Prevention and control of non-communicable diseases in iran: the case for Investment.

BACKGROUND: Non-communicable diseases are imposing a considerable burden on Iran. This study aims to assess the Return on Investment (ROI) for implementation of Non-communicable diseases (NCDs) prevention program in Iran. METHODS: Four disease groups including cardiovascular diseases, diabetes, cancer, and respiratory diseases were included in our ROI analysis. The study followed four steps: 1) Estimating the total economic burden of NCDs using the Cost-of-Illness approach. 2) Estimating the total costs of implementing clinical and preventive interventions using an ingredient based costing at delivering level and a program costing method at central level.3) Calculating health impacts and economic benefits of interventions using the impact measures of avoided incidence, avoided mortality, healthy life years (HLYs) gained, and avoided direct treatment costs. 4) Calculating the ROI for each intervention in 5- and 15- year time horizons. RESULTS: The total economic burden of NCDs to the Iranian economy was IRR 838.49 trillion per year (2018), which was equivalent to 5% of the country's annual Gross Domestic Product (GDP). The package of NCD will lead to 549 000 deaths averted and 2 370 000 healthy life years gained over 15 years, and, financially, Iranian economy will gain IRR 542.22 trillion over 15 years. The highest ROI was observed for the package of physical activity interventions, followed by the interventions addressing salt, tobacco package and clinical interventions. Conclusions NCDs in Iran are causing a surge in health care costs and are contributing to reduced productivity. Those actions to prevent NCDs in Iran, as well as yielding to a notable health impact, are giving a good economic return to the society. This study underscores an essential need for establishment of a national multi-sectorial NCD coordination mechanism to bring together and strengthen existing cross-agency initiatives on NCDs.

Awareness, treatment, control of hypertension, and associated factors: Results from a Turkish national study.

OBJECTIVE: Despite the fact that hypertension (HT) can be diagnosed and easily treated, it is frequently not handled well throughout the world, and as a developing country in Turkey. The objective of this study was to assess the factors associated with the awareness, treatment, and control of HT in Turkey. METHODS: Data came from Chronic Diseases and Risk Factors Survey, comprising a nationally representative sample of 12,971 individuals, conducted by the Turkish Ministry of Health in 2011. HT was defined as having systolic/diastolic blood pressure (BP) at least 140/90 mmHg, usage of HT medicines, or having a previous diagnosis. Awareness, treated, and controlled HT were determined by questionnaires/BP measurements. Stepwise multiple logistic regression analysis was used to estimate associated factors. RESULTS: The prevalence of HT was found to be 24.8%. Awareness, treatment, and control rates were 65%, 59%, and 30%, respectively. The risk factors for lack of awareness or treatment of HT were male gender, young age, rural residency, lower education, being employed, sedentary lifestyle, and less physical activity for women, unhealthy dietary habits for men, and modifiable risk factors, including smoking and drinking for men. Increasing age, low education for women, marital status subgroups within gender (being single for men and being married for women), smoking and alcohol use for men, and diseases such as diabetes and obesity were also correlated with poor control of HT. CONCLUSION: This study recognized associated risk factors that may guide policies and interventions to enhance awareness, treatment, and control of HT in Turkey.

Urban and rural differences in hypertension risk factors in Turkey.

OBJECTIVE: Existing literature shows considerable regional differences in terms of hypertension (HT) prevalence in Turkey. The purpose of this study was to analyze some of the known HT risk factors contributing to the variations between urban and rural areas of Turkey in HT development. METHODS: We used data from the 2011 Chronic Diseases and Risk Factors Survey that was conducted by the Turkish Ministry of Health on a representative sample of the Turkish adult population aged 20 years or more (n=16.227). HT was defined as having at least one of the following: a mean systolic/diastolic blood pressure of at least 140/90 mm Hg, a previously diagnosed disease, or use of antihypertensive medication. Stepwise multiple logistic regression analysis was used to estimate HT risk factors in urban and rural settings. RESULTS: Although the HT prevalence was higher in rural areas (28.4%) than in urban areas (23.9%), in this study, urbanization was found to be a contributing factor in multivariate regression analysis. Furthermore, separate regressions for urban and rural settings revealed that age, obesity, diabetes, hyperlipidemia, and smoking were independently and positively associated (p<0.05) with HT in both settings, while marital status, employment type, mental health, and lifestyle patterns; nutritional habits; and amount of physical activity and sedentary time (p<0.05) were risk indicators in urban areas only. CONCLUSION: The findings of our study demonstrate that contributory factors show some variations between urban and rural settings, and on gender within each setting. Taking into account the variations between urban and rural areas in HT development may provide greater insight into the design of prevention strategies.