Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030.

This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be - 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were - 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of - 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001-2016 were - 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be - 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.

The burden of colorectal cancer attributable to dietary risk in Middle East and North African from 1990 to 2019.

The incidence of colorectal cancer (CRC) is increasing in low- and middle-income countries. This study aimed to estimate the burden of CRC attributable to nutritional risk in the Middle East and North Africa (MENA) region. The GBD 2019 methods were used to estimate age-standardized mortality rates (ASMRs) and disability-adjusted life-years (DALYs) in 2019 and over the past three decades. We evaluated the 30-year trend in DALYs and mortality rates from nutrition-related risks of CRC, from 1990 to 2019 by sex and age groups in 21 countries in the MENA region. The rate of DALYs/100,000 due to diet-related risks for CRC in 2019 was 79.71 (95% UI: 56.79, 98.44) and 65.16 (95% UI: 45.86, 80.95) in men and women, respectively. The percent changes of DALYs/100,000 in men and women were 8.15% and 2.50%, respectively, between 1990 and 2019. The percent changes in ASMRs in men and women were 8.32% and 3.44%, respectively. The highest DALYs and ASMRs were observed in both sexes in the age group 75-79 years and above. The highest percent changes in DALYs/100,000 and ASMRs were observed between 1990 and 2019 in Afghanistan, Egypt, Iran, Iraq, Lebanon, Libya, Morocco, Palestine, Qatar, Saudi Arabia, Sudan and Yemen. DALYs and ASMRs attributed to dietary risk for CRC increased in 21 countries in the MENA region from 1990 to 2019. A modified diet with more fiber, dairy products and less red meat intake is a highly recommended strategy for prevention CRC.

A prospective cohort study protocol: monitoring and surveillance of adverse events following heterologous booster doses of Oxford AstraZeneca COVID-19 vaccine in previous recipients of two doses of Sinopharm or Sputnik V vaccines in Iran.

BACKGROUND: Regarding the paucity of evidence on the side effects of the booster dose of Oxford AstraZeneca vaccine in vaccinated people with Sinopharm or Sputnik V, we aimed to set up a cohort event monitoring (CEM) study to capture adverse events occurring in individuals who will receive the booster doses of AstraZeneca (either the first or second booster dose) following being vaccinated with Sinopharm or sputnik V vaccines in Iran. METHODS: The present study is an active COVID-19 vaccine safety surveillance through an observational prospective cohort study that will be conducted in vaccination centers in Iran. The study will be conducted in twelve provinces of Iran. Study sites are vaccination centers where the AstraZeneca vaccine is administered to the cohort population. The study population includes all individuals who have received two doses of Sinopharm or Sputnik V vaccines and either the first or second booster dose of AstraZeneca according to the national guidelines for immunization in Iran in 2023. We are planning to include 30,000 eligible people in this study. Each individual will be followed up for 13 weeks after either the first or second booster dose of the AstraZeneca vaccine. Furthermore, convenience sampling is used to include participants in the present study. Participation in the study will be strictly voluntary. DISCUSSION: With the planned study we will provide a valid epidemiological evidence to improve the understanding of the safety of the booster dose of the AstraZeneca and to better evaluate the effectiveness of public health interventions. This could help policy makers in managing the COVID-19 pandemic according to scientific evidence.

The burden of osteoarthritis due to high Body Mass Index in Iran from 1990 to 2019.

High BMI related burden of knee and hip osteoarthritis (OA) is on a significant rise worldwide. OA not only causes joint pain and stiffness, but it also leads to disability. This study investigated the trend and burden of OA attributable to high body mass index (BMI) in Iran. The age-standardized disability-adjusted life years (DALYs) rates of knee and hip OA due to high BMI, were estimated using data from the Global Burden of Disease 2019. We evaluated DALYs rate trend of high BMI related OA by sex and age in span of 30 years from 1990-2019 across the 31 provinces of Iran. The age-standardized prevalence trend of OA in the knee and hip showed an increase from 1990 to 2019. In 2019 there were 29.92 (95% CI: 10.98-64.92) and 42.50 (95% CI: 16.32-97.37) DALYs/100,000 related to OA from high BMI in men and women, respectively. 2019 saw the greatest DALYs/100,000 rate in the 65-79 age group. From 2005 to 2019, men and women saw DALYs/100,000 rate changes of 24.87 and 17.43 percent, respectively. The burden of knee OA was significantly higher than that of hip OA. DALYs rate of OA due to high BMI was found to be positively associated with the Socio-demographic Index (SDI). The burden of knee and hip OA due to high BMI has increased significantly in recent years in Iran among all age groups of both men and women. It is recommended that health policymakers develop weight control strategies to reduce the burden of OA and implement them at the national level.

A Comprehensive Evaluation of Occupational Epidemiology in Western Iran: A Cohort Study in Ravansar Noncommunicable Diseases.

OBJECTIVE: The present study aims to evaluate the prevalence of noncommunicable diseases (NCDs), biochemical and anthropometric indicators, and lifestyle among 10 occupational groups. METHOD: The sample included 4818 men aged 35 to 65 years. The occupational group is based on the International Standard Classification of Occupations. RESULT: The highest prevalence of cardiovascular diseases and type 2 diabetes mellitus was observed in managerial occupational groups (18.62%) and technicians and associate professionals ( 14 %), respectively. Musculoskeletal disorders were more in skilled agricultural, forestry, and fishery workers, as well as craft-related trades workers, and elementary occupations. The highest body mass index was related to the managers. CONCLUSIONS: Noncommunicable diseases were higher in managers, while musculoskeletal disorders belonged to farmers and workers. Finally, lifestyle modification can help reduce NCDs and improve biochemical markers by increasing physical activity.

Demographic and clinical characteristics and outcomes of COVID-19 patients admitted to a university hospital in the west of Iran: a retrospective study in the third wave.

COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of this infectious disease vary from a country to another and from one peak to the next. The aim of the present study was to describe the COVID-19 patients hospitalized in Kermanshah, a city in the west of Iran, in the third peak of the disease and to identify in-hospital mortality determinants in this disease. Methods: In this retrospective study, the clinical and demographic characteristics, laboratory findings, prescribed treatments and outcome of all COVID-19 patients (definitive, suspected, and probable) were collected from the medical records department of Farabi Hospital affiliated with Kermanshah University of Medical Sciences, Kermanshah, Iran from 22 October to 20 November 2020. Results: In total, 665 COVID-19 patients (265 females and 400 males, mean age: 58.7 years) were enrolled, including 479 confirmed, 15 probable, and 30 suspected cases. About 84% of the patients presented with low oxygen saturation levels. The most common comorbidities were hypertension (15%), diabetes (10%), and cardiovascular disease (3%). The median (IQR) length of hospital stay was 6 (Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021 (4., 5., 6., 7., 8.)) and 7 (Javadi Mamaghani et al., 2021; Abdolahnejad et al., 2022; Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021; Sayad et al., 2021; Hesni et al., 2022; Buttenschøn et al., 2022; Smits et al., 2022; Rosenberger et al., 2021; Shi et al., 2022 (2., 3., 4., 5., 6., 7., 8., 9., 10., 11., 12., 13., 14.)) day in discharged and deceased patients, respectively. Eighty-two out of 655 patients admitted to the hospital and 39of the 60 patients admitted to the ICU died. In total, in-hospital mortality rate was 12.33%. Regarding lab variables, in the adjusted model, no significant difference was observed between discharged and deceased patients.The results of multivariable logistic regression showed that each one-unit increase in oxygen saturation (SPO2) increased the odds of survival by 0.88 times (aOR 0.88, 95% CI 0.78-0.99, p = 0.043). Moreover, each one-day increase in the length of ICU stay reduced the odds of mortality by 0.49 times (aOR 0.82, 95% CI 0.26-0.95, p = 0.035). Conclusion: Hospitalized COVID-19 patients were generally more ill during the third peak so that about 85% of the patients had SPO2 ≤ 93%. The in-hospital mortality rate was also high. Demographic and paraclinical variables (except SPO2 level) were not suitable predictors of mortality.

Introducción: COVID-19 es una enfermedad causada por el síndrome respiratorio agudo severo coronavirus 2 (SARS CoV 2). Las características de esta enfermedad infecciosa varían de un país a otro y de un pico a otro. El objetivo del presente estudio fue describir a los pacientes con COVID-19 hospitalizados en Kermanshah, una ciudad al oeste de Irán, durante la tercera ola pandémica e identificar los determinantes de mortalidad hospitalaria de esta enfermedad.Métodos: en este estudio retrospectivo, las características clínicas y demográficas, los hallazgos de laboratorio, los tratamientos prescritos y el resultado de todos los pacientes ingresados por COVID-19 (definitivo, sospechoso y probable) se recopilaron a partir de los registros médicos del Hospital Farabi afiliado a la Universidad de Medicina de Kermanshah. Sciences, Kermanshah, Irán, del 22 de octubre al 20 de noviembre de 2020.Resultados: En total, se registraron 665 pacientes ingresados por COVID-19 (265 mujeres y 400 hombres), de los cuales 479 casosfueron confirmados, 15 probables y 30 sospechosos. La edad promedio del total de casos fue de 58,7 años. Alrededor del 84% de los pacientes presentaron niveles bajos de saturación de oxígeno. Las comorbilidades más comunes fueron hipertensión (15%), diabetes (10%) y enfermedad cardiovascular (3%). La mediana (RIC) de estancia hospitalaria fue de 6 (Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021 (4., 5., 6., 7., 8.)) y 7 (Javadi Mamaghani et al., 2021; Abdolahnejad et al., 2022; Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021; Sayad et al., 2021; Hesni et al., 2022; Buttenschøn et al., 2022; Smits et al., 2022; Rosenberger et al., 2021; Shi et al., 2022 (2., 3., 4., 5., 6., 7., 8., 9., 10., 11., 12., 13., 14.)) días en pacientes dados de alta y fallecidos, respectivamente. El 82 de los 655 pacientes ingresados en el hospital y el 39 de los 60 pacientes ingresados en UCI fallecieron. En total, la tasa de mortalidad hospitalaria fue del 12,33%. En cuanto a las variables de laboratorio, en el modelo ajustado no se observaron diferencias significativas entre los pacientes dados de alta y los fallecidos. Los resultados de la regresión logística multivariable mostraron que cada aumento de una unidad en la saturación de oxígeno (SPO2) aumentó las probabilidades de supervivencia en 0,88 veces (ORa 0,88, IC del 95% 0,78-0,99, p = 0,043). Además, cada aumento de un día en la duración de la estancia en la UCI redujo las probabilidades de mortalidad en 0,49 veces (ORa 0,82, IC del 95%: 0,26-0,95, p = 0,035).Conclusión: los pacientes hospitalizados con COVID-19 generalmente estaban más enfermos durante el tercer pico, de modo que aproximadamente el 85% de los pacientes tenían SPO2 ≤ 93%. La tasa de mortalidad hospitalaria también fue alta. Las variables demográficas y paraclínicas (excepto el nivel de SPO2) no fueron predictores adecuados de mortalidad.

Mortality and disability-adjusted life years for smoking-attributed cancers from 1990 to 2019 in the north Africa and middle east countries: a systematic analysis for the global burden of disease study 2019.

AIM AND BACKGROUND: Smoking is a modifiable risk factor for cancers. The aim of the study is to estimate the trend of mortality and DALYs of smoking-attributed cancers in the North Africa and Middle East (NAME) countries. METHODS: In this study, estimates from the Global Burden of Disease 2019 (GBD-2019) study were used to report the mortality and DALYs for 16 smoking-attributed cancers. The mortality and DALYs rates from smoking-attributed cancers were evaluated by age, sex, and the 21 countries of the NAME countries from 1990 to 2019. RESULTS: Age standardized mortality rates (ASMR) for the 29 smoking-attributed cancers in the NAME countries in 1990 and 2019 were estimated to be 24.7 (95% Uncertainty Interval: 21.5, 27.8) and 22.4 (95%UI: 19.8, 25.4) respectively, which shows a 9.2% decrease in the three decades. DALYs/100,000 for smoking-attributed cancers was, also, estimated to be 600.3 (95%UI: 521.6, 682.6) and 515.6 (95%UI: 454.9, 585.4) respectively, which indicates a 14.1% decreased in these three decades. In the last three decades, the percentage changes in DALYs/100,000 for smoking-attributed cancers in males and females were - 0.16 and - 0.03, respectively. Plus, The percentage changes in ASMR in males and females were - 12% and 8%, respectively. Furthermore, The highest ASMR and DALYs were observed in Lebanon, Turkey, and Palestine in 2019. CONCLUSION: The mortality rates of cancers from smoking have increased substantially among females, in most countries of the NAME region, in recent years. The burden caused by smoking can be reduced through modifying lifestyle and applying strict laws on smoking by governments and policymakers.

Evaluation of some toxic metals in breast milk samples with dietary and sociodemographic characteristics: a case study of Kermanshah, Western Iran.

This study aimed to investigate the concentration of some toxic metals (gold (Au), cadmium (Cd), chromium (Cr), mercury (Hg), nickel (Ni), lead (Pb), tin (Sn), and vanadium (V)) and arsenic (As) in breast milk based on demographic characteristics and the diet of mothers. In this cross-sectional study, 100 lactating mothers from Kermanshah, Western Iran, were included. The mean age of the participants was 29.5 (ranging from 16 to 43 years) with a mean BMI of 26.9 (± 3.81) kg (range: 17.0-39.1). The results of the pairwise correlation coefficient of trace elements illustrated that correlation was mostly positive and weak to moderate. A few exceptions of strong correlations were Cr-Ni (r = 0.82), Au-As (r = 0.64), Cr-V (r = 0.64), and Ni-V (r = 0.58). Moreover, results indicated that BMI (p = 0.008), cooking oil (0.042), and potato intake (p = 0.010) affected the trace element levels significantly. The concentrations of V (p = 0.044), Sn (p = 0.036), Au (p < 0.001), and As (p < 0.001) in the breast milk of women was affected by the BMI. The results of univariate linear regression analysis showed that the concentration of Pb in the milk of mothers who use cosmetics was significant (p < 0.05). Since the lifestyle of lactating women, such as cosmetics usage can impact the content of some elements in breast milk, they should be educated in this part.

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.

Disability-adjusted life years and mortality rate attributed to unsafe sex and drug use for AIDS in the Middle East and North Africa countries.

BACKGROUND: The Middle East and North Africa, is one of few regions where the number of new human immunodeficiency virus infections is increasing. The present study aimed to estimate the attributable burden of unsafe sex and drug use in Acquired immunodeficiency syndrome in the Middle East and North Africa countries. METHODS: We used the Global Burden of Disease data 2017 to estimate the attributable mortality and disability-adjusted life-years to unsafe sex and drug use in Acquired immunodeficiency syndrome in the Middle East and North Africa countries (21 countries) from 1990 to 2017 by region, sex and age. The percent change was calculated at three time points by country and sex. RESULTS: The rate of Disability-adjusted life years/100,000 attributed to drug use for Acquired immunodeficiency syndrome increased 1.10 (95% CI: 0.75-1.71) to 13.39 (95% CI: 9.98-18.17) in women of Middle East and North Africa countries from 1990 to 2017, and there is an increasing trend in Disability-adjusted life years attributable to drug use for Acquired immunodeficiency syndrome in men. The rate of Disability-adjusted life years/100,000 attributed to unsafe sex for Acquired immunodeficiency syndrome increased in women of Middle East and North Africa countries, 5.15 (95% CI: 3.34-8.07) to 53.44 (95% CI: 38.79-75.89); and 10.06 (95% CI: 6.61-16.18) to 46.16 (95% CI: 31.30-72.66) in men. Age-standardized mortality rate attributed to drug use and unsafe sex for Acquired immunodeficiency syndrome increased from 1990 to 2017 in both sex in Middle East and North Africa countries. CONCLUSION: The rate of Disability-adjusted life years /100,000 and age-standardized mortality rate attributed to unsafe sex and drug use increased in Middle East and North Africa from 1990 to 2017. While most of such countries have traditional cultures with religious believes, such increase need to be addressed in more depth by all policy makers.

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.

Association between depression with glycemic control and its complications in type 2 diabetes.

AIMS: This study aims to determine the association between depression with glycemic control (HbA1c) and its complications. MATERIALS AND METHODS: This was a cross-sectional study that included 514 diabetic patients. The patients were randomly selected from among all type 2 diabetes patients referred to health and medical centers in Khorramabad town (Iran). Two questionnaires used for data collection. The first questionnaire included demographic information, diabetes and its complications and the second questionnaire was Beck Depression Inventory (BDI-II) which was used to assess depression. The stata software version 14 was used for data analysis. Then, for evaluate the association between depression with glycemic contol and its complications, Univariate and multiple logistic regression analysis were employed. RESULTS: The prevalence of depression in diabetic patients under study was 46.3% and for female and male was 49.6 and 36.8%; respectively. The results showed that 48.6% of diabetic patients did not have appropriate glycemic control status (HbA1c > 8). There was no significant association between glycemic control expressed as HbA1c levels and depression (OR: 1.11, 95% CI: 0.87-1.57). By contrast, sex (OR: 2.03, CI 95%: 1.03-3.99), residence (OR: 1.92, 95% CI: 1.28-2.91) and sexual complications (OR: 5.54, 95% CI: 1.07-27.87) have a significant statistical association with depression. CONCLUSION: The study highlights the high prevalence of depression in diabetic patients. However, there was no significant association between depression and glycemic control. The implementation of mental health screening for rapid diagnosis and timely treatment of depression seems essential in diabetic patients.

Prevalence of underweight and wasting in Iranian children aged below 5 years: a systematic review and meta-analysis.

PURPOSE: Wasting and underweight are the 2 main indicators of children's undernutrition. We aimed to estimate the prevalence of undernutrition at the national level in Iran. METHODS: We performed a search for original articles published in international and Iranian databases including MEDLINE, Web of Science, Google Scholar, Scopus, CINHAL (Cumulative Index to Nursing and Allied Health Literature), Scientific Information Database, Irandoc, Iranmedex, and Magiran during January 1989-August 2017. Seven keywords, in English and Persian, including malnutrition, protein energy malnutrition, growth disorders, underweight wasting, weight loss, children below 5 years old, and children, were used to search the databases. RESULTS: Finally, 17 articles were included in the meta-analysis, based on which the prevalence of underweight and wasting in Iranian children were estimated to be 11% and 5%, respectively. The prevalence rates of underweight among children in the central, western, southern, and northern parts of Iran and at the national level were 24%, 5%, 20%, 17%, and 6%, respectively. The prevalence rates of wasting in the central, western, southern, and northern parts of Iran and at the national level were 9%, 4%, 11%, 5%, and 4%, respectively. CONCLUSION: Although the prevalence of underweight and wasting in Iran was low, some parts of the country showed high prevalence. The main reason behind this difference in the prevalence of malnutrition may be due to the level of development in different regions.