Global, regional, and national burden and quality of care index (QCI) of oral disorders: a systematic analysis of the global burden of disease study 1990-2017.

BACKGROUND: Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide. METHODS: We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders. RESULTS: Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values. CONCLUSION: The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders.

'Inequalities in prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment in 429 districts of Iran; a population-based STEPS 2016 small area spatial estimation model'.

Purpose: While many studies have reported hypertension (HTN) and pre-hypertension (PHTN) in large geographic locations of Iran, information regarding district levels is missing. We aimed to examine inequalities in the prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment of adults in districts of Iran. Methods: We used 27,165 participants' data from the STEPS 2016 study in Iran. A small area estimation model was carried out to predict HTN in the 429 districts of Iran. HTN and PHTN were defined based on the American Heart Association Guideline. Awareness of being hypertensive, treatment coverage, and effective treatment were also estimated. Results: HTN's crude prevalence was estimated to be in the range of 11.5-42.2% in districts. About PHTN, it was estimated to be 19.9-56.1%. Moreover, for awareness, treatment coverage, and effective treatment crude estimates ranged from 24.3 to 79.9%, 9.1 - 64.6%, and 19.5 - 68.3%, respectively, indicating inequalities in the distribution of aforementioned variables in 429 districts of Iran. Overall, better conditions were detected in central geographical locations and in females. Conclusion: The inequality of increased blood pressure disorder and related measures are high in districts of Iran and pave the way for policymakers and local health organizers to use the findings of this study to address the inequity of existing resources and improve HTN control. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01186-5.

Physical Inactivity, Inequalities, and Disparities Across Districts of Iran: A STEPs Survey-Based Analysis.

BACKGROUND: We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures. METHODS: Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran. RESULTS: All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%-47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%-64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively. CONCLUSIONS: The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden.

The incremental cost of implementing the world health organization Package of essential non-communicable (PEN) diseases interventions in Iran.

World-Health-Organization's PEN package proposes a minimum set of cost-effective interventions for early diagnosis and management of Non-Communicable-Disease (NCD). IraPEN (the PEN package implemented in Iran), adopted from PEN and Iran National Action Plans for NCDs, addresses challenges regarding NCD prevention and control. IraPEN was piloted in four districts of Iran. In this research, we estimate incremental per-capita cost of IraPEN program implementation in two of the pilot districts. We utilized a bottom-up, ingredient-based costing approach. Institutional expenditure data was collected via information forms. Information pertaining to personnel costs was gathered by performing task time measurements using Direct Observation Method. An individual-level survey was conducted in under-study districts to determine program coverage and its users' demographic information via systematic random cluster sampling. Sampling of districts was based on systematic random cluster sampling. In each district, 250 families in 25 clusters proportional to urban or rural populations were randomly selected by postal codes. All family members eligible for the program were interviewed. Interviews were organized and conducted in each district by NCD experts in provincial Universities of Medical Sciences. Costs were re-categorized into fixed and variable costs based on their dependency on the program's coverage. Fixed and variable costs were, respectively, divided by total eligible populations and covered populations in each district to calculate cost per-capita for each protocol. Total per-capita cost per-service was then calculated for each protocol and whole program by adding these figures. All costs are reported in US$ 2015-2016. The incremental costs of IraPEN implementation per user, with and without introduction cost, were US$24.90 and US$25.32, respectively. Total incremental cost per-capita for each protocol ranged between US$1.05 to US$7.45. The human resources and supplies had the highest contribution in total program cost (74.97% and 15.76%, respectively). The present study shows that IraPEN program implementation to be a high-cost package within Iranian context, that necessitates cautions in other similar contexts for implementation. It is, however, difficult to make decisions on implementation of NCD prevention and control programs purely based on their cost. Informed decision making requires assessment of a programs' effectiveness and justifications and alterations to the current package could reduce the costs, leading to increased efficiency of the program.

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.

The global, regional, and national burden and quality of care index (QCI) of colorectal cancer; a global burden of disease systematic analysis 1990-2019.

BACKGROUND: Colorectal cancer (CRC) is among the five most incident and lethal cancers in world and its burden varies between countries and sexes. We aimed to present a comprehensive measure called the quality of care index (QCI) to evaluate the inequity and healthcare quality of care regarding CRC by sex and location. METHODS: Data on the burden of CRC were extracted from the Global Burden of Disease study 2019. It was transformed to four ratios, including mortality-to-incidence, disability-adjusted life years (DALYs)-to-prevalence, prevalence-to-incidence, and years of life lost (YLLs)-to-years lived with disability (YLDs). Principal component analysis was implemented on the four ratios and the most influential component was considered as QCI with a score ranging from zero to 100, for which higher scores represented better quality of care. Gender Disparity Ratio (GDR) was calculated by dividing QCI for females by males. RESULTS: The global incidence and death numbers of CRC were 2,166,168 (95% uncertainty interval: 1,996,298-2,342,842) and 1,085,797 (1,002,795-1,149,679) in 2019, respectively. Globally, QCI and GDR values were 77.6 and 1.0 respectively in 2019. There was a positive association between the level of quality of care and socio-demographic index (SDI) quintiles. Region of the Americas and African Region had the highest and lowest QCI values, respectively (84.4 vs. 23.6). The QCI values started decreasing beyond the age of 75 in 2019 worldwide. CONCLUSION: There is heterogeneity in QCI between SDI quintiles. More attention should be paid to people aged more than 75 years old because of the lower quality of care in this group.

Global, regional, and national burden and quality of care index in children and adolescents: A systematic analysis for the global burden of disease study 1990-2017.

PURPOSE: To express a global view of care quality in major causes of mortality and morbidity in children and adolescences. METHODS: We used primary epidemiologic indicators from the Global Burden of Disease 1990-2017 database. We have created four secondary indices from six primary indices in order to assess the care quality parameters. We conducted a principal component analysis on incidence, prevalence, mortality, Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability Adjusted Life Years (DALYs) to create an index presented by quality-of-care index (QCI) to compare different countries. RESULTS: The global QCI scores of respiratory infection, enteric infection, leukemia, foreign body aspiration, asthma, epilepsy, diabetes mellitus, dermatitis, road injury, and neonatal disorders have improved remarkably. These causes showed equal distribution of qualified care for both sexes. The global trend of QCI score for mental health showed a steady pattern during the same time and disparities favoring females was evident. The quality of care for these causes was notably higher in developed areas. CONCLUSIONS: The global QCI revealed a universal growth in major causes of death and morbidity in <20y during 28 years. Quality of care is an associate of the level of country's development. Despite effective interventions, inequities still remain. Implementation of policies to invest in quality improvement and inequality elimination is needed.

Iran to achieve the SDG 3.4 at national and sub-national levels.

The present study investigates different scenarios to project the chance of achieving SDG 3.4 in Iran. In this study, the Iranian Death Registry System data was employed to estimate the Unconditional Probability of Dying (UPoD) for the four major categories of NCDs; then, the Bayesian model averaging was used to project the UPoD at the national and sub-national levels. Also, the prevalence of the risk factors was projected by 2030 based on STEPs as well as some other study data. Plus, UPoD and the possibility of achieving the target were estimated once again based on the assumption that the global reduction in risk factors proposed by WHO would be adopted in Iran. The UPoDs for the four NCDs in Iran were 17.5% (95% UI: 16.3-19.2) and 14.7% (13.3-16.2) in 2010 and 2015 respectively and if the current trend continues, 2030 will mark the UPoD of 10.8% (7.9-14.3). However, If the risk factors are reduced to the WHO target level by 2030, the UPoDs will be reduced to 5.44% (3.51-7.39) and 6.55% (5.00-8.13) of the 2010 and 2015 baseline scenarios, respectively, to enable some provinces to meet SDG 3.4. If the current trend continues, Iran will and will not achieve the SDG 3.4 in 2010 and 2015 baseline scenarios, respectively. However, if the global target set for reducing risk factors is achieved, Iran will meet all expectations in SDG 3.4 except in Asthma and COPD. Therefore, effective interventions are recommended to be designed and followed to reduce Asthma and COPD.

Trends in Global, Regional, and National Burden and Quality of Care Index for Liver Cancer by Cause from Global Burden of Disease 1990-2019.

Despite the tremendous burden of liver cancer and its underlying causes on humankind, there appear to be heterogeneities in coping approaches. The objective of this study was to compare the burden and the quality-of-care of liver cancer by causes among different countries and regions in both sexes and various age groups 1990-2019. Data of liver cancer and underlying causes, including hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, nonalcoholic steatohepatitis (NASH), and other causes were obtained from the Global Burden of Diseases 2019. Incidence, prevalence, death, and disability-adjusted life-years (DALYs) were assessed. Principal component analysis was used to combine age-standardized mortality-to-incidence ratio, DALY-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). Globally, the age-standardized incidence, DALYs, and death rates decreased from 1990 to 2019, while the QCI scores increased by 68.5%. The QCI score of liver cancer was from as high as 83.3 in high Sociodemographic Index (SDI) countries to values as low as 26.4 in low SDI countries in 2019. Japan had the highest QCI score (QCI = 100). The age-standardized death rates of liver cancer due to all underlying causes were decreasing during the past 30 years, with the most decrease for HBV. Consistently, the global QCI scores of liver cancer due to HBV, HCV, alcohol use, NASH, and other causes reached 53.5, 61.8, 54.3, 52.9, and 63.7, respectively, in 2019. Conclusion: Although the trends in burden are decreasing and the QCI improved from 1990 to 2019 globally, there is a wide gap between countries. Given the inequities in health care quality, there is an urgent need to address discrimination and bridge the gap.

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.

Global, regional, and national quality of care of gallbladder and biliary tract cancer: a systematic analysis for the global burden of disease study 1990-2017.

BACKGROUND: To improve health outcomes to their maximum level, defining indices to measure healthcare quality and accessibility is crucial. In this study, we implemented the novel Quality of Care Index (QCI) to estimate the quality and accessibility of care for patients with gallbladder and biliary tract cancer (GBBTC) in 195 countries, 21 Global Burden of Disease (GBD) regions, Socio-demographic Index (SDI) quintiles, and sex groups. METHOD: This cross-sectional study extracted estimates on GBBTC burden from the GBD 2017, which presents population-based estimates on GBBTC burden for higher than 15-year-old patients from 1990 to 2017. Four secondary indices indicating quality of care were chosen, comprising Mortality to incidence, Disability-Adjusted Life Year (DALY) to prevalence, prevalence to incidence, and years of life lost (YLL) to years lived with disability (YLD) ratios. Then, the whole dataset was analyzed using Principal Component Analysis to combine the four indices and create a single all-inclusive measure named QCI. The QCI was scaled to the 0-100 range, with 100 indicating the best quality of care among countries. Gender Disparity Ratio (GDR) was defined as the female to male QCI ratio to show gender inequity throughout the regions and countries. RESULTS: Global QCI score for GBBTC was 33.5 in 2017, which has increased by 29% since 1990. There was a considerable gender disparity in favor of men (GDR = 0.74) in 2017, showing QCI has moved toward gender inequity since 1990 (GDR = 0.85). Quality of care followed a heterogeneous pattern among regions and countries and was positively correlated with the countries' developmental status reflected in SDI (r = 0.7; CI 95%: 0.61-0.76; P value< 0.001). Accordingly, High-income North America (QCI = 72.4) had the highest QCI; whereas, Eastern Sub-Saharan Africa (QCI = 3) had the lowest QCI among regions. Patients aged 45 to 80 had lower QCI scores than younger and older adults. The highest QCI score was for the older than 95 age group (QCI = 54), and the lowest was for the 50-54 age group (QCI = 26.0). CONCLUSIONS: QCI improved considerably from 1990 to 2017; however, it showed heterogeneous distribution and inequity between sex and age groups. In each regional context, plans from countries with the highest QCI and best gender equity should be disseminated and implemented in order to decrease the overall burden of GBBTC.

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.

Distribution of Dietary Risk Factors in Iran: National and Sub-National Burden of Disease.

BACKGROUND: Non-communicable diseases (NCDs) are one of the greatest threats to public health, and have been related to poor quality dietary patterns. This study was conducted to determine the distribution of dietary risk factors in Iran. METHODS: Cross-sectional data was gathered between April and November 2016 from 30,541 eligible adults (out of 31 050 individuals who were selected through systematic proportional to size cluster random sampling) living in urban and rural areas, using the WHO-based STEPs risk factor questionnaire. Low intakes of fruits, vegetables, dairy products, and fish, and high intakes of salty processed food (SPF), as well as daily intake of hydrogenated fat (HF) were considered as nutritional risk factors. RESULTS: At the national level, 82.8% (95% CI: 82.4-83.2), 57.8% (95% CI: 57.2-58.4), 80.6% (95% CI: 80.1-81) and 90.3% (95% CI: 90-90.6) of participants of all age groups had sub-optimal intakes of fruits, vegetables, dairy products and fish, respectively. Furthermore, 12.8% (95% CI: 12.4-13.1), and 29.4% (95% CI: 28.9-29.9) of respondents had high SPF intakes and HF use, respectively. At the sub-national level, the highest distribution of suboptimal intake of fruits (97.2%; 95% CI:96-98.3), vegetables (79.2%; 95% CI: 76.3-82.1) and dairy products (92.9%; 95% CI: 91-94.7) was observed in Sistan and Baluchistan. Except for Boushehr and Hormozgan, the majority of the population of other provinces consumed fish less than twice a week. Similarly, the high intake of SPF was found mostly in the population of Yazd (23.7; 95% CI: 20.2-27.2). HF consumption was the highest in North Khorasan (64.2%; 95% CI: 60.3-68.1). CONCLUSION: These findings highlight the widespread distribution of dietary risk factors in Iran, which should be a priority for the people and the politicians in order to prevent NCDs.

Premature mortality of gastrointestinal cancer in Iran: trends and projections 2001-2030.

BACKGROUND: The present study was conducted to determine the trend and projection of premature mortality from gastrointestinal cancers (GI cancers) at national and subnational levels in Iran. METHODS: Employing the data obtained from Iranian Death Registry System (DRS) and population data from census, the mortality rates of GI cancers was calculated among 30-70 age groups. The trends of esophageal, colon and rectum, gallbladder, pancreases, stomach, and liver cancer premature mortalities were estimated and projected at the national and subnational levels from 2001 to 2030. Then, Spatio-temporal model was used to project spatial and temporal correlations. RESULTS: The overall mortality rate of GI cancers was higher in males than in females, indicating 6.1, 3.9 and 3.9% per 100,000 individuals among males in 2001, 2015 and 2030 respectively and 3.8, 3.1 and 3.7 per 100,000 individuals among females in the same time-frame. The overall mortality rate of GI cancers in males was decreasing until 2015 and will remain stationary into 2030; however, the rate will be increasing among females in both time-frames. Also, there was a considerable variation in the mortality trends of different cancers. Pancreatic, gallbladder, and liver cancers were shown to have an increasing trend while a drop was observed in the mortality rates of stomach, colon and rectum, and esophageal cancers. CONCLUSION: Variation of GI cancers patterns and trends around the country indicated that a more comprehensive control plan is needed to include the predicted variations.

Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines.

BACKGROUND: We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. METHODS: Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. RESULTS: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively. CONCLUSIONS: Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.

Liver cirrhosis mortality at national and provincial levels in Iran between 1990 and 2015: A meta regression analysis.

BACKGROUND: Liver cirrhosis mortality number has increased over the last decades. We aimed to estimate the liver cirrhosis mortality rate and its trends for the first time by sex, age, geographical distribution, and cause in Iran. METHOD: Iranian Death Registration System, along with demographic (Complete and Summary Birth History, Maternal Age Cohort and Period methods) and statistical methods (Spatio-temporal and Gaussian process regression models) were used to address the incompleteness and misclassification and uncertainty of death registration system to estimate annual cirrhosis mortality rate. Percentages of deaths were proportionally redistributed into cirrhosis due to hepatitis B, C and alcohol use based on the data from the Global Burden of Disease (GBD) 2010 study. RESULTS: Liver cirrhosis mortality in elder patients was 12 times higher than that in younger patients at national level in 2015. Over the 26 years, liver cirrhosis mortality in males has increased more than that in females. Plus, the percentage of change in age adjusted mortality rate at provincial levels varied between decreases of 64.53% to nearly 17% increase. Mortality rate has increased until 2002 and then decreased until 2015.The province with highest mortality rate in 2015 has nearly two times greater rate compare to the lowest. More than 60% of liver cirrhosis mortality cases at national level are caused by hepatitis B and C infection. The rate of hepatitis B mortality is four times more than that from hepatitis C. CONCLUSION: This study demonstrated an increasing and then decreasing pattern in cirrhosis mortality that could be due to national vaccination of hepatitis B program. However monitoring, early detection and treatment of risk factors of cirrhosis, mainly in high risk age groups and regions are essential. Cirrhosis mortality could be diminished by using new non-invasive methods of cirrhosis screening, hepatitis B vaccination, definite treatment of hepatitis C.