Burden of autism spectrum disorders in North Africa and Middle East from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019.

INTRODUCTION: Autism spectrum disorders (ASD) encompass a range of neurodevelopmental disorders that affect the patient's communication and behavior. There are some reports about the increasing prevalence of ASD in recent decades, mostly due to the improvement in diagnosis and screening status. Few studies suggested a lower prevalence of ASD in North Africa and Middle East compared to more developed regions. The aim of this study is to provide a comprehensive outlook of ASD in the region. METHODS: We used Global Burden of Disease (GBD) data from 1990 to 2019 in North Africa and Middle East, which is one of the seven super regions of the GBD categorization. In this study, we reported the epidemiologic indices, including prevalence, incidence, and years lived with disability (YLDs) for ASD in the 21 countries of the super region. We also compared these indices between the countries based on their sociodemographic index (SDI) which was calculated according to income per capita, mean education, and fertility rate. RESULTS: Age-standardized prevalence rate (ASPR) of ASD in the region is 304.4 (95% uncertainty interval 251.2-366.1) per 100,000 in 2019 with less than one percentage change since 1990. Age-standardized YLDs and incidence rates were 46.4 (30.4-67.5) and 7.7 (6.3-9.3) per 100,000 in 2019. The ASPR was 2.9 times greater in males compared to females in 2019. The highest age-standardized prevalence, incidence, and YLD rates among the countries were seen in Iran in 2019 (370.3, 9.3, and 56.4 per 100,000, respectively). High SDI countries had higher age-standardized YLDs rates compared to the other countries of the region. CONCLUSION: In conclusion, the trends of age-standardized epidemiologic indices remained approximately steady through the years 1990-2019 in the region. Though, there was a wide discrepancy between the countries of the region. The difference of YLDs among the countries of this region is related to the SDI of the countries. Monetary and public awareness status are the SDI factors that may affect the quality of life of ASD patients in the region. This study provides valuable information for governments and health systems to implement policies for maintaining the improving trend, achieving more timely diagnosis, and bettering the supportive actions in this region.

Trends in the drowning mortality rate in Iran.

OBJECTIVE: The WHO estimates the global incidence of death by drowning to be about 300 000 cases per year. The objective of this study was to estimate the trend in mortality due to drowning in all provinces of Iran in all age groups and both genders from 1990 to 2015. STUDY DESIGN: The National and Subnational Burden of Diseases (NASBOD) project is a comprehensive project in Iran. It is based on the Global Burden of Disease study and includes novel methods to estimate the burden of diseases in Iran. METHODS: This study used the results of the mortality rate due to drowning as part of NASBOD and investigated the causes behind the mortality rates. The data set recorded mortality rates by 19 age groups and two genders with the corresponding subnational pattern during the time period from 1990 to 2015. RESULTS: The drowning mortality rate decreased in Iran from 1990 to 2015. From 1990 to 2015, the annual percentage change for males and females was -5.28% and -10.73%, respectively. There were 56 184 male and 21 589 female fatalities during the study period. The highest number of deaths was seen in 1993 with 4459, and the lowest number of fatalities was observed in 2015 with 903 deaths. CONCLUSION: Our data showed a decline in drowning mortality in Iran from 1990 to 2015, but the rates and declines varied by province. Our findings are of great importance to health officials and authorities in order to further reduce the burden of drowning.