Worldwide, injuries are a major public health concern and make a considerable contribution to the disease burden. The present study is a component of the National and Subnational Burden of Diseases, ...Injuries, and Risk Factors from 1990 to 2013 (NASBOD) study in Iran, which was designed to investigate the burden of most important injuries (road traffic injuries, falls, burns, poisonings and drownings) at the national and sub-national levels in Iran. In this paper we explain definitions, organization, injuries selection process, data sources, data gathering methods, and data analyses of the national and sub-national burden of injuries study in Iran.
The burden of most important injuries in current metric of DALYs at the national and sub-national levels in Iran over 1990-2013 will be estimated through comprehensive reviews of either published or national data sources. Statistical modeling will be used to impute the missing data on the burden of selected important injuries for each district-year.
The results of present study can help health policy makers to plan more comprehensive and cost-effective strategies at national and sub-national level for prevention and control of burden caused by injuries.
Objectives
The Eastern Mediterranean Region faces several health challenges at a difficult time with wars, unrest, and economic change.
Methods
We used the Global Burden of Disease 2015 study to ...present the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region from 1990 to 2015.
Results
Ischemic heart disease was the leading cause of death in the region in 2015, followed by cerebrovascular disease. Changes in total deaths ranged from a reduction of 25% for diarrheal diseases to an increase of about 42% for diabetes and tracheal, bronchus, and lung cancer. Collective violence and legal intervention increased by 850% during the time period. Diet was the leading risk factor for disability-adjusted life years (DALYs) for men compared to maternal malnutrition for females. Childhood undernutrition was the leading risk factor for DALYs in 1990 and 2005, but the second in 2015 after high blood pressure.
Conclusions
Our study shows that the region is facing several health challenges and calls for global efforts to stabilise the region and to address the current and future burden of disease.
Short term randomized trials have shown the effectiveness of a fixed dose combination therapy (known as Polypill) on reducing blood pressure and serum cholesterol but the impact of Polypill on ...cardiovascular disease risk or mortality has not yet been directly investigated. Previous studies combined the effects of each component assuming a multiplicative joint risk model that may have led to overestimating the combined effects. We conducted an updated meta-analysis of randomized trials of anti-hypertensives, and aspirin. We used the estimated effect sizes applying a more conservative assumption to estimate the number of ischemic heart disease (IHD) and stroke deaths that could have been averted by Polypill in Iranians aged 55 years or older in 2006. We searched Medline and reviewed previous meta-analyses to select randomized trials on Angiotensin Converting Enzyme-inhibitors, thiazides, aspirin, and statins. We used a random-effects model to pool relative risks for each component and estimated the joint relative risks using multiplicative and additive assumptions for 4 combinations of Polypill components. We used age- and cause-specific mortality, separately by gender, and estimated the number of preventable deaths from IHD and stroke. Under the additive joint RR assumption, the standard Polypill formulation was estimated to prevent 28500 (95% CI: 21700, 34100) IHD deaths and 12700 (95% CI: 8800, 15900) stroke deaths. Removing aspirin from the combination decreased preventable IHD deaths by 15% under the additive assumption (5600 deaths) and by 21% under the multiplicative assumption (6800 deaths) and reduced preventable stroke deaths under both additive and multiplicative assumptions by 3% (300 deaths). There was no significant difference between Polypill combinations with anti-hypertensive agents in full-dose or half-dose. Polypill can prevent a large number of IHD and stroke deaths in Iran. The cost-effectiveness, feasibility, and acceptability of this prevention strategy remain to be investigated.
Objectives
To report the estimated trend in prevalence and years lived with disability (YLDs) due to vision loss (VL) in the Eastern Mediterranean region (EMR) from 1990 to 2015.
Methods
The ...estimated trends in age-standardized prevalence and the YLDs rate due to VL in 22 EMR countries were extracted from the Global Burden of Disease (GBD) 2015 study. The association of Socio-demographic Index (SDI) with changes in prevalence and YLDs of VL was evaluated using a multilevel mixed model.
Results
The age-standardized prevalence of VL in the EMR was 18.2% in 1990 and 15.5% in 2015. The total age-standardized YLDs rate attributed to all-cause VL in EMR was 536.9 per 100,000 population in 1990 and 482.3 per 100,000 population in 2015. For each 0.1 unit increase in SDI, the age-standardized prevalence and YLDs rate of VL showed a reduction of 1.5% (
p
< 0.001) and 23.9 per 100,000 population (
p
< 0.001), respectively.
Conclusions
The burden of VL is high in the EMR; however, it shows a descending trend over the past 25 years. EMR countries need to establish comprehensive eye care programs in their health care systems.
Non-communicable diseases (NCDs) and their risk factors are the major public health problems. There are some documented trend and point estimations of metabolic risk factors for Iranian population ...but there are little information about their exposure distribution at sub-national level and no information about their trends and their effects on the population health.
The present study protocol is aimed to provide the standard structure definitions, organization, data sources, methods of data gathering or generating, and data on trend analysis of the metabolic risk factors in NASBOD study. We will estimate 1990 to 2013 trends of prevalence, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) and disability-adjusted life years DALYs for MRFs by gender, age group, and province. We will also quantify the uncertainty interval for the estimates of interest.
The findings of study could provide practical information regarding metabolic risk factors and their burden for better health policy to reduce the burden of diseases, and to plan cost-effective preventive strategies. The results also could be used for future complementary global, regional, national, and sub national studies.
It is expected that gastrointestinal (GI) and liver diseases inflict considerable burden on health systems in Iran; therefore, highlighting the significance of GI disorders across the other most ...burdensome diseases requires comprehensive assessment and regular updates of the statistics of such diseases in Iran.
To assess in-depth sub-national estimates and trends for the incidence and prevalence of selected GI and liver diseases by age, gender and province over the period 1990 - 2013 in Iran.
This is a national and sub-national burden of disease study on 21 GI diseases using all available data sources, including cancer registry, death registration system data, hospital data, and all available published data. Analyses will be performed separately by gender, age groups, year, and province. We will conduct 21 separated systematic reviews of the literature for 21 diseases categories through searching online international electronic databases (i.e. the Medline database of the National Library of Medicine, Web of Science, and Scopus), Iranian search engines (i.e., IranMedex, Scientific Information Database (SID), and IRANDOC), and gray literature. We will search the medical literature published between January 1985 and December 2013. We generated two models, Spatio-temporal and Multilevel Autoregressive models, to estimate mean and uncertainty interval for the parameters of interest by gender, age, year, and province. The models will be informed by data of gender, age, year, and province. Markov Chain Monte Carlo (MCMC) methods will be used to perform Bayesian inference in both modeling framework. All programs will be written in R statistical packages (version 3.0.1).
We will calculate and present 1990 to 2013 trends in terms of prevalence, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years DALYs for the 21 selected GI diseases by gender, and province. We will also quantify the uncertainty interval for the estimates of interest.
Results of the present study will have implications for policy making; as they allow for understanding geographic distributions of the selected GI diseases, and identifying health disparities across provinces.
Short term randomized trials have shown the effectiveness of a fixed dose combination therapy (known as Polypill) on reducing blood pressure and serum cholesterol but the impact of Polypill on ...cardiovascular disease risk or mortality has not yet been directly investigated. Previous studies combined the effects of each component assuming a multiplicative joint risk model that may have led to overestimating the combined effects. We conducted an updated meta-analysis of randomized trials of anti-hypertensives, and aspirin. We used the estimated effect sizes applying a more conservative assumption to estimate the number of ischemic heart disease (IHD) and stroke deaths that could have been averted by Polypill in Iranians aged 55 years or older in 2006.
We searched Medline and reviewed previous meta-analyses to select randomized trials on Angiotensin Converting Enzyme-inhibitors, thiazides, aspirin, and statins. We used a random-effects model to pool relative risks for each component and estimated the joint relative risks using multiplicative and additive assumptions for 4 combinations of Polypill components. We used age- and cause-specific mortality, separately by gender, and estimated the number of preventable deaths from IHD and stroke.
Under the additive joint RR assumption, the standard Polypill formulation was estimated to prevent 28500 (95% CI: 21700, 34100) IHD deaths and 12700 (95% CI: 8800, 15900) stroke deaths. Removing aspirin from the combination decreased preventable IHD deaths by 15% under the additive assumption (5600 deaths) and by 21% under the multiplicative assumption (6800 deaths) and reduced preventable stroke deaths under both additive and multiplicative assumptions by 3% (300 deaths). There was no significant difference between Polypill combinations with anti-hypertensive agents in full-dose or half-dose.
Polypill can prevent a large number of IHD and stroke deaths in Iran. The cost-effectiveness, feasibility, and acceptability of this prevention strategy remain to be investigated.
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