Responsiveness of hospitals to inpatient and outpatient services in the low- and middle-income countries: A systematic review.

Responsiveness is the ability of health system to satisfy non-clinical people's expectations. This review aimed at assessing responsiveness of hospitals' services in the low- and middle-income countries, and identifying the influencing factors. This systematic review followed the PRISMA guidelines. PubMed, Scopus, Web of Science and ProQuest were searched. Studies of all designs aiming to assess responsiveness of hospitals' services in the period from 2005 up to the end of 2018 were included. Quality was appraised based on McMaster University tool. Results were presented as a narrative review. Fifteen studies originated from five low-middle- income countries have been included. Results have been proposed under five subtopics; level and distribution of responsiveness and its domains at hospitals, rank of domains according to the participants, and factors affecting responsiveness and its related domains. Most studies have focused on responsiveness level, but not the distribution. Socioeconomic status, organisational, systemic, and contextual factors have led to varied responsiveness, consequently, policymakers would benefit from these valuable results while planning for improving health system in order to accomplish its intrinsic goals. Further research is required in the low- and middle-income countries other than the five included in this review. Using the World Health Organization questionnaires for measuring responsiveness is recommended, and the contextual variations should be considered.

Patterns of the Social Approach to Health in Selected Countries and Iran: A Comparative Study.

Background : The complexity of health and the role of its relevant socioeconomic factors have led countries to adopt new approaches to promote health, including the socialization of health. This comparative study aimed at examining the patterns of the social approach to health in 9 selected countries. Methods: Using the scoping review method, we collected the data by searching published articles in databases and the websites of the World Health Organization, the United Nations, and the World Bank. A total of 66 articles were included in the study based on the PRISMA protocol. Results : The thematic analysis showed that the most efficient model among middle-income countries was the one that consisted of good governance, effective social participation, and empowerment of mothers and children. The study findings also revealed that considering social welfare, governance, social participation, empowerment, and health literacy, Ecuador, Bulgaria, Egypt, and Cuba had the highest scores among the selected countries, respectively. We define socialization of health as public engagement in maintaining and promoting individual and social and psychological health in the society, a part of which is achieved through community-based medical education. Conclusion : In Iran, the centralized structure of the health system and inadequate transparency and accountability of the government have led to restricted public participation and poor intersectoral collaboration. We propose empowering civil society, setting up free political parties, and implementing the family medicine project as an effective policy for improving the socialization of health to achieve sustainable development goals in Iran.

Gender equity in health: A secondary analysis of data in Iran.

BACKGROUND: Gender inequality harms the health of millions of women and girls in all over the world. This study aimed to identify the state of gender equity in the health sector of the Islamic Republic of Iran. METHODS: This study was based on the secondary analysis of the available data in four provinces. The research team held three sessions to select the appropriate indicators for measuring gender equity in Iran. Moreover, using the data of different sources, the indexes were evaluated by applying the brain storming method. To demonstrate the difference between females and males, the ratio of females to males was measured in each indicator. The confidence intervals were used to show significant differences in the gap between men and women. Educational indicators were analyzed using the appraisal framework of UNESCO and International Institute for Education Planning. RESULTS: Findings revealed gender equality in the indicators of education and under-five underweight in all the provinces. However, the indicator of information on the mild psychological diseases showed inequality in favor of males. Infants' mortality, under-five mortality, crude death, drug abuse and smoking showed inequality in favor of females in all the four provinces. The incidence of tuberculosis, severe psychological diseases, and basic and supplementary insurance coverage was equal in all provinces except Tehran. CONCLUSION: This study revealed gender inequality in many indicators among the provinces. Therefore, improving this condition requires policymaking, planning, and conducting appropriate strategies with proper gender approaches.

Suffering in silence: a community-based study of fecal incontinence in women.

OBJECTIVE: Fecal incontinence (FI) is a very common problem in women especially among the elderly. Women with FI experience significant physical and psychological disability and lifestyle limitations. This study attempts to estimate FI among community women above 40 years of age and its associated risk factors in Tehran, Iran. STUDY DESIGN: In this cross-sectional study, via cluster sampling, a total of 800 community middle-aged women were randomly selected and interviewed using a questionnaire. RESULTS: Prevalence of FI was 18.4 %. Our findings show that FI was associated with UI, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. CONCLUSIONS: FI was a prevalent condition in Iranian middle-aged women. Future efforts should be aimed at screening FI in women, offering services to treat them, reducing personal and complication-related costs, and improving their quality of life.

Barriers to Mental and Social Health Programs in Schools: A Qualitative Study.

Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views. Method : The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes. Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system). Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.

Women Participation in Health Research of Iran: Analysis of Challenges and Strategies with Literature of Review.

Background: Recent evidence provides the facts behind the perceptions about women researchers participating in health research (HR). Women scientists as almost half of active researchers in HR fields have important and fundamental role. The present study aimed to analyses the situation of women participation in HR of Iran. Methods: The present study comprised three complementary phases intended to identify and analysis challenges and problems of women participation in health research in Iran (2021-22). Following a review phase, using the content analysis approach through semi-structured interviews data gathered from key stakeholders of health research. At final step, aimed to aggregate and conclude the main key findings, through an expert panel all of the results analyzed to clarify the main messages of the study, focus on reflection to the target group. Results: The results reveal considerable gender differences in research contribution between Iranian men and women. The need for legal infrastructure and support for the active participation of women in HR was the main extracted point of study. The need for transparent documentation and implementation of related research that demonstrates the necessary challenges and gaps was another major point. Conclusion: Findings may help illuminate policy makings to promote participation of women in the country research. The optimal management of HR require facilities can play an important role in improving the quality and quantity of health studies and achieving scientific competitive positions at the regional and global levels.

Major Thalassemia, Screening or Treatment: An Economic Evaluation Study in Iran.

BACKGROUND: Beta-thalassemia minor and thalassemia major are an autosomal recessive disease with hypochromic, microcytic anemia, and morbidities, Today, therapeutic advances have significantly improved the life expectancy of thalassemia major patients, but at the cost of financial toxicity. The present study aimed to investigate the possibility of increasing the funding for thalassemia screening programs and comparing the cost-effectiveness of screening for thalassemia in the treatment of the patients. METHODS: In this study, screening for thalassemia minor was compared with the treatment of thalassemia major patients. A decision tree model was used for analysis. A hospital database, supplemented with a review of published literature, was used to derive input parameters for the model. A lifetime study horizon was used and future costs and consequences were discounted at 3%. The approach of purchases of services was used to evaluate the screening test costs for patients with thalassemia major. Also, a bottom-up method was applied to estimate other screening and treatment costs. All the costs were calculated over one year. The number of gained quality-adjusted life years (QALYs) was calculated using the EQ-5D questionnaire in the evaluated patients. RESULTS: In this study, 26.97 births of patients with thalassemia major were prevented by screening techniques. On the other hand, total screening costs for patients with thalassemia major were estimated equal to US$ 879879, while the costs of preventing the birth of each thalassaemia major patient was US$ 32 624 by screening techniques. In comparison, the cost of managing a patient with thalassemia major is about US$ 136 532 per year. The life time QALYs for this is 11.8 QALYs. Results are presented using a societal perspective. Incremental cost per QALY gained with screening as compared with managing thalassaemia major was US$ 11 571. CONCLUSION: Screening is a long-term value for money intervention that is highly cost effective and its long-term clinical and economic benefits outweigh those of managing thalassaemia major patients.

Health-promoting services provided in pharmacies: A systematic review.

Pharmacies are a major component of health systems and a major part of health service provision. This study aimed at identifying and introducing the potentials of pharmacies in health promotion. This was a systematic review that searched PubMed, Web of Science, Science Direct, SID, Magiran, and IranMedex from February 1990 to September 2018 for related materials. The main search keywords were (pharmacy services), (community pharmacy services), (retail pharmacy services), (pharmacy practice intervention). Inclusion was limited to those papers that discussed the health-promoting services provided in the pharmacies. The quality of included papers was assessed by the Critical Appraisal Skills Program checklists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was followed in all stages of the study. Of the 4156 papers retrieved, 18 met the inclusion criteria and included in the analysis. Study findings were categorized into three main categories: Health and prevention services, services related to treatments, and the awareness about the pharmacies' functions. The health and prevention category consisted of education, vaccination, screening and prevention of diseases, family planning, blood pressure monitoring, quitting smoking, limiting alcohol, and weight management. The treatment-related services consisted of adherence to medication, medication consultation, minor pains, and emergency medical services. Pharmacies can provide a wide variety of services besides the medications. Purposeful development of the services provided in the pharmacies and involving them in an extended array of services may accelerate the health promotion activities of the health system and result in improved quality of life and decreased costs. To do so, the legal, educational-skill, and pricing challenges should be resolved.

Factors affecting the successful implementation of the referral system: A scoping review.

An effective referral system ensures that there is a close relationship among all levels of health care, and individuals can receive the best possible care. The main purpose of the present study was to summarize studies that have addressed factors affecting the successful implementation of the referral system. A scoping review was performed to identify English and Farsi papers that were indexed in PubMed, Scopus, Science Direct, Trip Database, Cochrane Library, Embase, Google Scholar, SID, and Magiran until November 2020. Data was collected from the included studies by a reviewer and was checked by a second reviewer the collected data was analyzed using narrative methods. About 1245 relevant studies were identified in the first stage. After checking titles and abstracts, 63 studies were included. The factors that affected the referral system were classified in 4 themes and fourteen subthemes including technology (electronic referral, coordination, response and feedback), processes (effectiveness, efficiency), organizational (management, policy and planning, rules and regulations), patient centered individual (insurance coverage, social capital, transportation, awareness, attitude, satisfaction, and social influence). Therefore, a wide range of factors are affecting the performance of referral systems. For implementing an effective referral system, it is necessary to consider these factors.

The hidden epidemic of urinary incontinence in women: a population-based study with emphasis on preventive strategies.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is a prevalent clinical condition especially among women aged 40 years and above. It is not often reported as it is considered an age-related problem. This study attempts to estimate UI among women above 40 years and its determinants in an area zone of Tehran, Iran. METHODS: In this cross-sectional study, a total of 800 women were selected from residents of area zone 17 of Tehran. RESULTS: Prevalence of UI is estimated to be 38.4% (95% CI, 0.35-0.42). Our findings show that those who suffer from osteoarthritis or chronic cough, had any type of internal surgery, had rupture during delivery, and had no regular exercise are significantly at higher risk of UI. CONCLUSION: The rather high prevalence of UI among middle-aged women has negative impact on women's quality of life; therefore, strategies regarding prevention and management, medical education, and research programs have been proposed.

Cost-effectiveness analysis of enzyme replacement therapy (ERT) for treatment of infantile-onset Pompe disease (IOPD) in the Iranian pharmaceutical market.

Infantile-onset Pompe disease (IOPD) or acid maltase deficiency is a rare metabolic disorder. It is caused by a deficiency in functioning of the enzyme acid alpha-glucosidase and leads to the accumulation of glycogen in the liver, heart, muscle, and other tissues. Myozyme is an effective drug, but it imposes a heavy financial burden on societies and healthcare systems. Therefore, this study was conducted to analyze the cost-effectiveness of Myozyme compared to conventional therapy for the treatment of IOPD. PubMed, Scopus, Web of Science, and Cochrane library databases were searched on December 2018 to identify the effectiveness of Myozyme versus conventional therapy. Then, a cost-effectiveness and a cost utility study were conducted in patients suffering from IOPD. In this cost effectiveness and cost utility analysis, Markov and decision tree models were used for modeling. Model parameters were obtained from international data, and the perspective of the payer was considered. Every cycle was one year; the model was run for 22 cycles. TreeAge pro 2011 was used for analysis. Finally, one-way and probabilistic sensitivity analyses were performed. Two papers were included and 39 patients were evaluated as the treatment group in both studies. Results revealed the effectiveness of Myozyme. Results also revealed a wide range of adverse reactions. Enzyme replacement therapy (ERT) resulted in 4.21038 quality-adjusted life years (QALY) per $381,852. The incremental cost per QALY was $96,809 and the incremental cost per life years gained (LYG) was 74,429 over a 22-year time horizon. Sensitivity analysis indicated the robustness of the results. Myozyme is effective for IOPD and could increase the life expectancy of patients significantly. However, since the calculated incremental cost per QALY was 17 times higher than the GDP per capita of Iran, Myozyme is not cost effective in Iran.

National Women's Health Plan, Selected Countries Experiences and Necessity of Developing It in Iran: A Narrative Review Article.

BACKGROUND: National plans have an important role in defining vision, goals, priorities, and action plans. The present paper examined the international experience in developing upstream documents concerning women's health; it regards the necessity of developing Iranian women's health plan. METHODS: This review, conducted with search in electronic databases and literature of no limitation in terms of years conducted. The phrases such as "woman health policy", "woman health promotion", "woman health strategy" and "woman health plan" were searched. The criteria based on which the countries were chosen were the degree to which they were developed in health system, health indexes, the accessibility of required information, and the possibility of benchmarking the new methods. RESULTS: Emphasize on gender as a determinant of health, increasing the economic activities of women, decreasing the violence against women, gender-based researches, and inter-sectorial approach are some common items in the women's health plans in selected countries. The main upstream documents about women health in Iran such as 'Research policies and principles of women issues', "Women Charter of Rights in Iran" were not developed and implemented in form of a comprehensive plan so we need to formulate a full women health national plan that summarizes all previous policies with addition of new needed strategies inclusion. CONCLUSION: Developing a national plan for Iranian women's health regarding with selected countries experiences makes a long-term vision for health and obtains the institutional and organizational efforts and resources necessary for women health promotion in Iran.

Causes of conflict between clinical and administrative staff in hospitals.

BACKGROUND: Providing the high-quality services in hospitals depends on to minimize conflict between all members within a health team. This study aimed to identify the causes of conflicts experienced by clinical and administrative staff in hospitals. METHODS: A cross-sectional study was carried out in 2018. The sample included 320 clinical and administrative staff from six hospitals affiliated to Ardabil University of Medical Sciences that were selected using two-step clustering sampling method. Data collection was accomplished by self-administered questionnaires. Descriptive statistics, t-test, and ANOVA were used for data analysis. RESULTS: Total conflict score revealed that clinical staff had higher levels of perceived conflict than administrative staff. In terms of organizational position, the study results showed a significant difference in the reported conflict between nurse groups and other groups (physicians and paramedical, administrative, financial, and logistic staff). The most important causes of conflict in the viewpoint of clinical staff were organizational and job characteristics (3.54 ± 1.28), poor management (3.51 ± 1.12), and inefficient communication system (3.42 ± 1.33). For administrative staff, on the other hand, poor management (3.18 ± 1.33), inefficient communication system (3.17 ± 1.36), and attitudes and perceptions (3.06 ± 1.41) were shown to be paramount factors. CONCLUSION: Clinical and administrative staff of hospitals are like parts of a train track. The irrational relationship between them will result in distortion and lower quality of services. Therefore, effective strategies to decrease staffs' experience of conflict need to be developed. This might create a healthier and more productive work environment which positively affects the care quality.

Evaluation of students' mental and social health promotion educational programs: A systematic review.

INTRODUCTION: Various programs are implemented internationally to promote the mental and social health of the students in schools. This study systematically reviewed and categorized all resources, indicators, and criteria for evaluating mental and social programs of schools. MATERIALS AND METHODS: This systematic review was conducted by collecting data from the PubMed, Google Scholar, Scopus, ProQuest, and Web of Science databases using the keywords of "evaluation, mental health program, social health program, behavioral and emotional program." In the initial review, 4295 studies were found, which reduced to 75 after removing the repetitions and evaluating the studies' quality. The articles were selected using the PRISMA chart. RESULTS: The findings resulted in three main categories of structure, process, and outcome; 16 subcategories; and 166 codes. The category of structure included the subcategories of human resources, physical space, facilities, training, needed committees and teams, financing, and implementing mental and social programs. The subcategories of process category were functional indicators, guidelines and protocols, communication, documentation, planning/coordination, time management, and monitoring. The subcategories of behavioral-therapeutic, satisfaction, and educational outcomes were associated with the outcome category. CONCLUSION: Application of the structure, process, and outcome indicators, derived from the findings of this study, will greatly improve evaluation of the international mental health programs in schools.

Factors influencing the migration of Iranian healthcare professionals: A qualitative study.

BACKGROUND: The migration of healthcare specialists from developing countries has increased in recent years. This has caused a rapid reduction in the access to and quality of healthcare services in such countries. The aim of this study is to evaluate the factors affecting the migration of specialist human resources in Iran's healthcare system. METHODS: This is a qualitative study, which was carried out through semi-structured interviews between 2015 and 2016. For sampling, purposive sampling method with maximum variation sampling was used. Further, data saturation was observed by conducting 21 interviews, and data analysis was performed using the MAXQDA10 content analysis software. RESULTS: Factors affecting the migration of specialists were classified into five key themes, including structural, occupational, personal, socio-political and economic factors. These themes consisted of 12 categories and 50 subcategories. The most important factors affecting the migration of our study population were structural issues, occupational problems, and personal concerns. CONCLUSION: Identification of factors influencing migration is the first step to prevent the migration of specialist human resources. Implementing the recommendations proposed in this study would assist to prevent migration of medical professionals.

Factors affecting intent to immigration among Iranian health workers in 2016.

BACKGROUND: Loss of human resources in the health sector through migration has caused many problems in the delivery of healthcare services in developing countries. OBJECTIVE: The aim of this study was to determine factors influencing intention to migrate in skilled human resources in Iran's healthcare sector. METHODS: This cross-sectional study was carried out in 2016 in Iran. The study population included health sector human resources at the Tehran and Iran University of Medical Sciences. Using multi-stage cluster sampling, 827 people were selected for participation. Participants included four groups: hospital staff, health workers, medical students, and postgraduate students (Masters and PhD). Data were collected using a valid and reliable questionnaire and analyzed by descriptive parameters, chi-square and logistic regression test using SPSS version 18. RESULTS: Inclination to migrate, in the study population, was 54.77%. There was a significant relationship between inclination to migrate and age, work experience, employment status, marital status, familiarity with a foreign language, foreign language skills, foreign language courses, having relatives or family living abroad, and prior experience of being abroad (p<0.05). The most important factors influencing inclination to migrate were: reaching out for better life (81.92±21.95), interdisciplinary discrimination (80.83±20.75), and experience of living and studying abroad. (80.55±18.12). CONCLUSION: Considering the high rate of intention to emigrate in the studied population (54.77%), a lot of whom will emigrate if their situation is ready, it can be a serious problem for the health system in the near future in which it will face lack of skilled health workers, and so requires more attention of health sector authorities.

Multimorbidity as an important issue among women: results of a gender difference investigation in a large population-based cross-sectional study in West Asia.

OBJECTIVES: To investigate the impact of gender on multimorbidity in northern Iran. DESIGN: A cross-sectional analysis of the Golestan cohort data. SETTING: Golestan Province, Iran. STUDY POPULATION: 49 946 residents (age 40-75 years) of Golestan Province, Iran. MAIN OUTCOME MEASURES: Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors. RESULTS: Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40-49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01). CONCLUSION: Prevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women.

Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran.

INTRODUCTION: Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system. METHODS: A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics' involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran's health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data. RESULTS: In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well. CONCLUSION: Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and the public satisfaction with healthcare and legitimate the representative of people they served for. This model can provide a practical guide for managers and policy makers to involve people in making the decisions that influence their lives.

Economic Burden of Thalassemia Major in Iran, 2015.

BACKGROUND: Major Thalassemia is an autosomal recessive disease with complications, mortality and serious pathology. Today, the life expectancy of patients with major thalassemia has increased along with therapeutic advances. Therefore, they need lifelong care, and caring for them would incur many costs. Being aware of the patients' costs can be effective for controlling and managing the costs and providing efficient treatments for the care of patients. Hence, this study was conducted to estimate the economic burden of the patients with major thalassemia. METHODS: Totally, 198 patients with major thalassemia were randomly selected from among the patients with major thalassemia in Tehran, Iran in 2015. The economic burden of the patients was estimated from a social perspective and through a bottom-up, prevalence-based approach. RESULTS: The average annual cost per patient was estimated $ 8321.8 regardless of the cost of lost welfare. Of this amount, $ 7286.8 was related to direct medical costs, $ 461.4 to direct non-medical costs, and $ 573.5 to indirect costs. In addition, the annual cost per patient was estimated $ 1360.5 due to the distress caused by the disease CONCLUSIONS: Considering the high costs of the treatment of patients with major thalassemia, adopting new policies to reduce the costs that patients have to pay seems necessary. In addition, making new decisions regarding thalassemia screening, even with higher costs than the usual screening costs, can be useful since the costs of treatment are high.

Multimorbidity: Epidemiology and Risk Factors in the Golestan Cohort Study, Iran: A Cross-Sectional Analysis.

Advances in medicine and health policy have resulted in growing of older population, with a concurrent rise in multimorbidity, particularly in Iran, as a country transitioning to a western lifestyle, and in which the percent of the population over the age of 60 years is increasing. This study aims to assess multimorbidity and the associated risk factors in Iran. We used data from 50,045 participants (age 40-75 y) in the Golestan Cohort Study, including data on demographics, lifestyle habits, socioeconomic status, and anthropometric indices. Multimorbidity was defined as the presence of 2 or more out of 8 self-reported chronic conditions, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, liver disease, gastroesophageal reflux disease, tuberculosis, and cancer. Multivariate logistic regression models were used to examine the associations between multiple different factors and the risk factors. Multimorbidity prevalence was 19.4%, with the most common chronic diseases being gastroesophageal reflux disease (76.7%), cardiovascular diseases (72.7%), diabetes (25.3%), and chronic obstructive pulmonary disease (21.9%). The odds of multimorbidity was 2.56-fold higher at the age of >60 years compared with that at <50 years (P < 0.001), and 2.11-fold higher in women than in men (P < 0.001). Other factors associated with higher risk of multimorbidity included non-Turkmen ethnicity, low education, unemployment, low socioeconomic status, physical inactivity, overweight, obesity, former smoking, opium and alcohol use, and poor oral health. Apart from advanced age and female sex, the most important potentially modifiable lifestyle factors, including excess body weight and opium use, and opium user, are associated with multimorbidity. Policies aiming at controlling multimorbidity will require a multidimensional approach to reduce modifiable risk factors in the younger population in developing countries alongside adopting efficient strategies to improve life quality in the older population.