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.

The burden of childhood and adolescent cancers in North Africa and the Middle East (NAME) region: findings from the Global Burden of Disease study 2019.

INTRODUCTION: Despite the significant burden of childhood and adolescent cancers, no specific studies recently discussed the burden of cancer in this group in the North Africa and the Middle East (NAME) region. Therefore, we aimed to study the burden of cancers in this group in this region. MATERIALS AND METHODS: We retrieved the Global Burden of Disease (GBD) data for children and adolescent cancers (0-19 years old) in the NAME region from 1990 to 2019. 21 types of neoplasms were grouped as "neoplasms", comprising 19 specific cancer groups as well as "other malignant neoplasms" and "other neoplasms". Three significant parameters of incidence, deaths, and Disability-Adjusted Life Years (DALYs) were studied. The data are presented with 95% uncertainty intervals (UI), and reported rates per 100,000. RESULTS: In 2019, almost 6 million (95% UI: 4.166 M-8.405 M) new cases and 11,560(9770-13,578) deaths due to neoplasms occurred in the NAME region. Incidence was higher in females (3.4 M), while deaths (6226 of overall 11,560) and DALYs (501,118 of overall 933,885) were estimated as higher in males. Incidence rates did not significantly change since 1990, while deaths and DALYs rates declined significantly. After excluding "other malignant neoplasms" and "other neoplasms", leukemia was responsible for the highest number of incidence and deaths (incidence: 10,629(8237-13,081), deaths: 4053(3135-5013), followed by brain and central nervous system cancers (incidence: 5897(4192-7134), deaths: 2446(1761-2960)), and non-Hodgkin lymphoma (incidence: 2741 (2237-3392), deaths: 790(645-962)). Incidence rates of neoplasms were similar for most countries, but countries varied more in terms of death rates. Afghanistan 8.9(6.5-11.9), Sudan 6.4(4.5-8.6), and the Syrian Arab Republic 5.6(4.3-8.3) had the highest overall death rates. CONCLUSION: The NAME region is observing relatively constant incidence rates and a decreasing pattern in the deaths and DALYs. Despite this success, several countries are lagging behind in development. Different issues such as economic problems, armed conflicts and political instabilities, lack of equipment or experienced staff or poor distribution, stigmatization and disbelief in the healthcare systems account for unfavorable numbers in some countries. Such problems require urgent solutions as new sophisticated and personalized cares raise the alarm for even more inequalities between high and low-income countries.

Estimating the seasonally varying effect of meteorological factors on the district-level incidence of acute watery diarrhea among under-five children of Iran, 2014-2018: a Bayesian hierarchical spatiotemporal model.

Under-five years old acute watery diarrhea (U5AWD) accounts for most diarrheal diseases' burden, but little is known about the adjusted effect of meteorological and socioeconomic determinants. A dataset containing the seasonal numbers of U5AWD cases at the district level of Iran is collected through MOHME. Accordingly, the district-level standardized incidence ratio and Moran's I values are calculated to detect the significant clusters of U5AWD over sixteen seasons from 2014 to 2018. Additionally, the author tested twelve Bayesian hierarchical models in order to determine which one was the most accurate at forecasting seasonal number of incidents. Iran features a number of U5AWD hotspots, particularly in the southeast. An extended spatiotemporal model with seasonally varying coefficients and space-time interaction outperformed other models, and so became the paper's proposal in modeling U5AWD. Temperature demonstrated a global positive connection with seasonal U5AWD in districts (IRR: 1.0497; 95% CrI: 1.0254-1.0748), owing to its varying effects during the winter ((IRR: 1.0877; 95% CrI: 1.0408-1.1375) and fall (IRR: 1.0866; 95% CrI: 1.0405-1.1357) seasons. Also, elevation (IRR: 0.9997; 95% CrI: 0.9996-0.9998), piped drinking water (IRR: 0.9948; 95% CrI: 0.9933-0.9964), public sewerage network (IRR: 0.9965; 95% CrI: 0.9938-0.9992), years of schooling (IRR: 0.9649; 95% CrI: 0.944-0.9862), infrastructure-to-household size ratio (IRR: 0.9903; 95% CrI: 0.986-0.9946), wealth index (IRR: 0.9502; 95% CrI: 0.9231-0.9781), and urbanization (IRR: 0.9919; 95% CrI: 0.9893-0.9944) of districts were negatively associated with seasonal U5AWD incidence. Strategically, developing geoinformation alarm systems based on meteorological data might help predict U5AWD high-risk areas. The study also anticipates increased rates of U5AWD in districts with poor sanitation and socioeconomic level. Therefore, governments should take appropriate preventative actions in these sectors.

Trends in dental caries of deciduous teeth in Iran: a systematic analysis of the national and sub-national data from 1990 to 2017.

BACKGROUND: Dental caries is the most prevalent child affliction in the world and can be reduced through effective preventive interventions. To plan cost-effective interventions, clear and integrated data are needed. This study has been designed to overcome the lack of national trend in deciduous dental caries in Iran. OBJECTIVE: To estimate the dental caries trend in deciduous teeth in the Iranian population at different ages from 1990 to 2017. METHODS: From 1990 to 2017 a literature search about dmf and its components (decayed, missed, and filled tooth, abbreviated as dt, mt, and ft) as well as dental caries was done in the Iranian population in three English (PubMed, Web of Science, and Scopus) and three national databases (in Persian). All eligible national oral health surveys in these 28 years were included. National dmft data were categorised based on age (1-4, 5-9, and 10-14), sex, province and year. The final trends were estimated using an age-spatio-temporal hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. Finally, the estimations of dmft, dt, mt, and ft with a 95% UI were reported from 1990 to 2017. RESULTS: Almost 22% of the Iranian deciduous teeth were involved with dental caries in 1990 [dmft = 4.37; (95% UI 2.23, 6.62)] which more than 83% of it was dt [3.64 (1.53, 5.88)] and less than 7% was ft [0.30 (0.06, 0.65)]. During 1990-2017, dmft increased by more than 15% [in 2017, dmft = 5.03 (2.82, 7.29)]. The highest increase was seen in dt which was more than 17% [in 2017, dt = 4.27 (1.96, 6.57)]. CONCLUSION: Increasing dental caries among Iranian children over 28 years shows that oral health policies in Iran need critical evaluation. We need cost-effective nationwide interventions (e.g., supervised tooth brushing and improving dietary habits) and training well-experienced intermediate manpower (e.g., dental hygienists) to reduce dental caries.

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.

Burden of multiple sclerosis in Iran from 1990 to 2017.

BACKGROUND: Multiple Sclerosis (MS) is a burdensome, chronic and autoimmune disease of the central nervous system. We aimed to report the incidence, prevalence, mortality, and Disability Adjusted Life Years (DALYs) of MS in Iran at a national level for different age and sex groups over a period of 28 years (1990-2017). METHODS: Data were extracted from the Global Burden of Disease study (GBD) from 1990 to 2017, published by the Institute for Health Metrics and Evaluation. The incidence of DALYs and prevalence of MS were estimated to report the burden of MS based on sex and age in Iran from 1990 to 2017. RESULTS: At the national level, the Age-Standardized Incidence Rate (ASIR), Age-Standardized Prevalence Rate (ASPR), Age-Standardized DALYs Rate (ASDR) and the Age-Standardized Mortality Rate (ASMR) in Iran in 2017 were 2.4 (95% Uncertainty Interval [UI]: 2.1 to 2.7), 69.5 (62.1 to 77.8), 29.1 (23.6 to 34.7), and 0.4 (0.3 to 0.4) per 100,000 population, respectively. During the period of 1990 to 2017, all measures increased, and were higher among females. The incidence rate began upward trend at the age of 20 and attained its highest level at the age of 25. CONCLUSION: In Iran, all of the age-standardized MS rates have been increasing during the 28 years from 1990 to 2017. Our findings can help policy makers and health planners to design and communicate their plans and to have a better resource allocation, depending on the incidence and prevalence of the growing numbers of MS patients in Iran.

Disparities and spatial variations of high salt intake in Iran: a subnational study of districts based on the small area estimation method.

OBJECTIVE: High salt intake is one of the leading diet-related risk factors for several non-communicable diseases. We aimed to estimate the prevalence of high salt intake in Iran. DESIGN: A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to risk factor Surveillance (STEPS) 2016. The modelling estimated the prevalence of high salt intake, defined as a daily salt intake ≥ 5 g in all districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country. SETTING: 429 districts of all provinces of Iran, 2016. PARTICIPANTS: 18 635 salt intake measurements from individuals 25 years old and above who participated in the Iran STEPS 2016 survey. RESULTS: All districts in Iran had a high prevalence of high salt intake. The estimated prevalence of high salt intake among females of all districts ranged between 72·68 % (95 % UI 58·48, 84·81) and 95·04 % (95 % UI 87·10, 100). Estimated prevalence for males ranged between 88·44 % (95 % UI 80·29, 96·15) and 98·64 % (95 % UI 94·97, 100). In all categorisations, males had a significantly higher prevalence of high salt intake. Among females, the population with the lower economic status had a higher salt consumption than the participants with higher economic status by investigating the concentration index. CONCLUSIONS: Findings of this study highlight the high salt intake as a prominent risk factor in all Iran regions, despite some variations in different scales. More suitable population-wide policies are warranted to handle this public health issue in Iran.

The level and trend of road traffic injuries attributable mortality rate in Iran, 1990-2015: a story of successful regulations and a roadmap to design future policies.

BACKGROUND: Road-Traffic-Injuries (RTIs) are predicted to rise up to the fifth leading cause of worldwide death by 2030 and Iran has the third highest RTIs mortality among higher-middle income countries. Although the high mortality of RTI in Iran is a warning, it provides the opportunity to indirectly assess the implemented RTI-related regulations' effectiveness via high-resolution relevant statistics and, hence, Iran could serve as a guide for countries with similar context. In order to do so, we utilized this study to report the time and spatial trends of RTIs-related mortality in different age and sex groups and road user classes in Iran. METHODS: Based on the national death-registration-system (DRS), cemeteries data, and the demographic characteristics, and after addressing incompleteness, we estimated mortality rates using spatiotemporal and Gaussian process regression models. We assessed Pearson seatbelt and helmet use and RTIs-attributable Age-Standardized-Morality-Rate (ASMR) associations. We also predicted RTIs-death-numbers, 2012-2020, by fitting a Generalized Additive Model to assess the status of achieving relevant sustainable development goal (SDG), namely reducing the number of RTIs-related deaths by half. RESULTS: Overall RTIs-attributable death and ASMR at the national level increased from 12.64 [95% UI, 9.52-16.86] to 29.1 [22.76-37.14] per 100,000 people in the time period of 1990-2015. The trend consisted of an increasing segment in 1990-2003 followed by a decreasing part till 2015. The highest percentage of death belonged to the three-or-more-wheels motorized vehicles. Pedestrian injuries percentage increased significantly and the highest mortality rate occurred in 85 years and older individuals. Low prevalence of seatbelt and helmet use were observed in provinces with higher than the median ASMR due to the relevant cause of each. RTIs-attributable death number is expected to reduce by 15.99% till 2020 which is lower than the established SDG goal. CONCLUSIONS: Despite the observed substantial moderation in the RTI-ASMR, Iran is till among the leading countries in terms of the highest mortality rates in the world. The enforced regulations including speed limitations (particularly for elder pedestrians) and mandatory use of seatbelt and helmet (for young adult and male drivers) had a considerable effect on ASMR, nevertheless, the RTI burden reduction needs to be sustained and enhanced.

Global, regional, and national burden and quality of care index (QCI) of lip and oral cavity cancer: a systematic analysis of the Global Burden of Disease Study 1990-2017.

BACKGROUND: To measure the quality of care for lip and oral cavity cancer worldwide using the data from the Global Burden of Disease (GBD) Study 2017. METHODS: After devising four main indices of quality of care for lip and oral cavity cancer using GBD 2017 study's measures, including prevalence, incidence, years of life lost, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine a component that bears the most proportion of info among the others. This component of the PCA was considered as the Quality-of-Care Index (QCI) for lip and oral cavity cancer. The QCI score was then reported in both men and women worldwide and different countries based on the socio-demographic index (SDI) and World Bank classifications. RESULTS: Between 1990 and 2017, care quality continuously increased globally (from 53.7 to 59.6). In 1990, QCI was higher for men (53.5 for men compared with 50.8 for women), and in 2017 QCI increased for both men and women, albeit a slightly higher rise for women (57.2 for men compared with 59.9 for women). During the same period, age-standardised QCI for lip and oral cavity cancer increased in all regions (classified by SDI and World Bank). Globally, the highest QCI scores were observed in the elderly age group, whereas the least were in the adult age group. Five countries with the least amount of QCIs were all African. In contrast, North American countries, West European countries and Australia had the highest indices. CONCLUSION: The quality of care for lip and oral cavity cancer showed a rise from 1990 to 2017, a promising outcome that supports patient-oriented and preventive treatment policies previously advised in the literature. However, not all countries enjoyed such an increase in the QCI to the same extent. This alarming finding could imply a necessary need for better access to high-quality treatments for lip and oral cavity cancer, especially in central African countries and Afghanistan. More policies with a preventive approach and paying more heed to the early diagnosis, broad insurance coverage, and effective screening programs are recommended worldwide. More focus should also be given to the adulthood age group as they had the least QCI scores globally.

National and Subnational Trend of Dental Caries of Permanent Teeth in Iran, 1990-2017.

OBJECTIVE: There are currently no integrated data on the trend of dental caries amongst distinct age groups in Iran. We aimed to assess the national and subnational trend of dental caries of permanent teeth in Iran from 1990 to 2017. METHODS: A literature search about dental caries and the decayed-missing-filled teeth index (DMFT) was performed in PubMed, Web of Science, Scopus, and 3 national databases (in Persian). All eligible national oral health surveys in these 28 years were included. We categorised and aggregated the DMFT values and their components based on age (5-year-based groups from 5 to 9 to 60+ years), sex, year, and province. The data for missing spots were estimated using the spatiotemporal Bayesian hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. RESULTS: Nationally, the all-ages mean DMFT increased by nearly 58.0% (6.8 [95% UI, 4.1-10.5] in 1990 to 10.8 [95% UI, 7.5-14.5] in 2017). Decayed teeth (DT) and missing teeth (MT) rose by 84.5% and 31.6% during this period, respectively. Filled teeth (FT) showed almost a 2.6-fold increase in the same period from 0.6 (95% UI, 0.01-1.6) in 1990 to 1.7 (95% UI, 0.6-2.8) in 2017. The proportion of DT and FT continuously increased in both sexes. In 2017, the highest DT, MT, and FT were estimated in the 25-29 (4.9 [95% UI, 2.5-7.2]), 60+ (21.5 [95% UI, 17.5-25.4]), and 35-39 (2.6 [95% UI, 1.3-4.0]) year age groups. CONCLUSIONS: Caries of permanent dentition levies a growing burden on the Iranian population. Considering the continuous increase in caries during the 1990-2017 period, Iranian policymakers should pay heed to these findings and react more proactively to mitigate this perpetuating issue. Implementing nationwide interventions such as sugar consumption management should be encouraged to achieve sustainable outcomes in this regards.

Validation of the self-reported diagnosis of diabetes mellitus, hypercholesterolemia, and hypertension in Iran; STEPS 2016.

Purpose: As a part of STEPwise approach to risk factor Surveillance (STEPS) study, our aim was to evaluate the validity of the self-reported diagnosis of diabetes (DM), hypertension (HTN), and hypercholesterolemia (Hyper-Chol) in the Iranian population. Methods: Using systematic proportional to size cluster sampling, 27,232 participants were included in our study. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to assess the validity of self-reported diagnoses. Furthermore, logistic regression was employed to examine the relationship between the validity of self-reported diagnoses and sociodemographic and lifestyle factors. All analyses were performed using STATA version 14. Results: The PPV for self-report of DM, HTN, and Hyper-Chol were estimated to be 69%, 74% and 80%, and NPV measured up to 95%, 84%, and 50%, respectively. Positive/negative self-reports were more accurate among older (younger) individuals. Age had a negative correlation with the validity of self-reported Hyper-Chol but a positive correlation with the validity of self-reported DM and hypertension HTN. Additionally, an increase in BMI was associated with an increase/decrease in PPV and a decrease/increase in NPV across all diseases. Conclusion: Self-report studies hold value in situations where direct in-person interaction is not feasible, either due to prohibitive costs or restrictions imposed by infectious diseases (COVID-19). Self-report surveys are valuable tools in studying the epidemiology of diseases; however, the type of the disease, the study purpose, either finding sick people or healthy people, the age subgroups, and socioeconomic status should be taken into consideration.

Unveiling the lead exposure attributed burden in Iran from 1990 to 2019 through the lens of the Global Burden of Disease study 2019.

This study aimed to investigate the estimated burden attributed to lead exposure (LE), at the national and subnational levels from 1990 to 2019 in Iran. The burden attributed to LE was determined through the estimation of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) using the comparative risk assessment method of Global Burden of Disease (GBD) study presenting as age-standardized per 100,000 person year (PY) with 95% uncertainty intervals (95% UI). Furthermore, the burden of each disease were recorded independently. Eventually, the age-standardized YLLs, DALYs, deaths and YLDs rates attributed to LE demonstrated a decrease of 50.7%, 48.9%, 38.0%, and 36.4%, respectively, from 1990 to 2019. The most important causes of LE burden are divided into two acute and chronic categories: acute, mainly causes mental disorders (DALYs rate of 36.0 in 2019), and chronic, results in cardiovascular diseases (CVDs) (DALYs rate of 391.8) and chronic kidney diseases (CKDs) (DALYs rate of 26.6), with CVDs bearing the most significant burden. At the sub-national level, a decrease in burden was evident in most provinces; moreover, low and low-middle SDI provinces born the highest burden. The burden increased mainly by ageing and was higher in males than females. It was concluded that although the overall decrease in the burden; still it is high, especially in low and low-middle SDI provinces, in advanced ages and in males. Among IDID, CKDs and CVDs that are the most important causes of LE-attributed burden in Iran; CVDs bear the highest burden.

Exploring metabolically healthy obesity: prevalence, characteristics, and cardiovascular risk in the Iranian population based on the STEPS 2021.

Background: Regarding the rapidly increasing prevalence of obesity throughout the globe, it remains a serious public health concern. A subgroup of obesity that does not meet metabolic syndrome criteria is called metabolically healthy obesity (MHO). However, whether the MHO phenotype increases cardiovascular disease (CVD) risk is controversial. This study aimed to evaluate the prevalence of MHO and its 10-year CVD risk in Iranian populations. Methods: Based on the STEPS 2021 project in Iran, we collected data on 18119 Iranians 25 years and older from all 31 provinces after applying many statistical factors. Using the Framingham score, we evaluated the 10-year cardiovascular risk associated with the various MHO definition criteria for Iranian populations. Results: The prevalence of MHO was 6.42% (5.93-6.91) at the national level according to the AHA-NHLBI definition, and 23.29% of obese women and 24.55% of obese men were classified as MHOs. Moreover, the MHO group was younger than the metabolically unhealthy obesity (MUO) group based on all definitions (p < 0.001). The odds ratio of MUO individuals being classified as high-risk individuals by the Framingham criteria for CVD was significantly higher than that of MHO individuals by all definitions, with a crude odds ratio of 3.55:1 based on AHA-NHLBI definition. Conclusion: This study reveals a significant prevalence of MHO in the Iranian population, with approximately 25% of obese individuals classified as MHO. While MHO is associated with a lower risk of cardiovascular disease compared to MUO, MHO carries the potential for transitioning to an unhealthy state. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01364-5.

Effect of air pollution on disease burden, mortality, and life expectancy in North Africa and the Middle East: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND: Air pollution is the sixth highest risk factor for attributable disability-adjusted life-years (DALYs) in North Africa and the Middle East, but the relative importance of different subtypes of air pollution and any potential differences in their health effects by population demographics or country-level socioeconomic factors have not been fully explored. The objective of this study was to investigate the effect of high ambient particulate matter less than 2·5 µm in size (PM) and ambient ozone air pollution on disease burden, mortality, and life expectancy in 21 countries in the North Africa and the Middle East super-region from 1990 to 2019 using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. METHODS: The study data were derived from GBD 2019, examining data from 1999 to 2019 in North Africa and the Middle East. In this study, the types of air pollution investigated included PM pollution and ambient ozone pollution. PM pollution itself was categorised as household air pollution from solid fuels and ambient PM pollution. The burden attributable to each risk factor, directly or indirectly, was incorporated in the population attributable fraction to estimate the total attributable deaths and DALYs. The summary exposure value (SEV) as the relative risk-weighted prevalence of exposure was extracted to compare the distribution of excess risk times the exposure level in a population where everyone is at maximum risk and ranges from zero (no excess risk exists in a population) to 100 (highest risk). The effect of air pollution on life expectancy was estimated via a cause-deleted life table analysis. FINDINGS: The age-standardised DALYs rate attributable to air pollution declined by 44·5%, from 4884·2 (95% uncertainty interval 4381·5-5555·4) to 2710·4 (2317·3-3125·6) per 100 000 from 1990 to 2019. Afghanistan (6992·3, 5627·7-8482·7), Yemen (4212·4, 3241·3-5418·1), and Egypt (4034·8, 3027·7-5138·6) had the highest age-standardised DALYs rates attributable to air pollution in 2019 per 100 000, whereas Türkiye (1329·2, 1033·7-1654·7), Jordan (1447·3, 1154·2-1758·5), and Iran (1603·0, 1404·7-1813·8) had the lowest rates. During the study period, the age-standardised SEV of air pollution (PM and ambient ozone in total) decreased by 10·9% (5·8-17·7%) in the super-region, whereas the SEV of ambient ozone pollution alone increased by 7·7% (0·7-14·3%). Among the components of PM pollution, the SEV of ambient PM pollution increased by 40·1% (25·2-63·7%); however, the SEV of household air pollution from solid fuels decreased by 70·6% (64·1-77·0%). Among the investigated types of air pollution, 98·9% of the DALYs from air pollution in the super-region were attributable to PM pollution. If air pollution had been lowered to the theoretical minimum risk exposure levels for 2019, then the average life expectancy would have been 1·6 years higher. INTERPRETATION: The burden attributable to air pollution substantially decreased in the study period across the super-region as a whole. Most of the burden from air pollution is attributed to PM pollution, the exposure to which has substantially increased in the past three decades. Interventions and policies that reduce population exposure to PM pollution could potentially increase the average life expectancy in the super-region. This finding calls for concerted efforts from governments and public health authorities in the super-region to tackle air pollution as an important threat to population health. FUNDING: Bill & Melinda Gates Foundation.

National and sub-national burden and trend of type 1 diabetes in 31 provinces of Iran, 1990-2019.

The aim of the study was to report the burden of type one diabetes mellitus (T1DM) by sex, age, year, and province in Iran over the past 30 years, according to data provided by the global burden of disease (GBD) study. Incidence, prevalence, death, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability due to T1DM by age groups and sex was reported for 31 provinces of Iran from 1990 to 2019 with their 95% uncertainty intervals (UI). In 2019, national age-standardized incidence (11.0 (95% UI: 8.9-13.5)), prevalence (388.9 (306.1-482.1)), death (0.7 (0.6-0.8)), and DALYs (51.7 (40.9-65.1)) rates per 100,000 wre higher than 1990 except for death. Also, the mortality to incidence ratio reduced in all provinces over time particularly after 2014 as well. GBD data analysis showed that age-standardized incidence and prevalence rates of T1DM have increased, the death rate reduced, and DALYs remained unchanged during the past 30 years in Iran and its 31 provinces. death rate reduced and DALYs remained unchanged during the past 30 years in Iran and its 31 provinces.

Predicting Iran's achievement to Sustainable Development Goal 3.2: A systematic analysis of neonatal mortality with scenario-based projections to 2030.

BACKGROUND: Sustainable Development Goal 3.2 (SDG 3.2) is to reduce Under-5 and neonatal mortality rates (U5MR and NMR), two major health systems' performance indicators, globally by 2030. We aimed to report Iran's U5MR and NMR status during 2010-2017 and its achievement of SDG 3.2 by 2030, using scenario-based projection. STUDY DESIGN: To estimate the national and subnational levels of U5MR and NMR, we applied an Ensemble Bayesian Model Averaging (EBMA) with Gaussian Process Regression (GPR) and Spatio_temporal models. We used all available data sources including: 12-year data from the Death Registration System (DRS), two censuses, and a demographic and health surveys (DHS). This study employed two approaches, Maternal Age Cohort (MAC) and Maternal Age Period (MAP), to analyze summary birth history data obtained from censuses and DHS. In addition, we calculated the child mortality rate directly from DHS using the complete birth history method. National and subnational NMR was projected up to 2030 with a scenario-based method using average Annual Rate of Reduction (ARR) introduced by UN-IGME. RESULTS: In 2017, national U5MR and NMR were 15·2 (12·4-18·0) and 11·8 (10·4-13·2), with an average ARR of 5·1% (2·1-8·9) and 3·1% (0·9-5·8) during 2010-2017, respectively. According to our projection scenarios, 17 provinces have not fulfilled SDG 3.2 for NMR yet, and the current trend (the current trend of NMR improvement in Iran) will not result in reaching SDG for some provinces by 2030; However, if each province has the same neonatal mortality annual reduction rate as the best-performing province in the same region, besides achieving SDG, the national NMR will be reduced to 5·2, and almost 92,000 newborn lives will be saved. CONCLUSIONS: Iran has achieved SDG3.2 regarding U5MR and NMR; however, there are provincial inequalities. For all provinces to reach SDG3.2, health policies should focus on reducing provincial inequalities by precise planning for neonatal health care.

A Global, Regional, and National Burden and Quality of Care Index for Schizophrenia: Global Burden of Disease Systematic Analysis 1990-2019.

BACKGROUND AND HYPOTHESIS: Schizophrenia is a mental disorder usually presented in adulthood that affects roughly 0.3 percent of the population. The disease contributes to more than 13 million years lived with disability the global burden of disease. The current study aimed to provide new insights into the quality of care in Schizophrenia via the implementation of the newly introduced quality of care index (QCI) into the existing data. STUDY DESIGN: The data from the global burden of disease database was used for schizophrenia. Two secondary indices were calculated from the available indices and used in a principal component analysis to develop a proxy of QCI for each country. The QCI was then compared between different sociodemographic index (SDI) and ages. To assess the disparity in QCI between the sexes, the gender disparity ratio (GDR) was also calculated and analyzed in different ages and SDIs. STUDY RESULTS: The global QCI proxy score has improved between 1990 and 2019 by roughly 13.5%. Concerning the gender disparity, along with a rise in overall GDR the number of countries having a GDR score of around one has decreased which indicates an increase in gender disparity regarding quality of care of schizophrenia. Bhutan and Singapore had 2 of the highest QCIs in 2019 while also showing GDR scores close to one. CONCLUSIONS: While the overall conditions in the quality of care have improved, significant disparities and differences still exist between different countries, genders, and ages in the quality of care regarding schizophrenia.

Risk of incident cardiovascular diseases at national and subnational levels in Iran from 2000 to 2016 and projection through 2030: Insights from Iran STEPS surveys.

BACKGROUND: Cardiovascular Disease (CVD) is the leading cause of death in developing countries. CVD risk stratification guides the health policy to make evidence-based decisions. AIM: To provide current picture and future trend of CVD risk in the adult Iranian population. METHODS: Nationally representative datasets of 2005, 2006, 2007, 2008, 2009, 2011, and 2016 STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) studies were used to generate the 10-year and 30-year risks of CVD based on Framingham, Globorisk, and World Health Organization (WHO) risk estimation models. Trend of CVD risk was calculated from 2000 until 2016 and projected to 2030. RESULTS: In 2016, based on Framingham model, 14.0% of the Iranian, aged 30 to 74, were at great risk (≥20%) of CVD in the next 10 years (8.0% among females, 20.7% among males). Among those aged 25 to 59, 12.7% had ≥45% risk of CVD in the coming 30 years (9.2% among females, 16.6 among males). In 2016, CVD risk was higher among urban area inhabitants. Age-standardized Framingham 10-year CVD risk will increase 32.2% and 19%, from 2000 to 2030, in females and males, respectively. Eastern provinces had the lowest and northern provinces had the greatest risk. CONCLUSIONS: This study projected that CVD risk has increased from 2000 to 2016 in Iran. Without further risk factor modification, this trend will continue until 2030. We have identified populations at higher risks of CVD to guide future intervention.

Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021.

Smoking is recognised as a critical public health priority due to its enormous health and economic consequences. Constant monitoring of the effectiveness of tobacco control programs calls for timely population-based data. This study reports the national and sub-national patterns in tobacco consumption among Iranian adults based on the results from the STEPwise approach to chronic disease risk factor surveillance (STEPS) survey 2021. This study was performed through an analysis of the results of the STEPS survey 2021 which had been conducted as a nationally representative cross-sectional study. Participants included Iranian adults aged ≥ 18 years in all provinces of Iran, who were selected via multistage cluster sampling method. Data were analyzed via survey analysis while considering population weights. The total number of participants was 27,874, including 15,395 (55.23%) women and 12,479 (44.77%) men. The all-ages prevalence of current tobacco smoking was 14.01% overall, 4.44% among women, and 25.88% among men. The all-ages prevalence of current cigarette smoking was 9.33% overall, 0.77% among women, and 19.95% among men. The all-ages prevalence of current hookah smoking was 4.5% overall, 3.64% among women, and 5.56% among men. The mean (SD) number of cigarettes smoked per day was 12.41 (10.27) overall, 7.65 (8.09) among women, and 12.64 (10.31) among men. The mean (SD) monthly times of hookah use was 0.42 (7.87) overall, 2.86 (23.46) among women, and 0.3 (6.2) among men. The national all-ages prevalence of second-hand smoking at home was 24.64% overall, 27.38% among women, and 20.26% among men. The national all-ages prevalence of second-hand smoking at work was 19.49% overall, 17.33% among women, and 22.94% among men. The tobacco consumption in Iran remains alarmingly high, indicating the current tobacco control policy implementation level is ineffective and insufficient. This calls for adopting, implementing, and enforcing comprehensive packages of evidence-based tobacco control policies.