Alcohol consumption and related disorders in Iran: Results from the National Surveillance of Non-Communicable Diseases' Survey (STEPs) 2016.

BACKGROUND: Alcohol consumption is a public health concern which is illegal in Iran. Moreover, due to cultural and religious beliefs, the available population-based research findings on alcohol consumption are inadequate. We aimed to provide an estimate on alcohol consumption using a large-scale population-based survey in Iran. MATERIALS AND METHODS: The National Surveillance of Non-Communicable Risk Factors in Iran was a population-based survey conducted in 2016. The epidemiologic distribution of alcohol consumption and its related disorders were assessed using weighted survey methods and multiple logistic regression models. Age standardized rates were calculated using Iran's national population census in 2016. RESULTS: At the national level, the prevalence rates of lifetime and current alcohol consumption were 8.00% (95% CI: 7.67-8.32) and 4.04% (95% CI: 3.81-4.27), respectively. The highest prevalence was reported among 25 to 34 year-olds. Individuals of higher socioeconomic status consumed significantly greater levels of alcohol. At provincial level, the highest and lowest percentages of the current alcohol drinking rates in Iran's provinces were, 23.92% (95% CI: 17.56-30.28) and 0.4% (95% CI: 0-1.18) in males, 1.58% (95% CI: 0.22-2.94) and 0% in females, respectively. In urban regions, the highest alcohol consumption rate was more than 22 times greater than the lowest alcohol consumption rate. Current alcohol drinkers were 2 times more prone to injury as compared to nondrinkers (ORadj: 2.0, 95%CI: 1.7, 2.3). CONCLUSION: In Iran, the prevalence of alcohol consumption is low, although there is a considerable variation of alcohol consumption at provincial level as well as in different gender groups. Therefore, preventive WHO-recommended measures should be adopted more seriously by vulnerable groups.

A systematic review on the prevalence of endometriosis in women.

Background & objectives: Endometriosis is one of the causes of female infertility, but the prevalence of endometriosis is not exactly known. We conducted a systematic review and meta-analysis to provide an estimate of the prevalence of endometriosis in women considering the stage of disease, diagnostic method, geographical distribution, clinical symptoms and sample size. Methods: MEDLINE, Web of Science, Google Scholar, Scopus and Cumulative Index of Nursing and Allied Health were searched to identify peer-reviewed studies published from January 1990 to December 2018 reporting the prevalence of endometriosis. Relevant additional articles were identified from the lists of the retrieved articles. Studies with cross-sectional design were included in the meta-analysis. Results: The overall prevalence of endometriosis was 18 per cent [95% confidence interval (CI): 16-20] and the prevalence of endometriosis by stage ranged from two per cent (95% CI: 1-4) for stage 4 to 20 per cent (95% CI: 11-28) for stage 1. The prevalence levels of endometriosis in women with infertility, chronic pelvic pain and asymptomatic were 31 (95% CI: 15-48), 42 (95% CI: 25-58) and 23 per cent (95% CI: 19-26), respectively. Interpretation & conclusions: The results of this study showed that the prevalence of endometriosis in developing countries was high. Future studies are needed to explore other factors affecting the prevalence of endometriosis worldwide, which may help develop future prevention programmes.

The relationship between lifestyle and anthropometric factors with the sleep characteristics among university students in Iran: the MEPHASOUS study.

BACKGROUND: Healthy sleep habits have an important role in normal cognitive function, emotional performance, and well-being. The aims of this study were to describe the characteristics of sleep among university students in Iran. In addition, we assessed the relationship between lifestyle and anthropometric factors with the sleep characteristics. METHODS: This population-based cross-sectional study was conducted using the data of "Mental and Physical Health Assessment of University Students in Iran" survey 2012-2013. This survey was conducted on newly admitted students in 74 public universities in 28 provinces. The participants were younger adults. Univariate and multivariate logistic regression models were utilized to recognize associated factors with sleep pattern and range. RESULT: Of total 78,848 students who completed the survey, 54.64% (n = 43,079) were females. The average age of the students was 21.53 ± 4.08 and 21.54 ± 3.99 among males and females, respectively. More than 90% (n = 70,923), were non-smokers. Out of the total respondents, 40.56% (n = 31,756) had irregular sleep pattern. Male students were less likely to have irregular sleep pattern than female students. CONCLUSION: Our findings indicated that irregular sleep pattern is associated with overweight and obesity. So, these results underscore the need to educate students on importance of healthy sleep pattern and duration on health conditions.

Prevalence of behavioural risk factors for road-traffic injuries among the Iranian population: findings from STEPs 2016.

BACKGROUND: To achieve Sustainable Development Goal 3.6 in Iran, we need to have a comprehensive understanding of the distribution of risky behaviours regarding road-traffic injuries at national and sub-national levels. Little is known about the road-use vulnerability patterns of road-traffic injuries in Iran. The aim of this study is to describe the prevalence of self-reported human risk factors in road-traffic injuries using the findings from a large-scale cross-sectional study based on the World Health Organization's stepwise approach to surveillance of non-communicable diseases (STEPs). METHODS: A cross-sectional survey study in 2016 assessed the road-use pattern and prevalence of risky behaviours of people more than 18 years old. In this study, we planned to recruit 31 050 individuals as a representative sample at national and provincial levels. In practice, 30 541 individuals (3105 clusters) from urban and rural areas of Iran were selected. Basic socio-demographic data, major behavioural risk factors such as seatbelt and helmet non-compliance, drunk driving and occupant in a car with a drunk driver were assessed through baseline interviews gathered through an Android tablet-based questionnaire. RESULTS: The overall prevalence of seatbelt and helmet compliance was 75.2% (95% confidence interval: 74.7-75.7) and 13.9% (13.4-14.5), respectively, at the national level. The prevalence of risk-taking behaviours such as drink driving was 0.5% (0.4-0.6) and for being an occupant in a car with a drunk driver was 3.5% (3.2-3.8). At the provincial level, the highest age-standardized prevalence of seatbelt compliance (89.6%) was almost 1.5 times higher than the lowest provincial prevalence (58.5%). In 63% of provinces, the lowest prevalence of seatbelt compliance was observed among people aged 18-24 years old. CONCLUSIONS: In Iran, existing disease-prevention and health-promotion programmes should be expanded to target vulnerable subgroups that have more prevalent human risk factors for road-traffic injuries. Further research is required to investigate the context-specific proximal human risk factors and vulnerability patterns in Iran.

Socio-economic risk factors of household food insecurity and their population attributable risk: A population-based study.

Background: Food insecurity as a major public health problem has associations with a wide range of adverse consequences on health and quality of life. The aim of this study is to determine the prevalence of food insecurity among Iranian households, its key socioeconomic risk factors and population attributable risk via a large-scale cross-sectional study in the capital of Iran. Methods: This cross-sectional study was performed among 30,809 households with complete questionnaires of food security, during 2011. The univariate test was used to investigate the association between economic status and covariates with household food insecurity. Multiple logistic regression model was used to assess the independent effect of economic status on household food insecurity. Results: Totally, 37.8% (95% CI: 37.25, 38.34%) of the households were food insecure. There were significant associations between economic status and household food insecurity after adjustment for other variables (p-value<0.001). The extent of household food insecurity that could be attributed to the economic status in the 1st and 2nd quintiles (poorest and poor households), compared with the 5th quintile (richest households), was estimated to be 48.43% and 60.12%, respectively. Conclusion: Food insecurity is relatively prevalent among households in Tehran. Economic status was identified as the most significant determinant of household food security, as 62.7% of poorest households were food insecure. Therefore, there is a crucial need to address food insecurity as a priority in food policies.

COST-EFFECTIVENESS ANALYSIS OF IVABRADINE IN TREATMENT OF PATIENTS WITH HEART FAILURE IN IRAN.

OBJECTIVES: This study aimed to assess the cost-effectiveness of ivabradine plus standard of care (SoC) in comparison with current SoC alone from the Iranian payer perspective. METHODS: A cohort-based Markov model was developed to assess the incremental cost-effectiveness ratio (ICER) over a 10-year time horizon in a cohort of 1,000 patients. The baseline transition probabilities between New York Heart Association (NYHA), mortality rate, and hospitalization rate were extracted from the literature. The effect of ivabradine on mortality, hospitalization, and NYHA improvement or worsening were retrieved from the SHIFT study. The effectiveness was measured as quality-adjusted life-years (QALYs) using the utility values derived from Iranian Heart Failure Quality of Life study. Direct medical costs were obtained from hospital records and national tariffs. Deterministic and probabilistic sensitivity analyses were conducted to show the robustness of the model. RESULTS: Ivabradine therapy was associated with an incremental cost per QALY of USD $5,437 (incremental cost of USD $2,207 and QALYs gained 0.41) versus SoC. The probabilistic sensitivity analysis showed that ivabradine is expected to have a 60 percent chance of being cost-effective accepting a threshold of USD $6,550 per QALY. Furthermore, deterministic sensitivity analysis indicated that the model is sensitive to the ivabradine drug acquisition cost. CONCLUSIONS: The cost-effectiveness model suggested that the addition of ivabradine to SoC therapy was associated with improved clinical outcomes along with increased costs. The analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost in eligible heart failure patients with sinus rhythm and a baseline heart rate ≥ 75 beats per minute (bpm).

Estimation of burden of ischemic heart diseases in Isfahan, Iran, 2014: using incompleteness and misclassification adjustment models.

BACKGROUND: Over the past decade, cardiovascular diseases (CVDs) have been the leading cause of death in the world. Ischemic heart diseases (IHDs) are the main form of CVDs and are the most important single cause of death around the world. This study aimed to estimate the burden of IHDs in the city of Isfahan by calculating disability-adjusted life years (DALYs). METHODS: This population-based study was conducted on the population living in the city of Isfahan in 2014. Years of life lost due to premature mortality (YLLs) were calculated by multiplying the number of deaths due to IHDs (that was collected from death registration system (DRS) and was adjusted for incompleteness and misclassification) with life expectancy (that was extracted from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2013). Years lived with disability (YLDs) were calculated by multiplying the prevalent cases of IHDs in each age-sex group (that was calculated using the stepwise approach to non-communicable disease risk factor surveillance (STEPS)) with total disability weight of IHDs (that was calculated using the GBD 2013). DALYs were calculated as the sum of YLDs and YLLs. RESULTS: In 2014, the number of DALYs due to IHDs was 43517.71 years which was formed of 31891.79 years of YLLs and 11625.92 years of YLDs. The rate of DALYs due to IHDs was 4412.33 (95% uncertainty interval (UI): 3636.70-5162.72) person-years per 100,000 persons in males and 3476.66 (95% UI: 2948.95-4010.51) person-years per 100,000 persons in females. The highest rates of YLLs, YLDs, and DALYs due to IHDs in both sexes were occurred in 80 years and older. CONCLUSIONS: The highest proportion of the burden of IHDs in the city of Isfahan was attributed to YLLs in the elderly people. Since the majority of the population of Isfahan is <60 years old and IHDs are long-lasting, the health authorities are recommended to design and implement educational and cultural programs to inform people about the risk factors and the methods to prevent these diseases. These programs can be used as a strategy to reduce the incidence of IHDs from an early age.