Global and regional burden and quality of care of non-rheumatic valvular heart diseases: a systematic analysis of Global Burden of Disease 1990-2017.

BACKGROUND: With an increase in the incidence and prevalence of non-rheumatic valvular heart diseases (NRVHDs), having a proper understanding of the disease current status in terms of quality of care and healthcare access can considerably affect further planning for the healthcare system. OBJECTIVE: In this study, we aimed to evaluate and compare the quality and equity of care concerning NRVHDs in terms of gender and sociodemographic index (SDI) using a newly proposed index. METHODS: We obtained the primary measures (e.g. incidence) from the Global Burden of Disease (GBD) data about NRVHD from 1990 to 2017 to calculate the subsequent secondary indices (e.g. mortality-to-incidence ratio) with close association to quality of care. Then, using principal component analysis (PCA), quality of care index (QCI) was calculated as a novel index from the secondary indices, rescaled to 0-100. QCI was calculated for all age groups and both genders, globally, regionally and nationally between 1990 and 2017. RESULTS: Globally, the QCI for NRVHDs in 2017 was 87.3, and it appears that gender inequity was unremarkable (gender disparity ratio = 1.00, female QCI: 90.2, male QCI: 89.7) in 2017 similar to the past three decades. Among WHO world regions, the Western Pacific Region and Eastern Mediterranean Region showed the highest (90.1) and lowest (74.0) QCI scores. Regarding SDI, the high-middle-SDI quintile with a QCI of 89.4 and the low-SDI quintile with a QCI of 77.8 were the two extremes of healthcare quality in 2017. CONCLUSION: Although global status regarding the NRVHD's quality of care is acceptable, higher attention is required for lower SDI countries.

Trends of Diabetes Mortality in Iran at National and Sub-National Levels from 1990 to 2015 and Its Association with Socioeconomic Factors.

Background: Following global commitments to prevent and control non-communicable diseases, we sought to estimate national and sub-national trends in diabetes mortality in Iran and assess its association with socioeconomic factors. Methods: In a systematic analytical study, to assess the correlation between diabetes mortality and socioeconomic factors, we used data obtained from the Death Registration System (DRS), the Spatio-temporal model and Gaussian Process Regression (GPR) levels and the diabetes mortality trends, which were estimated by sex, age and year at national and sub-national levels from 1990 to 2015. Results: Between the years 1990 and 2015, the age-standardized diabetes mortality rate (per 100,000) increased from 3.40 (95% UI: 2.33 to 4.99) to 7.72 (95% UI: 5.51 to 10.78) in males and from 4.66 (95% UI: 3.23 to 6.76) to 10.38 (95% UI: 7.54 to 14.23) in females. In 1990, the difference between the highest age-standardized diabetes mortality rate among males was 3.88 times greater than the lowest (5.97 vs. 1.54), and in 2015 this difference was 3.96 times greater (14.65 vs. 3.70). This provincial difference was higher among females and was 5.13 times greater in 1990 (8.41 vs. 1.64) and 5.04 times greater in 2015 (19.87 vs. 3.94). The rate of diabetes mortality rose with urbanization yet declined with an increase in wealth and years of schooling as the main socio-economic factors. Conclusion: The rising trend of diabetes mortality rate at the national level and the sub-national disparities associated with socioeconomic status in Iran warrant the implementation of specific interventions recommended by the '25 by 25' goal.

Global, regional, and national survey on the burden and quality of care of pancreatic cancer: a systematic analysis for the Global Burden of Disease study 1990-2017.

BACKGROUND: Pancreatic cancer (PC) is among the most lethal cancers worldwide, and the quality of care provided to PC patients is a vital public health concern. We aimed to investigate the quality of care of PC globally and to report its current burden. METHODS: The Quality of Care Index (QCI) was achieved by performing a Principal Component Analysis utilizing the results of the GBD study 2017. The QCI was defined as a range between 0 and 100, in which higher QCIs show higher quality of care. Possible gender- and age-related inequalities in terms of QCI were explored based on WHO world regions and the sociodemographic index (SDI). RESULTS: In 2017, Japan had the highest QCI among all countries (QCI = 99/100), followed by Australia (QCI = 83/100) and the United States (QCI = 76/100). In Japan and Australia, males and females had almost the same QCIs in 2017, while in the United States, females had lower QCIs than males. In contrast to these high-QCI nations, African countries had the lowest QCIs in 2017. Besides, QCI increased by SDI, and high-SDI regions had the highest QCIs. Regarding patients' age, elderly cases had higher QCIs than younger patients globally and in high-SDI regions. CONCLUSION: This study provides clinicians and health authorities with a wider vision around the quality of care of PC worldwide and highlights the existing disparities. This could help them investigate possible effective strategies to improve the quality of care in regions with lower QCIs and higher gender- and age-related inequities.

Is salt intake reduction a universal intervention for both normotensive and hypertensive people: a case from Iran STEPS survey 2016.

PURPOSE: There is a direct association between salt intake and blood pressure (BP), one of the main risk factors for CVDs. However, yet there has been a debate that how strong is this association in people with and without hypertension. This study was conducted to evaluate the magnitude of the association between salt intake and BP in hypertensive and normotensive population among a nationally representative population. METHODS: The study was conducted on a nationally representative sample of 18,635 Iranian adults aged 25 years and older who participated in the STEPS survey 2016 and provided urine sample. Salt intake was estimated through spot urine sample and Tanaka equation. Multiple linear regression model in survey data analysis was used to assess the independent effect of salt intake on BP. RESULTS: After adjusting for covariates, there was a significant association between salt intake and SBP in hypertensive (p < 0.001) and normotensive people (p < 0.001). In hypertensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.37 mmHg and 0.07 mmHg, respectively. Whereas in normotensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.26 mmHg and 0.05 mmHg, respectively. Moreover, there was a significant trend toward an increase of SBP across salt intake quartiles in both hypertensive (p < 0.001) and normotensive people (p = 0.002), though the slope was steeper in hypertensive than in normotensive people. CONCLUSIONS: The present study demonstrated that salt intake significantly increased SBP in both hypertensive and normotensive people, though the magnitude of this increase was greater in hypertensive people as compared with normotensive people.

Impact of rural family physician program on child mortality rates in Iran: a time-series study.

BACKGROUND: The rural family physician program and social protection scheme were started in Iran about 10 years ago, and no comprehensive study has been carried out to investigate the effects of this program on mortality-related health indicators yet. The present study aims to examine the impacts of implementation of the family physician program and rural insurance program, which was launched in June 2005, on neonatal (NMR), infant (IMR), and under-5-year (U5MR) mortality rates in rural areas of Iran between 1995 and 2011, using a time-series analysis. METHODS: Three segmented regression models were built to evaluate the effects of the program on NMR, IMR, and U5MR, and several independent variables were entered into the models, including annual incremental effect of the program (variable of interest), time effect, behvarz density, effect of the family physician and rural insurance programs, as well as socioeconomic variables including years of schooling, wealth index, sex ratio, and logarithmic scales of rural population size in each area. Data were gathered from secondary sources and other studies. Data pertaining to the year 2007 were excluded from the final analysis due to their inaccuracy. RESULTS: Our results show that the incremental effect of implementing the rural family physician program is associated with significant reductions in NMR (ß = - 0.341. p - value = 0.003) and IMR (ß = - 0.016. p - value = 0.009). Although the association between this effect and reductions in U5MR were evident, they were not statistically significant (ß = - 0.003. p - value = 0.542). Moreover, wealth status of inhabitants was associated with reductions in NMR (ß = - 0.889. p - value = 0.001), IMR (ß = - 0.052. p - value < 0.001), and U5MR (ß = - 0.055. p - value < 0.001) in the time period of the study. CONCLUSIONS: In this nationally representative study, we showed that implementation of the second health system reform in Iran, known as the family physician program and social protection scheme for rural inhabitants, is associated with significant reductions in NMR and IMR. However, reported reductions in U5MR were not found to be statistically associated with the launch of the program. The advantage of this study was the ability to depict a more precise picture of the outcomes of a national-level intervention.

Socioeconomic inequalities in neonatal and postneonatal mortality: Evidence from rural Iran, 1998-2013.

BACKGROUND: Over the past three decades, interventions have been implemented to reduce childhood mortality in Iran. Despite declines in overall mortality rates, inequalities in mortality across socioeconomic groups have remained unchanged. In this study, we assessed inequalities in infant mortality in rural regions of Iran. METHODS: We obtained data from the Iranian vital registration system, which includes data on 5,626,158 live births, 79,457 neonatal deaths, and 36,397 postneonatal deaths in rural areas of Iran over the course of a 16-year period, which was then divided into 4 four-year intervals. In addition to building multivariate regression models to identify factors associated with mortality, we calculated a concentration index for each province to measure inequalities in neonatal and postneonatal mortality, using wealth index as the socioeconomic variable of interest. We further assessed these inequalities as a component of their contributors by using the decomposition method. RESULTS: Although both neonatal (17.62 to 10.92) and postneonatal (8.11 to 5.14) mortality rates exhibited decreasing trends from 1998-2001 to 2010-2013, the inequalities observed in these indices remained nearly unchanged (concentration indices of -0.062 to -0.047 and -0.098 to -0.083, respectively). Furthermore, fraction of births occurred in hospitals and literate women contributed positively to the inequalities observed in both neonatal and postneonatal mortality rates, whereas the proportion of infants classified as low birth weight contributed negatively over all study periods. We also identified decreasing trends in inequalities of the proportion of infants classified as having low birth weight, being born in hospitals, being covered by health insurance, mothers' age, and literacy of women within the time intervals under study. CONCLUSIONS: Although infant mortality rates in Iran decreased over the studied time period, we observed notable inequalities in these measures. Several steps are needed to overcome these inequalities, including improving access to professional health services for lower income households, fairly distributing facilities and human resources, and improving insurance coverage to protect families from financial hardships. Moreover, social factors, such as literacy of women, were found to be important in decreasing inequalities in infant mortality. These steps require improving societal awareness of infant mortality and implementing improved and problem-oriented health policies.

Prevalence of dyslipidemia in Iranian children and adolescents: A systematic review.

BACKGROUND: Dyslipidemia is considered as an important modifiable risk factor for cardiovascular disease (CVD). The link between childhood dyslipidemia and occurrence of atherosclerosis and its sequels in adulthood are well-documented. This study aimed to systematically review the prevalence of dyslipidemia among Iranian children and adolescents. MATERIALS AND METHODS: An electronic search was conducted on studies published from January 1990 to January 2014. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases with systematic search capability including IranMedex, Irandoc, and Scientific Information Database (SID). We included all available population-based studies and national surveys conducted in the pediatric age group (aged <21 years). RESULTS: In this review, 1772 articles were identified (PubMed: 1464; Scopus: 11; ISI: 58; SID: 90; IranMedex: 149; Irandoc: 57). During three refine steps and after removing of duplicates, 182 articles related to the study domain were selected. After quality assessment, 46 studies were selected for text appraisal, of which 26 qualified articles were evaluated at the final step. The prevalence range of hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol (HDL-C) were 3-48%, 3-50%, 5-20% and 5-88%, respectively. Low HDL-C and hypertriglyceridemia were the most prevalent lipid disorders in this group of population. CONCLUSION: Dyslipidemia is a common health problem among Iranian children and adolescents. Few data were available in preschool children. This finding provides useful information for health policy makers to implement action-oriented interventions for prevention and early control of this important CVD risk factor.

Diabetes research in Middle East countries; a scientometrics study from 1990 to 2012.

BACKGROUND: Diabetes burden is a serious warning for urgent action plan across the world. Knowledge production in this context could provide evidences for more efficient interventions. Aimed to that, we quantify the trend of diabetes research outputs of Middle East countries focusing on the scientific publication numbers, citations, and international collaboration. MATERIALS AND METHODS: This scientometrics study was performed based on the systematic analysis through three international databases; ISI, PubMed, and Scopus from 1990 to 2012. International collaboration of Middle East countries and citations was analyzed based on Scopus. Diabetes' publications in Iran specifically were assessed, and frequent used terms were mapped by VOSviewer software. RESULTS: Over 23-year period, the number of diabetes publications and related citations in Middle East countries had increasing trend. The number of articles on diabetes in ISI, PubMed, and Scopus were respectively; 13,994, 11,336, and 20,707. Turkey, Israel, Iran, Saudi Arabia, and Egypt have devoted the five top competition positions. In addition, Israel, Turkey, and Iran were leading countries in citation analysis. The most collaborative country with Middle East countries was USA and within the region, the most collaborative country was Saudi Arabia. Iran in all databases stands on third position and produced 12.7% of diabetes publications within region. Regarding diabetes researches, the frequent used terms in Iranian articles were "effect," "woman," and "metabolic syndrome." CONCLUSION: Ascending trend of diabetes research outputs in Middle East countries is appreciated but encouraging to strategic planning for maintaining this trend, and more collaboration between researchers is needed to regional health promotion.

The first nationally and sub-nationally representative non-communicable diseases cohort study in Iran: Iran Cohort Study (ICS) protocol.

Purpose: Non-communicable diseases (NCDs) have become a global health priority with a great need for prompt evidence-based preventing and managing interventions. Here, we describe the development of a comprehensive cohort study that provides the most accurate results for NCDs' risk factors, named the Iran Cohort Study (ICS) to estimate the effect size of the risk factors associated with major NCDs. Methods: This cohort is an observational prospective study, which its baseline data was gathered through the Iran STEPwise Approach to NCD Risk Factor Surveillance (STEPs) survey in 2016. Following the STROBE criteria, the protocols for investigation of several areas were developed. The follow-up phase began through telephone calls to estimate the effect size of socio-demographic, behavioral, and metabolic risk factors on the incidence of or death due to major NCDs during the three years of study period. Delinerables: The main deliverables of ICS are planned to be as following; a comprehensive bank of primary data and follow-up data, national and subnational reports on estimation of the effect size of various risk factors, and a policy brief on the policy options and recommendations for promotion of ongoing programs and designing new interventions. Also, the collected data on the individuals' health status will be sent to the participants as an electronic health record. Conclusion: The present study is the first comprehensive national and sub-national representative cohort study on NCDs' risk factors in Iranian adults. The results could be used for promotion of health planning and also future complementary studies and programs.

Development and psychometric properties of a new social support scale for self-care in middle-aged patients with type II diabetes (S4-MAD).

BACKGROUND: Social support has proved to be one of the most effective factors on the success of diabetic self-care. This study aimed to develop a scale for evaluating social support for self-care in middle-aged patients (30-60 years old) with type II diabetes. METHODS: This was a two-phase qualitative and quantitative study. The study was conducted during 2009 to 2011 in Tehran, Iran. In the qualitative part, a sample of diabetic patients participated in four focus group discussions in order to develop a preliminary item pool. Consequently, content and face validity were performed to provide a pre-final version of the questionnaire. Then, in a quantitative study, reliability (internal consistency and test-retest analysis), validity and factor analysis (both exploratory and confirmatory) were performed to assess psychometric properties of the scale. RESULTS: A 38-item questionnaire was developed through the qualitative phase. It was reduced to a 33-item after content validity. Exploratory factor analysis loaded a 30-item with a five-factor solution (nutrition, physical activity, self monitoring of blood glucose, foot care and smoking) that jointly accounted for 72.3% of observed variance. The confirmatory factor analysis indicated a good fit to the data. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.94), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (ICC=0.87). CONCLUSION: The findings showed that the designed questionnaire was a valid and reliable instrument for measuring social support for self-care in middle-aged patients with type II diabetes. It is an easy to use questionnaire and contains the most significant diabetes related behaviors that need continuous support for self-care.

Assessing the effect of socioeconomic factors on prevalence of dyslipidemia among iranian adult population; district level analysis from 2016 STEPS national study using small area estimation.

Background: Atherosclerotic Cardiovascular Disease (CVD) is the leading cause of death globally and dyslipidemia plays a critical role in the development of this condition. This study aimed to analyze the potential impact of socioeconomic factors on the prevalence of dyslipidemia at district level in Iran. Understanding these factors is important for development of future risk factor control programs. Methods: We used the nationwide Iran STEPwise approach to risk factor Surveillance (STEPS) 2016 survey as a representative dataset on the Non-Communicable Diseases (NCDs) risk factors in Iran. To obtain a district level dyslipidemia estimates, we utilized the small area estimation method with a Bayesian spatial hierarchical multilevel regression and multilevel mixed models. The principal component analysis was applied to derive household wealth index. For evaluation of education, successful years of schooling was calculated at district level. Urbanization ratio was defined as the proportion of residents in the urban area to the urban and rural areas for each district. Results: The highest difference was found for hypercholesterolemia coverage with 9.11 times difference among the lowest and highest prevalence across the country's district for males. Men with lower income, lower urbanization, and lower education levels had lower values of high-density lipoprotein (HDL) cholesterol, and higher level of hypercholesterolemia, and hypertriglyceridemia (P-value < 0.001). Triglyceride levels were directly correlated with all analyzed socioeconomic factors in both females and males (P-value < 0.001). Conclusion: We demonstrated that there is an inverse relationship between socioeconomic levels and dyslipidemia indices as populations with higher socioeconomic levels consistently had higher mean dyslipidemia levels. Our findings provide an excellent fundamental framework for healthcare administrators and policymakers to set goals and pursue effective preventive strategies. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01027-x.

Twenty-Six-Year Trend of Mortality Rate Due to Ischemic Heart Diseases (IHDs) in Iran: 1990-2015.

Background: Ischemic Heart Diseases (IHDs) are the main causes of deaths all over the world. Since there is no comprehensive study on IHDs mortality rate in Iran, the present study aimed to estimate age-standardized IHDs mortality rate by sex, age, geography, and time trends at both national and sub-national levels in Iran. Methods: We used the Death Registration System (DRS) data from 1990 to 2015 collected by the Iranian Ministry of Health and Medical Education across the country, Tehran, and Isfahan main cemetery, not included in the DRS. Utilized death distribution methods to overcome the incompleteness of data. Statistical models including Spatio-temporal and Gaussian-Process Regression models were used to extrapolate all-cause and cause-specific mortality rates. Results: Age-standardized IHDs mortality rate in Iran almost doubled from 1990 to 2015. Forty-nine deaths per 100.000 population in 1990, which increased to 91.6 deaths per 100.000 in 2015). Male to female age-standardized mortality rate increased from 1.07 to 1.32 during the studied period. Aging was associated with an increase in age-standardized IHDs mortality rate in both sexes, all provinces, and all of the years. The range of age-standardized IHDs mortality rate for both sexes was from 58 to 136.2 deaths per 100,000 across provinces in 2015. Conclusion: Due to the increase in age-standardized IHDs mortality rate in Iran, it seems necessary to design and implement appropriate public health interventions by health authorities to prevent and control this group of diseases.

Global, regional, and national quality of care of ischaemic heart disease from 1990 to 2017: a systematic analysis for the Global Burden of Disease Study 2017.

AIMS: By 2030, we seek to reduce premature deaths from non-communicable diseases, including ischaemic heart disease (IHD), by one-third to reach the sustainable development goal (SDG) target 3.4. We aimed to investigate the quality of care of IHD across countries, genders, age groups, and time using the Global Burden of Diseases Study (GBD) 2017 estimates. METHODS AND RESULTS: We did a principal component analysis on IHD mortality to incidence ratio, disability-adjusted life-years (DALYs) to prevalence ratio, and years of life lost to years lived with disability ratio using the results of the GBD 2017. The first principal component was scaled from 0 to 100 and designated as the quality of care index (QCI). We evaluated gender inequity by the gender disparity ratio (GDR), defined as female to male QCI. From 1990 to 2017, the QCI and GDR increased from 71.2 to 76.4 and from 1.04 to 1.08, respectively, worldwide. In the study period, countries of Western Europe, Scandinavia, and Australasia had the highest QCIs and a GDR of 1 to 1.2; however, African and South Asian countries had the lowest QCIs and a GDR of 0.8 to 1. Moreover, the young population experienced more significant improvements in the QCI compared to the elderly in 2017. CONCLUSION: From 1990 to 2017, the QCI of IHD has improved; nonetheless, there are remarkable disparities between countries, genders, and age groups that should be addressed. These findings may guide policymakers in monitoring and modifying our path to achieve SDGs.

A Report on Statistics of an Online Self-screening Platform for COVID-19 and Its Effectiveness in Iran.

BACKGROUND: The most recent emerging infectious disease, coronavirus disease 2019 (COVID-19), is pandemic now. Iran is a country with community transmission of the disease. Telehealth tools have been proved to be useful in controlling public health disasters. We developed an online self-screening platform to offer a population-wide strategy to control the massive influx to medical centers. METHODS: We developed a platform operating based on given history by participants, including sex, age, weight, height, location, primary symptoms and signs, and high risk past medical histories. Based on a decision-making algorithm, participants were categorized into four levels of suspected cases, requiring diagnostic tests, supportive care, not suspected cases. We made comparisons with Iran STEPs (STEPwise approach to Surveillance) 2016 study and data from the Statistical Centre of Iran to assess population representativeness of data. Also, we made a comparison with officially confirmed cases to investigate the effectiveness of the platform. A multilevel mixed-effects Poisson regression was used to check the association of visiting platform and deaths caused by COVID-19. RESULTS: About 310 000 individuals participated in the online self-screening platform in 33 days. The majority of participants were in younger age groups, and males involved more. A significant number of participants were screened not to be suspected or needing supportive care, and only 10.4% of males and 12.0% of females had suspected results of COVID-19. The penetration of the platform was assessed to be acceptable. A correlation coefficient of 0.51 was calculated between suspected results and confirmed cases of the disease, expressing the platform's effectiveness. CONCLUSION: Implementation of a proper online self-screening tool can mitigate population panic during wide-spread epidemics and relieve massive influx to medical centers. Also, an evidence-based education platform can help fighting infodemic. Noticeable utilization and verified effectiveness of such platform validate the potency of telehealth tools in controlling epidemics and pandemics.

Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990-2019.

BACKGROUND: Peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 5-10% in the general population. Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in prevention, diagnosis, treatment, and follow-up. Quantifying and benchmarking health systems' performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care. OBJECTIVE: The objective of this study was to compare the health-system quality-of-care and inequities for PUD among age groups and sexes worldwide. METHODS: Data were derived from the Global Burden of Disease Study 1990-2019. Principal-Component-Analysis was used to combine age-standardized mortality-to-incidence-ratio, disability-adjusted-life-years-to-prevalence-ratio, prevalence-to-incidence-ratio, and years-of-life-lost-to-years-lived-with-disability-into a single proxy named Quality-of-Care-Index (QCI). QCI was used to compare the quality of care among countries. QCI's validity was investigated via correlation with the cause-specific Healthcare-Access-and-Quality-index, which was acceptable. Inequities were presented among age groups and sexes. Gender Disparity Ratio was obtained by dividing the score of women by that of men. RESULTS: Global QCI was 72.6 in 1990, which increased by 14.6% to 83.2 in 2019. High-income-Asia-pacific had the highest QCI, while Central Latin America had the lowest. QCI of high-SDI countries was 82.9 in 1990, which increased to 92.9 in 2019. The QCI of low-SDI countries was 65.0 in 1990, which increased to 76.9 in 2019. There was heterogeneity among the QCI-level of countries with the same SDI level. QCI typically decreased as people aged; however, this gap was more significant among low-SDI countries. The global Gender Disparity Ratio was close to one and ranged from 0.97 to 1.03 in 100 of 204 countries. CONCLUSION: QCI of PUD improved dramatically during 1990-2019 worldwide. There are still significant heterogeneities among countries on different and similar SDI levels.

Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries.

OBJECTIVES: To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries. DESIGN: Secondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020. SETTING: Population based survey data. PARTICIPANTS: 1 231 068 individuals aged 15 years and older. MAIN OUTCOME MEASURES: Self-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco). RESULTS: The smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age. CONCLUSIONS: Both smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals.

Non-communicable diseases' risk factors in Iran; a review of the present status and action plans.

Non-communicable Diseases (NCDs) are the leading causes of death globally, imposing a heavy burden on the healthcare systems, especially in low- and middle-income countries. Iran is a country in the Middle-East region with an aging population and changing disease risk factors, and now is facing NCDs as the major health problem of the country. Investigating NCDs' risk factors and tackling preventable ones is the main intervention to control their heavy burden. In this review, we discussed the most critical risk factors in Iran and the implemented programs and action plans to control them. A better knowledge on current status of risk factors and plans to tackle them, could help policymakers effectively rule policies and allocate resources to curb heavy burden of NCDs in Iran.

Epidemiologic pattern of cancers in Iran; current knowledge and future perspective.

Iran is a developing country facing demographic transition. Cancers are among the major non-communicable disorders with remarkable budern on the health-care governing systems. Extended life expectancy of Iranian population, change in living style, as well as promoted diagnostic and treatment methods have resulted into significant malignancies emergence and detection. Understanding the trend of this epidemiologic transition is required for proper allotment of resources. In this manuscript, overall epidemiologic pattern of cancers and their burden transition is reviewed. In addition, more concerning neoplasia (gastrointestinal, breast, thyroid, urologic, and respiratory system cancers) are reviewed in more details.

A national and sub-national metaregression of the trend of insufficient physical activity among Iranian adults between 2001 and 2016.

Insufficient physical activity (IPA) caused approximately 5% of mortalities in 2017 in Iran, almost double its global average. Despite the relatively considerable burden, a knowledge gap exists regarding the trend of IPA in recent years. We described the trend of IPA prevalence utilizing the data from six rounds of STEPwise approach to risk factor Surveillance (STEPS) in Iran. We estimated the physical activity status of Iranian adults from 2006 to 2016 after adjusting for years of schooling, urbanization percentage, and wealth index. We used the spatiotemporal model to interpolate and extrapolate the IPA prevalence for the years in-between the series and from 2001 to 2006, respectively. We used the data of 177,910 participants from six STEPS surveys and found that the national prevalence of IPA had steadily increased over the course of 16 years and had almost doubled in this time period (23.1% in 2001 to 55.4% in 2016). The increase was persistent across all age and gender strata and in every province. Moreover, IPA was more prevalent among women than their male peers regardless of their age category or province of residence. The prevalence of IPA in Khuzestan (highest prevalence) was almost double compared to that in Lorestan (lowest prevalence) in 2016. The IPA prevalence increased considerably and almost doubled in 16 years among Iranian adults, particularly women. Policies need to target IPA as a high priority contributing to the burden of Non-communicable diseases.

National and Subnational Incidence, Mortality, and Years of Life Lost Due to Breast Cancer in Iran: Trends and Age-Period-Cohort Analysis Since 1990.

Breast cancer is the most common cancer among women, causing considerable burden and mortality. Demographic and lifestyle transitions in low and low-middle income countries have given rise to its increased incidence. The successful management of cancer relies on evidence-based policies taking into account national epidemiologic settings. We aimed to report the national and subnational trends of breast cancer incidence, mortality, years of life lost (YLL) and mortality to incidence ratio (MIR) since 1990. As part of the National and Subnational Burden of Diseases project, we estimated incidence, mortality and YLL of breast cancer by sex, age, province, and year using a two-stage spatio-temporal model, based on the primary dataset of national cancer and death registry. MIR was calculated as a quality of care indicator. Age-period-cohort analysis was used to distinguish the effects of these three collinear factors. A significant threefold increase in age-specific incidence at national and subnational levels along with a twofold extension of provincial disparity was observed. Although mortality has slightly decreased since 2000, a positive mortality annual percent change was detected in patients aged 25-34 years, leading to raised YLLs. A significant declining pattern of MIR and lower provincial MIR disparity was observed. We observed a secular increase of breast cancer incidence. Further evaluation of risk factors and developing national screening policies is recommended. A descending pattern of mortality, YLL and MIR at national and subnational levels reflects improved quality of care, even though mortality among younger age groups should be specifically addressed.