Thought Believability and Anxious Feelings about COVID-19: A Case-Control Study in Northeastern Iran.

Background: Believability and thoughts are considered as the pillars of behaviors over time, and anxious feelings are a risk factor for mental disorders, especially during the coronavirus disease (COVID-19) pandemic. This study aimed to explore the thought believability and anxious feelings of COVID-19 among infected and healthy families. Methods: In this hospital-based matched case-control study, health surveillance files of COVID-19 patients were collected from January to June 2021 and were analyzed statistically. In this study, two questionnaires of demographic characteristics and the Believability of Anxious Feelings and Thoughts (BAFT) were used. Data were analyzed using the One-way ANOVA. Results: Of 600 participants, 300 (50%) were PCR-confirmed and 300 (50%) were non-infected. Overall, 163 (54.33%) of infected people were male, 146 (48.67%) single, and 156 (52.00%) government employees. The results showed that the mean scores of physical anxiety (PA) and negative evaluation (NE) in the case group is significantly higher than the control group (P = 0.001); while emotional regulation (ER) in the control group was significantly higher than the case group (P = 0.001). Conclusion: Having high believability to the risks of COVID-19 may be a predictor of preventive behaviors in individuals. Worrying about COVID-19 can increase the perceived risk of a pandemic in societies and consequence, increase the general public health.

Towards engineering mitigation of leaching of Cd and Pb in co-contaminated soils using metal oxide-based aerogel composites and biochar.

Applications of metal-based nanomaterials for the remediation of heavy metal (HM) contaminated environments are of great importance. The ability of metal oxide-based carbon aerogel composite to immobilize HMs in multi-metal contaminated soils has not yet been investigated, particularly under acidic conditions. Herein, we investigate the performance of metal oxides (Sr0.7 Mn0.3 Co0.5 Fe0.5O3-δ)-based carbon aerogel composite (MO-CAg) compared with coconut coil fiber biochar (CCFB) and carbon aerogel (CAg) for Cd and Pb immobilization in contaminated soil. The MO-CAg, applied at 2% (w/w), significantly decreased Pb leaching by 67-75% and Cd by 60-65%, CAg decreased Cd by 54% and Pb by 46%, while biochar decreased Cd by 40-44% and Pb by 43%. The addition of MO-CAg altered Cd and Pb geochemical fractions by increasing their residual fraction, i.e., stabilized both metals compared to the control. This presents a comprehensive elaboration on the probable reaction interactions between the MO-Cag and heavy metals, including a combination of (co)precipitation, and reduction-oxidation as the predominant mechanisms of metal stabilization with MO-CAg. Moreover, MO-CAg increased Pb and Cd stabilization in soils by strengthening the bonding between metal oxides and Cd/Pb. By imbedding MO into the CAg, in MO-CAg, the immobilization of Cd(II) and Pb(II) occurred through inner-sphere complexation, while with CCFB and CAg metals, immobilization occurred through outer-sphere complexation. MO-CAg is a promising and highly efficient material that could be recommended for the remediation of Cd- and Pb-contaminated soils in subsequent studies.

Environmental health risk factors and cutaneous leishmaniasis (CL): A case-control study in northeastern Iran.

Background & objectives: Cutaneous leishmaniasis (CL) is one of the main causes of vector-born diseases in younger population. To evaluate the association of environmental health factors on the odds of CL incidence, a case-control study was conducted in northeastern Iran. Methods: This study was conducted within 2020-2021 based on individual and household data from a tertiary referral center. Cases were patients diagnosed with CL by PCR method; controls were selected among the patients' relatives, and information was obtained from a health registry system. Demographic and socioeconomic data of 1871 subjects, included age, sex, household information and environmental health factors. Multivariable models with environmental factors in various conditions and CL were separately fit by univariate and mixed multiple unconditional logistic regression. Results: Participants included 617 cases (mean [SD] age, 13.62[13.72] years; 58.20% male) and 1264 controls (mean [SD] age, 16.45[15.44] years; 50.40% male). Results revealed that the use of well-water sources compared to surface water is significantly associated with CL (odds ratio [OR]=0.204; 95%CI, 0.13-0.33;P<0.001). Muddy houses, ruined buildings or wastelands and stagnant water, canals and rivers near the houses were also associated with CL (OR=3.85; 95%CI, 1.66-8.89; P=.002; OR=2.47; 95%CI, 1.76-3.47; P<.001). Besides, existence of pine tree was found to be a risk factor (OR=3.25; 95%CI, 2.12-4.99; P<.001) and similarly for the use of waste collection system (OR=4.43; 95%CI, 3.32-7.51; P<.001). Interpretation & conclusion: Environmental factors related to houses were significantly associated with CL and may represent the modifiable risk factors of CL disease.

The Effect of Month of Birth on Multiple Sclerosis: A Sase-Control Study in Northeast Iran.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune and multi-factorial (e.g. environmental, genetic) disease. We conducted a case-control study of month and season of birth (MOB and SOB) and multiple sclerosis (MS) risk in the east of Iran. METHODS: The MS patients registered in Mashhad and Torbat Heydariyeh MS Society until 20 March 2018 was compared with the MOB and SOB in the healthy population during 1988 to 2018. Case group was matched for age, sex and place of residence with the control group. Differences in the distributions of MOB and SOB between the patients and the control groups were assessed using the chi-square test. RESULTS: There were 2,160 MS patients in case group and 2,245 in control group. There was a significant relationship between MOB ans SOB with the risk of MS (P less than 0.05). Analysis showed a significant (p less than 0.01) peak in the MOB during Mar-Apr (OR is equal to 1.60), May-Jun (OR is equal to 1.30) and Aug-Sep (OR is equal to 2.42). CONCLUSION: The findings show a relationship between MOB and SOB as risk factor for MS in Northeast Iran. Further studies are needed to confirm this result. Keyword: Multiple sclerosis, Month of Birth, seasonality, case-control, Iran.

Temporal trends of incidence and prevalence of multiple sclerosis in Razavi Khorasan Province, Northeast Iran.

OBJECTIVES: The prevalence of multiple sclerosis (MS) in the Persian Gulf countries has been significantly increasing during the past decades. This study was conducted for investigating the prevalence and incidence of MS in Northeast Iran (Khorasan Razavi province). METHODS: This cross-sectional study was conducted during 1 January 1988 and 23 September 2018. All patients with a clinically definite diagnosis of MS according to the McDonald criteria (2005) and MRI along with the medical diagnosis, recorded in the Khorasan MS society, were considered for calculation of crude and age-standardized prevalence, and incidence rates of MS. The periodic incidence rates were calculated based on the year of onset of MS. Also, we calculated gender ratios for prevalence and incidence rates. RESULTS: The mean age-standardized prevalence and incidence rates of MS in the Khorasan Razavi were 8.69 (95% CI 8.05-9.41) per 100,000 (3.99 (95% CI 3.39-4.74) for males, 13.49 (95% CI 12.37-14.76) for females). Age-standardized prevalence was 48.87 (95% CI 48.37-49.35) per 100,000 (22.47 (95% CI 22.01-22.93) for males, 75.65 (95% CI 74.80-76.51) for females). Also, the mean incidence and prevalence for Mashhad County as capital of province were 11.38 and 59.09 per 100,000 populations, respectively. The female/male ratio was 3.33 for all age groups. CONCLUSION: Our results showed that this region is a high-risk area for MS like central region of Iran. Our results revealed that the prevalence and incidence of MS in the study area have increased during the recent decades with a sharp slope.

Air quality index variation before and after the onset of COVID-19 pandemic: a comprehensive study on 87 capital, industrial and polluted cities of the world.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic provided an opportunity for the environment to reduce ambient pollution despite the economic, social and health disruption to the world. The purpose of this study was to investigate the changes in the air quality indexes (AQI) in industrial, densely populated and capital cities in different countries of the world before and after 2020. In this ecological study, we used AQI obtained from the free available databases such as the World Air Quality Index (WAQI). Bivariate correlation analysis was used to explore the correlations between meteorological and AQI variables. Mean differences (standard deviation: SD) of AQI parameters of different years were tested using paired-sample t-test or Wilcoxon signed-rank test as appropriate. Multivariable linear regression analysis was conducted to recognize meteorological variables affecting the AQI parameters. RESULTS: AQI-PM2.5, AQI-PM10 and AQI-NO2 changes were significantly higher before and after 2020, simultaneously with COVID-19 restrictions in different cities of the world. The overall changes of AQI-PM2.5, AQI-PM10 and AQI-NO2 in 2020 were - 7.36%, - 17.52% and - 20.54% compared to 2019. On the other hand, these results became reversed in 2021 (+ 4.25%, + 9.08% and + 7.48%). In general, the temperature and relative humidity were inversely correlated with AQI-PM2.5, AQI-PM10 and AQI-NO2. Also, after adjusting for other meteorological factors, the relative humidity was inversely associated with AQI-PM2.5, AQI-PM10 and AQI-NO2 (ß = - 1.55, ß = - 0.88 and ß = - 0.10, P < 0.01, respectively). CONCLUSIONS: The results indicated that air quality generally improved for all pollutants except carbon monoxide and ozone in 2020; however, changes in 2021 have been reversed, which may be due to the reduction of some countries' restrictions. Although this quality improvement was temporary, it is an important result for planning to control environmental pollutants.

COVID-19, body mass index and cholesterol: an ecological study using global data.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is now globally considered a serious economic, social and health threat. A wide range of health related factors including Body Mass Index (BMI) is reported to be associated with the disease. In the present study, we analyzed global databases to assess the correlation of BMI and cholesterol with the risk of COVID-19. METHODS: In this ecological study, we used age-standardized BMI and cholesterol levels as well as the incidence and mortality ratio of COVID-19 at the national-levels obtained from the publicly available databases such as the World Health Organization (WHO) and NCD Risk Factor Collaboration (NCD-RisC). Bivariate correlation analysis was applied to assess the correlations between the study variables. Mean differences (standard deviation: SD) of BMI and cholesterol levels of different groups were tested using independent sample t-test or Mann-Whitney rank test as appropriate. Multivariable linear regression analysis was performed to identify variables affecting the incidence and mortality ratio of COVID-19. RESULTS: Incidence and mortality ratio of COVID-19 were significantly higher in developed (29,639.85 ± 20,210.79 for cases and 503.24 ± 414.65 for deaths) rather than developing (8153.76 ± 11,626.36 for cases and 169.95 ± 265.78 for deaths) countries (P < 0.01). Results indicated that the correlations of BMI and cholesterol level with COVID-19 are stronger in countries with younger population. In general, the BMI and cholesterol level were positively correlated with COVID-19 incidence ratio (ß = 2396.81 and ß = 30,932.80, p < 0.01,| respectively) and mortality ratio (ß = 38.18 and ß = 417.52, p < 0.05,| respectively) after adjusting for socioeconomic and demographic factors. CONCLUSION: Countries with higher BMI or cholesterol at aggregate levels had a higher ratios of COVID-19 incidence and mortality. The aggregated level of cholesterol and BMI are important risk factors for COVID-19 major outcomes, especially in developing countries with younger populations. We recommend monitoring and promotion of health indicices to better prevent morbidity and mortality of COVID-19.

Interaction between meteorological parameters and COVID-19: an ecological study on 406 authorities of the UK.

Understanding the factors affecting COVID-19 transmission is critical in assessing and mitigating the spread of the pandemic. This study investigated the transmissibility and death distribution of COVID-19 and its association with meteorological parameters to study the propagation pattern of COVID-19 in UK regions. We used the reported case and death per capita rate (as of November 13, 2020; before mass vaccination) and long-term meteorological data (temperature, humidity, precipitation, wind speed, and visibility) in 406 UK local authority levels based on publicity available secondary data. We performed correlation and regression analysis between COVID-19 variables and meteorological parameters to find the association between COVID-19 and independent variables. Student's T and Mann-Whitney's tests were used to analyze data. The correlation and regression analyses revealed that temperature, dew point, wind speed, and humidity were the most important factors associated with spread and death of COVID-19 (P <0.05). COVID-19 cases negatively correlated with humidity in areas with high population density, but the inverse in low population density areas. Wind speeds in low visibility areas, which are considered polluted air, may increase the spread of disease (r=0.42, P <0.05) and decrease the spread in high visibility areas (r=-0.16, P <0.05). Among low (T <10°C) and high (T >10°C) temperature areas, the average incidence rates were 2056.86 (95% confidence interval (CI): 1909.49-2204.23) and 1446.76 (95% CI: 1296.71-1596.81). Also, COVID-19 death per capita rates were 81.55 (95% CI: 77.40-85.70) and 69.78 (95% CI: 64.39-75.16) respectively. According to the comprehensive analysis, the spread of disease will be suppressed as the weather warms and humidity and wind speed decrease. Different environmental conditions can increase or decrease spread of the disease due to affecting spread of disease vectors and by altering people's behavior.

Association between water and sanitation, air and emission pollution and climate change and neurological disease distribution: A study based on GBD data.

Along with the urbanization and industrialization of countries, the prevalence of chronic diseases has increased. There is ample evidence that ambient pollution can play a major role in these diseases. This study aimed to investigate the association between neurological disorders (NDs) and their subtypes with environmental factors. In this country-level study, we used the age-standardized prevalence and incidence rate (per 100,000 populations) of NDs and its subtypes that have been taken from the Global Burden of Disease (GBD) database in 2019. We used correlation and regression analysis to assess the association between variables. Also, multivariable regression analysis was performed to identify the most important variables in NDs distribution. Age-adjusted NDs incidence rate was significantly higher in developed countries compared to developing countries (11345.25 (95% CI: 11634.88-11055.62) and 9956.37 (95% CI: 10138.66-9774.08)). Association results indicated that the impact of water and sanitation could be more effective than air pollution on NDs. The increase in water and sanitation index levels was positively correlated with NDs incidence rate and prevalence (regression coefficient (b) = 38.011 (SE = 6.50) and b = 118.84 (SE = 20.64), p < 0.001, respectively) after adjusting socio-economic and demographic factors. Furthermore, the incidence of NDs was negatively correlated with the increase in air quality (b = -16.30 (SE = 7.25), p = 0.008). Water and sanitation and their related factors are plausible factors in the distribution of NDs, which may be linked to the potential role of air and water pollution, such as heavy metals and particle matters. These results can be used by politicians and municipal service planners for future planning.

Relationship of fluoride in drinking water with blood pressure and essential hypertension prevalence: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Previous studies showed controversial results of the relationship between fluoride exposure through drinking water and elevated blood pressure. We conducted a systematic review and meta-analysis to assess the direct relationship of drinking water fluoride exposure with blood pressure and essential hypertension prevalence in general populations. METHODS: We conducted a systematic search in databases including Web of Knowledge, PubMed, Scopus, and Embase by MeSH and non-MeSH terms for relevant studies with any design published until August 2019, with no limitation in time and language. The pooled effect measure was calculated within a 95% confidence interval (CI). RESULTS: Our search retrieved 630 journal articles, six of which were eligible for data extraction. The random-effects model found significantly higher systolic blood pressure (mean difference = 6.49 mmHg; 95% CI 3.73-9.25; p value < 0.01) and diastolic blood pressure (mean difference = 4.33 mmHg; 95% CI 1.39-7.26; p value < 0.01) in groups exposed to high-fluoride drinking water than in groups exposed to normal/low-fluoride drinking water. A significant relationship was also found between high-fluoride drinking water and essential hypertension (odds ratio = 2.14; 95% CI 1.02-4.49; p value = 0.045). CONCLUSION: The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.

Socioeconomic determinants of global distribution of multiple sclerosis: an ecological investigation based on Global Burden of Disease data.

BACKGROUND: Socioeconomic factors may be involved in risk of multiple sclerosis (MS), either indirectly or as confounding factors. In this study two comprehensive indicators reflecting socioeconomic differences, including the Human Development Index (HDI) and Prosperity Index (PI), were used to assess the impact of these factors on the worldwide distribution of MS. METHODS: The data for this global ecological study were obtained from three comprehensive databases including the Global Burden of Disease (as the source of MS indices), United Nations Development Programme (source for HDI) and the Legatum Institute Database for PI. MS indices (including prevalence, incidence, mortality, and disability-adjusted life years) were all analyzed in the form of age- and sex-standardized. Correlation and regression analyses were used to investigate the relationship between HDI and PI and their subsets with MS indices. RESULTS: All MS indices were correlated with HDI and PI. It was also found that developed countries had significantly higher prevalence and incidence rates of MS than developing countries. Education and governance from the PI, and gross national income and expected years of schooling from the HDI were more associated with MS. Education was significantly related to MS indices (p < 0.01) in both developed and developing countries. CONCLUSION: In general, the difference in income and the socioeconomic development globally have created a landscape for MS that should be studied in more detail in future studies.

Association of the global distribution of multiple sclerosis with ultraviolet radiation and air pollution: an ecological study based on GBD data.

Given the growing global trend of multiple sclerosis (MS), this study was designed to evaluate environmental determinates of the worldwide distribution of MS in the presence of socioeconomic and geographic indices. MS data was obtained from the Institute for Health Metrics and Evaluation website. The air pollution parameters, including particles with aerodynamic diameter less than 2.5 µm (PM2.5), tropospheric ozone, and solid fuel use, were acquired from global burden of disease resources and the World Health Organization. Ultraviolet index (UVI) values were obtained from the Tropospheric Emission Monitoring Internet Service website. Correlation and linear regression analyses were used to investigate the relationship between air pollution and environmental parameters with MS variables. The average prevalence and incidence rates in countries with high UVI were 5.17 and 0.25 per 100,000, respectively, and in countries with low UVI were 101.37 and 0.78, respectively. The results showed negative associations between prevalence, incidence and mortality of MS with ozone concentrations (ß = - 1.04, - 0.04, and - 0.01 respectively; P < 0.01). Also, the fully adjusted model showed significant negative correlation of UVI with the MS variables in the presence of other variables (P < 0.01). Our findings demonstrated that UVI had the strongest significant inverse association with MS distribution. Consequently, vitamin D intake may be a major contributor to MS development. However, this study showed a slight influence of air pollution on the prevalence of MS in the presence of other parameters. Given the inconsistent results of previous studies, further studies may be required.

Association of COVID-19 distribution with air quality, sociodemographic factors, and comorbidities: an ecological study of US states.

This ecological study investigated the association between COVID-19 distribution and air quality index (AQI), comorbidities and sociodemographic factors in the USA. The AQI factors included in the study are total AQI, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide (NO2). Other demographic, socioeconomic, and geographic variables were included as covariates. The correlations of COVID-19 variables-proportion of cases and deaths in each population, as well as case fatality rate with independent variables were determined by Pearson and Spearman correlation and multiple linear regression analyses. The results revealed that AQI-NO2, population density, longitude, gross domestic product per capita, median age, total death of disease, and pneumonia per population were significantly associated with the COVID-19 variables (P < 0.05). Air pollutants, especially NO2 in the US case, could be addressed as an important factor linked with COVID-19 susceptibility and mortality.

Comparison of different extracting agents for the recovery of Pb and Zn through electrokinetic remediation of mine tailings.

This study was conducted to investigate the feasibility of Electrokinetic Remediation to remove lead and zinc from real mine tailings, collected from the Lacan's lead and zinc Mineralized Flotation Processing Plant (Markazi province, Iran). High buffering capacity, high organic matter, and heavy metal contamination were the unique characteristics of this mine tailing. Electrokinetic remediation of the mine tailings was carried out in 11 separate experiments under constant voltage gradient of 2 V/cm for 9 days. Various enhancement techniques were tested, such as 1) electrolyte conditioning using chelating agents including ethylenediaminetetraacetic acid, citric acid, acetic acid, and hydrochloric acid; 2) increasing the concentration of the catholyte solution, and 3) adding chelating agents to the soil as a pre-treatment of the tailings and the electrolyte condoning simultaneously. The concentration of each electrolyte solution was selected based on the different extraction tests that resulted in the optimal or highest extraction percentage of lead and zinc. Electrolyte conditioning, in the case of using citric acid 1 M enhanced the removal of Pb and Zn dramatically. Catholyte conditioning, using citric acid 1 M, was the most effective enhancement technique for removing Zn (38.34%); also, the best removal efficiency of Pb (51.31%) was achieved using the same electrolyte solution in both electrode chambers. Increasing the acetic acid concentration was favorable for removal of both heavy metals. Compared to catholyte conditioning, pre-treatment coupled with catholyte conditioning could not improve the removal efficiency considerably.

A new method of "student-centered formative assessment" and improving students' performance: An effort in the health promotion of community.

BACKGROUND: Improving the learning process in education will empower medical students, and also formative assessment helps improve the teaching-learning process by providing ongoing reflective information about learning gaps. OBJECTIVE: The aim of this study was to explore the effect of student-centered formative assessment by weekly reflective self-correction quizzes on medical laboratory students' performance on the final examination of hematology course in 2018. MATERIALS AND METHODS: A semi-experimental study was conducted on fifty students divided randomly into intervention (n = 25) and control groups (n = 25) using convenience sampling in 2018 from Torbat Heydariyeh University of Medical Sciences, Iran. Data analysis was performed using SPSS software version 16, two-sample t-test, Chi-square test, and analysis of covariance. RESULTS: The intervention had positive effects on students' mean test scores in hematology II so that the intervention and control groups managed to obtain 18.45 ± 1.46 and 14.57 ± 2.64, respectively (P < 0.01). CONCLUSIONS: The results suggested that weekly formative assessments along with reflective self-correction activity and active participation of students in the learning process by designing questions could improve student learning.

Copper concentration in multiple sclerosis: a systematic review and meta-analysis.

BACKGROUND: A wide range of risk factors, from genetic to environmental, have been identified to play role in the etiology of multiple sclerosis. However, the role of trace element remains mostly unknown. We sought to combine all available evidence to assess the association between copper concentration and multiple sclerosis. METHODS: This systematic review and meta-analysis was conducted based on PRISMA guidelines. PubMed, Scopus, Embase, and Web of Science were searched since inception till July 2020. Observational studies that assessed copper as exposure in serum, plasma, whole blood, and cerebrospinal fluid were included. Standardized mean differences (SMD), comparing the mean of copper concentration in multiple sclerosis patients versus healthy controls, were considered as the measure of association. The fixed-effect model with inverse variance weighting was used to combine the findings. RESULTS: Twenty studies inclusive of 797 multiple sclerosis cases and 875 healthy controls were included in the meta-analysis (all case-control studies). The combined SMDs were 1.25 (95% confidence interval [CI] 0.95 to 1.55, number of included studies [n]=4) in plasma, 0.45 (CI 0.22 to 0.68, n=4) in whole blood, 0.19 (CI 0.06 to 0.33, n=12) in blood serum and 1.23 (CI 0.83 to 1.64, n=4) in cerebrospinal fluid. CONCLUSIONS: We found a higher concentration of copper in multiple sclerosis patients than healthy controls. The possible causal nature of the observed associations warrants further investigation with prospective data.

Efficient technologies for carwash wastewater treatment: a systematic review.

Carwash wastewater (CWW) is considered as an important source of either water pollution or water consumption. Therefore, its treatment is critical not only from the prevention of environmental contamination but also from the recycling of such high-volume water source. Unfortunately, the effective treatment of CWW is almost unknown, complex, and expensive. To overcome the former challenge, this study aimed to systematically review different technologies for CWW treatment. For this, a comprehensive literature survey was conducted and 48 research articles were found suitable to be included in the investigation. The included studies were of coagulation and adsorption (n = 5), membrane-based technologies (n = 15), and electrochemical (n = 11) and combined (n = 17) systems. This comprehensive review showed that the treatment methods of advanced filtration membrane techniques, electrical and chemical coagulation, and advanced oxidation processes can be effective in the removal of pollutants from carwash wastewater (CWW). The mining of different studies, however, showed that the combined methods are the most promising option in the remediation of such wastewater.

Association of COVID-19 global distribution and environmental and demographic factors: An updated three-month study.

We investigated the association of some environmental and economic factors and the global distribution indicators of the COVID-19 pandemic. Since the number of cases and deaths is higher in high-income countries located in higher latitudes and colder climates, further studies are required to shed light on this matter.

Do socioeconomic factors affect the prevalence of multiple sclerosis in Iran?

BACKGROUND: A rising trend for incidence of multiple sclerosis (MS) has been observed during the recent years in Iran. Several factors have been investigated as the reason, but socioeconomic determinants have been neglected. The present study aimed to investigate the relationship between Human Development Index (HDI), income and education and MS prevalence in the provinces of Iran. METHODS: The data used in this study were obtained from three sources: (a) National Registry of MS for MS prevalence data from 2006 to 2013, (b) Statistical Centre of Iran for demographic, income, and percentage of educated people data, and (c) some previous studies for HDI data. RESULTS: The findings showed high prevalence of MS in the provinces of Iran. Most patients were residents of provinces with a higher socioeconomic level. Significant relationships were found between the prevalence of MS and HDI, income and educational level (P = .002, P = .006, and P = .001, respectively). CONCLUSION: Socioeconomic determinants in Iran are different from those in many other countries. It seems that Iranian provinces with a higher socioeconomic level have higher prevalence of MS. Further studies in smaller scale are needed to better understand the relationship between socioeconomic determinants and MS prevalence in the provinces of Iran.