiological Research Studies in IrAN (PERSIAN). A sample of 162,842 adults aged > = 35 years was analyzed. HTN was defined according to the Joint National Committee)JNC-7(. socioeconomic inequality was measured using concentration index (Cn) and curve. RESULTS: The mean age of participants was 49.38(SD = ± 9.14) years and 44.74% of the them were men. The prevalence of HTN in the total population was 22.3%(95% CI: 20.6%; 24.1%), and 18.8%(95% CI: 16.8%; 20.9%) and 25.2%(95% CI: 24.2%; 27.7%) in men and women, respectively. The percentage of awareness treatment and control among individuals with HTN were 77.5%(95% CI: 73.3%; 81.8%), 82.2%(95% CI: 70.2%; 81.6%) and 75.9%(95% CI: 70.2%; 81.6%), respectively. The Cn for prevalence of HTN was -0.084. Two factors, age (58.46%) and wealth (32.40%), contributed most to the socioeconomic inequality in the prevalence of HTN. CONCLUSION: The prevalence of HTN was higher among low-SES individuals, who also showed higher levels of awareness. However, treatment and control of HTN were more concentrated among those who had higher levels of SES, indicating that people at a higher risk of adverse event related to HTN (the low SES individuals) are not benefiting from the advantage of treatment and control of HTN. Such a gap between diagnosis (prevalence) and control (treatment and control) of HTN needs to be addressed by public health policymakers.

Contributing factors to healthcare costs in individuals with autism spectrum disorder: a systematic review.

BACKGROUND: Individuals with autism spectrum disorder (ASD) are more likely to use healthcare than their counterparts without disabilities, which imposes high medical costs to families and health systems. This study aimed to investigate healthcare costs and its determinants among individuals with ASD. METHODS: In this systematic review, we searched online databases (Web of Science, Medline through PubMed and Scopus) for observational and experimental studies that included data on service use and costs associated with ASD and published between January 2000 and May 2021. Exclusion criteria included non-English language articles, duplicates, abstracts, qualitative studies, gray literature, and non-original papers (e.g., letters to editors, editorials, reviews, etc.). RESULTS: Our searches yielded 4015 articles screened according to PRISMA guidelines. Of 4015 studies identified, 37 articles from 10 countries were eligible for final inclusion. Therapeutic interventions, outpatient visits and medications constituted the largest proportion of direct medical expenditure on individuals with ASD. Included studies suggest lack of health insurance, having associated morbidities, more severe symptoms, younger age groups and lower socioeconomic status (SES) are associated with higher medical expenditure in individuals with ASD. CONCLUSIONS: This systematic review identified a range of factors, including lower SES and lack of health insurance, which are associated with higher healthcare costs in people with ASD. Our study supports the formulation of policy options to reduce financial risks in families of individuals with ASD in countries which do not have a tax-based or universal health coverage system.

Socio-economic inequality in reported dental self-care behaviour among Iranian households: A national pooled study.

BACKGROUND: Setting out effective prevention strategies in dental diseases needs recognition related factors of the prevention behaviours and targeting the most disadvantaged groups in the term of dental hygiene. This study aimed to investigate socio-economic inequality in the dental self-care status (DSS) of Iranian households and decompose the measured inequality into its contributors. METHOD: In this cross-sectional study, pooled data were extracted from Households Income and Expenditure Surveys (HIESs) conducted in Iran from 2012 to 2017. The index of socio-economic status (SES) for each household was constructed using principal components analysis (PCA). We used Wagstaff normalized concentration index as a measure of socio-economic inequality in dental self-care. Decomposition analysis was applied to determine the main factors contributed to the measured inequality. RESULTS: The prevalence of dental self-care in the whole population was 40.56%. The total concentration index was 0.271 (CI: 0.266, 0.275). The results of decomposition analysis for the measured inequality showed that SES, was the highest positive contributors (90.19%) followed by sex of household's head (12.15%), place of residence (11.79%) and education level of household's head (11.71%). Furthermore, the province of residence had the highest negative contribution (-11.37) to the inequality. CONCLUSION: The findings of this study showed that a huge portion of the observed inequality was explained by SES that might give us a policy recommendation: There is room for improving dental health and reducing inequality in dental self-care by paying more attention to SES-disadvantaged households.

Sexual health concerns in women with intellectual disabilities: a systematic review in qualitative studies.

BACKGROUND: Studies indicate that women with intellectual disabilities (ID) face various personal and socio-environmental barriers in their sexual lives. This study aimed to identify the concerns and sexual health needs experienced by women with ID. METHOD: A systematic review of relevant qualitative articles was conducted in PubMed, Web of Science Scopus and PsycINFO databases from June 2018 to August 2018. We designed our search strategy according to two main foci: (1) sexuality; and (2) women with ID. In the study, searches were limited to articles published from January 2000 to December 2017. In this review, studies on women ages 16 and over were included. RESULTS: Within the four databases, the search found 274 unique articles. After three steps of screening (title, abstract and full text), 22 studies were included in the final review. The articles mentioned difficulties with lack of sexual experience, negative experiences with sexuality, negative attitudes towards sexuality by nondisabled individuals, limited cognitive capacities to understand sexual identity, difficulty with finding the right partner, lack of access to sexual health information, lack of school-based sexuality education, violence and sexual abuse, lack of support from families and caregivers about sexuality, fear of sexual acts and unwanted pregnancy, shyness in expressing sexual desires, and limited knowledge of sexual behaviors. CONCLUSION: Our findings indicate that women with ID need to be provided with school-based sexuality education tailored to the level of understanding needed to attain the requisite knowledge to form relationships, understand sexual and romantic relationships, and practice safe sex when they choose this option. Families along with education and healthcare systems should provide opportunities for women with ID to talk about their sexual needs and make their own choices.

Eliciting preferences of patients about the quality of hospital services in the west of Iran using discrete choice experiment analysis.

OBJECTIVES: Knowing about accurate customer expectations is the most important step in defining and delivering high-quality services. This study aimed to evaluate the preferences of patients referring to two hospitals in Kermanshah, Iran. METHOD: Discrete choice experiment (DCE) method used to elicit preferences of 328 patients who were admitted in two hospitals of Kermanshah city in the west of Iran. Literature review and experts opinion were used to identify a candidate list of attributes related to the quality of cares in hospitals. The final study attributes were quality of physician care, quality of nursing care, waiting time for admission, cleaning of wards and toilets, and behavior of staff. Experimental design applied to extract choice sets of hospitals. The data was analyzed by a conditional logit regression. RESULTS: The regression results showed the most important predictors of hospital selection by respondents was the good quality of physician care (aOR: 3.18, 95% CI 2.61, 3.87), followed by friendly behavior of staffs (aOR: 2.03, 95% CI 1.81, 2.27), cleanness of wards and toilet (aOR: 1.61, 95% CI 1.40, 1.85), and finally quality of nursing cares (aOR: 1.13, 95% CI 0.89, 1.44). However, increasing waiting time made disutility in the study participants (aOR: 0.69, 95% CI 0.60, 0.80). CONCLUSIONS: Our study finding emphasized some potential opportunity of quality augmentation in hospital sector by paying attention to different quality attributes including quality of physician, friendly behavior of staffs, cleanness of hospital environment and finally quality of nursing cares. Considering patients preferences in decision making process could lead to substantial satisfaction improvement.

Health-care determinants of mortality and recovered cases from COVID-19: Do heath systems respond COVID-19 similarly?

BACKGROUND: The COVID-19 pandemic has spread rapidly across the world and has currently impacted most countries and territories globally. This study aimed to identify health-care determinants of mortality and recovery rates of COVID-19 and compare the efficiency of health systems in response to this pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted using data obtained from the World Bank database, that provides free and open access to a comprehensive set of health- and socioeconomic-related data, by September 12, 2020. An adjusted linear regression model was applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1 MP) in the included countries. One-way analysis of variance was applied to assess health systems' efficiency in response to COVID-19 pandemic using mortality and recovery rate (output variables) and current health expenditure (CHE) per capita (input variable). RESULTS: Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1 MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and population aged 65 years and over as a percentage of total population (SC = -0.79, P < 0.001) significantly predicted recovered cases from COVID-19 in the included countries. CONCLUSION: This study revealed that countries with higher CHE per capita and higher proportion of older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore, our study indicated that health systems with higher CHE per capita statistically had a greater efficiency in response to COVID-19 compared to those with lower CHE per capita. More attention to preventive strategies, early detection, and early intervention is suggested to improve the health system efficiency in controlling COVID-19 and its related mortalities worldwide.

Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies.

BACKGROUND: Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally. METHODS: We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities. RESULTS: Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare. CONCLUSIONS: Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD's access to health care.

Explaining Socioeconomic Inequality Differences in Catastrophic Health Expenditure Between Urban and Rural Areas of Iran After Health Transformation Plan Implementation.

OBJECTIVE: Ensuring fair financial contribution is one of the main goals of the Health Transformation Plan (HTP) of Iran. This study aims to estimate socioeconomic inequality differences in catastrophic health expenditure (CHE) between urban and rural areas of Iran after the implementation of the HTP during 2017. MATERIALS AND METHODS: Data from a representative survey of households' income and xpenditure from the Iran Statistical Center (ISC) were used for the analysis. We applied the World Health Organization (WHO) cut-off of 40% payment for CHE, and Wagstaff's normalized concentration index (C) to measure and decompose the inequality. Also, Blinder-Oaxaca decomposition analysis was used to decompose contributors of inequality differences between rural and urban areas. RESULTS: The overall incidence of CHE among Iranian households during the year 2017 was 3.32% with a standard deviation (SD) of 17.91%, and the mean (SD) levels of CHE in rural and urban areas of Iran were 4.37% (20.45%) and 2.97% (16.99%), respectively. The aggregate socioeconomic status (SES)-related inequality in CHE was significantly (p<0.001) different from zero (C=-0.238) and there was a significant (p<0.05) difference between rural (C=-0.150) and urban (C=0.218) areas. SES was the highest contributor to inequality in both rural (130.09) and urban (144.17) areas. The Blinder-Oaxaca decomposition revealed that SES (175.01%) followed by outpatient services (120.29%) were the main contributors to differences in inequality in rural and urban areas. Sex (-101.42%) and health insurance coverage were among negative contributors to this inequality difference. CONCLUSION: Our findings revealed a significant pro-rich inequality in CHE. Also, some variables, such as sex and region, made different contributions in rural and urban areas. However, SES, itself, made the highest contribution in both areas and explained the greatest share of difference in inequality between the two areas. This issue calls for revision of the HTP to further address the risk of CHE and socioeconomic disparity among Iranian households, especially those with lowSES.

Socioeconomic inequality in dental caries experience expressed by the significant caries index: cross-sectional results from the RaNCD Cohort Study.

INTRODUCTION: Socioeconomic inequality in dental caries among Iranian middle-aged adults remains largely unstudied. This study aimed to measure socioeconomic inequality in dental caries experience and to identify determinants of this inequality. MATERIALS AND METHODS: Data were obtained from the Ravansar Non-Communicable Diseases (RaNCD) Cohort Study. This cross-sectional analysis included 10,002 adults aged 35-65 years. Caries experience was dichotomised based on the decayed, missing and filled teeth (DMFT) of one-third of the population with the highest caries scores (i.e. significant caries index). Socioeconomic status (SES) was calculated using the principal component analysis. The concentration index (CI) was used to quantify the extent of socioeconomic inequality in dental caries experience. Decomposition analysis was conducted to quantify the contribution of each determinant to the observed inequality. RESULTS: The mean DMFT for all individuals was 16.1(SD 9.1). The CI of having significant dental caries was -0.236 (95% CI: -0.0259, -0.213), indicating that having significant dental caries was more concentrated among low-SES individuals. SES (65.6%), age group (24.7%) and female gender (3.7%) were found to have the largest percentage of contributions to the observed inequality in dental caries. CONCLUSION: This study indicates pro-rich inequalities in dental caries experience among middle-aged adults in Iran. The findings highlight the importance of early prevention of dental caries experience before it happens. To mitigate inequalities in dental caries experience, policy interventions should focus on females, older age groups, and low-SES individuals.