Burden of Hypertensive Heart Disease in Iran during 1990-2017: Findings from the Global Burden of Disease study 2017.

BACKGROUND: Hypertension and its consequent end-organ damage including Hypertensive Heart Disease (HHD) are a major concern that impact health, resulting into impairment and reduced quality of life (QOL). The purpose of this study was to describe the burden of HHD in Iran and comparing it with the World Bank upper middle-income countries (UMICs) in terms of disability-adjusted life years (DALY), mortality and prevalence. METHODS: Using data from the Global Burden of Disease study 2017, we compared the number of DALYs, deaths and prevalence trends for HHD from 1990 to 2017 in all age groups for both sex in Iran, and compared the epidemiology and trends with UMICs and globally. RESULTS: The age-standardized DALY rate for HHD increased by 51.6% for men (95% uncertainty interval [UI] 305.8 to 436.7 per 100,000) and 4.4% for women (95% UI 429.4 to 448.7 per 100,000) in Iran. The age-standardized prevalence of HHD in Iran was almost twice times higher than globally and 1.5-times more than the World Bank UMICs. The age-standardized death rate for HDD increased by 60.1% (95% UI 17.3 to 27.7% per 100,000) for men and by 21.7% (95% UI 25.85 to 31.48 per 100,000) for women from 1990 to 2017. Age-standardized death rate in Iran was 2.4 and 1.9 times higher than globally and UMICs, respectively. CONCLUSIONS: The higher prevalence and death rate in Iran in comparison with UMICs and globally should encourage health care provider to perform intensive screening activities in at risk population to prevent HHD and mitigate its mortality.

The completeness of the registration system and the economic burden of fatal injuries in Iran.

BACKGROUND: The present study aims to calculate completeness of the current registration system of fatal injuries in the legal Medicine Organization (LMO) and to estimate the economic burden of fatal injuries at the national level of Iran. METHODS: We estimated the completeness of registered fatal injuries using a three-source capture-recapture method among the Legal Medicine Organization, health departments and Traffic police in Hamedan County (HC) from June 22, 2015 to June 21, 2016. We also estimated the economic burden of fatal injuries using Years of Life Lost (YLL) during one year. Then, using appropriate statistical methods, we generalized the estimates to the national level. RESULTS: There were 487 registered fatal injuries in the LMO of HC. The male to female ratio was 2.89. Road Traffic Crashes (RTC) and suicide pertained 45 and 21 percent of deaths, respectively. The completeness of fatal injuries registration was estimated at 86.9%. Based on LMO information of HC, the percentage of fatal injuries numbering errors at the national level was estimated 1.1 times that was reported by LMO in the same period (41,936 vs. 36442). YLL and the economic burden of fatal injuries were estimated 1,706,373 years and 8,692,264,432 US$ at the national level, respectively. CONCLUSION: The completeness of the current registration system of fatal injuries is good. The economic burden of fatal injuries, especially due to motor vehicle crashes in Iran, is substantial. Strategies, legislative actions, and preventive programs should be considered to decrease the number of fatal injuries in our country.

Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2).

OBJECTIVES: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). SETTING: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. PARTICIPANTS: Patients aged ≥ 20 and ≤ 80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. RESULTS: A total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and ß-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients. CONCLUSIONS: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.

Social disparities in prevalence, treatment and control of hypertension in Iran: second National Surveillance of Risk Factors of Noncommunicable Diseases, 2006.

OBJECTIVE: Assessing hypertension prevalence, treatment and control by sociodemographic factors in Iran. METHODS: We analyzed data from the 2006 National Surveillance of Risk Factors for Noncommunicable Diseases of Iran with a population-based sample of almost 30,000 people aged 15-64 years. Multiple logistic regression models were used to explore differences in hypertension prevalence, treatment and control, adjusting for sociodemographic factors, comorbidities and behavioral factors. RESULTS: Hypertension prevalence was 17.37%. Among hypertensive patients, 33.35% were under treatment, and, among treated people, 35.10% had hypertension controlled. In multiple-regression analysis, age, male sex, low level of education, Kurd ethnicity, overweight and obesity, diabetes mellitus, lower level of physical activity and high-Human Development Index provinces were independently associated with higher prevalence of hypertension. Income and living in rural or urban area were not related to hypertension prevalence. Treatment rates were lower in men, younger people and people of low education and low income, but there were no treatment rate disparities connected to living area, ethnicity and provinces (by Human Development Index). In addition, diabetic patients, obese people and past daily smokers had higher treatment rates. Lower control rates were independently associated with male sex, higher age and lower education, but not with other variables. CONCLUSION: In Iran, there is comparatively higher prevalence of hypertension among people of Kurdish ethnicity, people of low education and in high-Human Development Index provinces; a lower treatment rate among men, younger people, people of low education and low income; and a lower control rate among men and people of low education. These disparities should be addressed by researchers and health policy makers.

Assessment of fertility among mustard-exposed residents of Sardasht, Iran: a historical cohort study.

BACKGROUND: Mustard gas (HD) is an alkylating agent with mutagenic and carcinogenic effects. Previous reports have demonstrated the ability of this class of compounds to cause adverse reproductive effects, however as of the time of this writing, few correlations have been established between HD exposure and human infertility. In the present study we hypothesize that infertility among mustard-exposed individuals is higher than among the general population. METHODS: 117 couples, 90 with at least one partner, and 27 with both partners exposed to HD in June 1987, were evaluated for occurrence of infertility (defined as the failure to conceive after 12 months of unprotected intercourse). Two groups of subjects were considered in order to establish dose-responsive effect of HD on fertility. One cohort was married at the time of exposure and were evaluated in a time period 12 months from that date. The second cohort married after the date of exposure and each couple was evaluated for a year during a period following marriage. Measurements of these subjects were compared with worldwide incidence of fertility. RESULTS: A 7.5% rate of infertility was observed among couples who were married at the time of exposure; and a rate of 10.3% was noted among individuals single at exposure and subsequently married, for an overall rate of 8.3%, which compares with a worldwide rate of 10-15%. CONCLUSIONS: This study showed that within a population of HD-exposed individuals, elevated environmental levels of the agent during a time period in which couples were actively attempting to conceive, failed to correlate with increased risk of infertility. However, these results must be interpreted with caution based on experimental design which limits the definition of infertility to one 12 month time period.