Sadaf G Sepanlou1, Mahboubeh Parsaeian2, Kristopher J Krohn3, Ashkan Afshin3, Farshad Farzadfar4, Gholamreza Roshandel1, Chante Karimkhani5, Sharzad Bazargan-Hejazi6, Aliasghar Ahmad Kiadaliri7, Hamid Ahmadieh8, Shirin Djalalinia9, Hedyeh Ebrahimi10, Babak Eshrati11, Ali Reza Esteghamati12, Maryam S Farvid13, Seyed-Mohammad Fereshtehnejad14, Nima Hafezi-Nejad12, Mohammad Sadegh Hassanvand15, Pouria Heydarpour16, Farhad Islami17, Seyed M Karimi18, Marzieh Katibeh19, Ardeshir Khosravi20, Jagdish Khubchandani21, Mahdi Mahdavi22, Farhad Pishgar10, Mostafa Qorbani23, Vafa Rahimi-Movaghar24, Sare Safi8, Mohammad Ali Sahraian16, Saeid Shahraz25, Sara Sheikhbahaei12, Alireza Mohammadi26, Ali H Mokdad3, Theo Vos3, Christopher J L Murray3, Maziar Moradi-Lakeh27, Mohsen Naghavi3, Reza Malekzadeh1. 1. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 3. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. 4. Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 5. Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. 6. Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA. 7. Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden. 8. Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 9. Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran, Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran. 10. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 11. Arak University of Medical Sciences, Arak, Iran. 12. Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. 13. Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. 14. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden. 15. Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran. 16. Sina Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran. 17. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Surveillance and Health Service Research, American Cancer Society, Atlanta, GA, USA. 18. University of Washington Tacoma, Tacoma, WA, USA. 19. Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark. 20. Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran. 21. Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA. 22. National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran. 23. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. 24. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. 25. Tufts Medical Center, Boston, MA, USA. 26. Neuroscience Research Center, Baqiyatallah University of Medical Science, Tehran, Iran. 27. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA, Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran.
Abstract
BACKGROUND: Summary measures of health are essential in making estimates of health status that are comparable across time and place. They can be used for assessing the performance of health systems, informing effective policy making, and monitoring the progress of nations toward achievement of sustainable development goals. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) as main summary measures of health. We assessed the trends of health status in Iran and 15 neighboring countries using these summary measures. METHODS: We used the results of GBD 2015 to present the levels and trends of DALYs, life expectancy (LE), and HALE in Iran and its 15 neighboring countries from 1990 to 2015. For each country, we assessed the ratio of observed levels of DALYs and HALE to those expected based on socio-demographic index (SDI), an indicator composed of measures of total fertility rate, income per capita, and average years of schooling. RESULTS: All-age numbers of DALYs reached over 19 million years in Iran in 2015. The all-age number of DALYs has remained stable during the past two decades in Iran, despite the decreasing trends in all-age and age-standardized rates. The all-cause DALY rates decreased from 47,200 in 1990 to 28,400 per 100,000 in 2015. The share of non-communicable diseases in DALYs increased in Iran (from 42% to 74%) and all of its neighbors between 1990 and 2015; the pattern of change is similar in almost all 16 countries. The DALY rates for NCDs and injuries in Iran were higher than global rates and the average rate in High Middle SDI countries, while those for communicable, maternal, neonatal, and nutritional disorders were much lower in Iran. Among men, cardiovascular diseases ranked first in all countries of the region except for Bahrain. Among women, they ranked first in 13 countries. Life expectancy and HALE show a consistent increase in all countries. Still, there are dissimilarities indicating a generally low LE and HALE in Afghanistan and Pakistan and high expectancy in Qatar, Kuwait, and Saudi Arabia. Iran ranked 11th in terms of LE at birth and 12th in terms of HALE at birth in 1990 which improved to 9th for both metrics in 2015. Turkey and Iran had the highest increase in LE and HALE from 1990 to 2015 while the lowest increase was observed in Armenia, Pakistan, Kuwait, Kazakhstan, Russia, and Iraq. CONCLUSIONS: The levels and trends in causes of DALYs, life expectancy, and HALE generally show similarities between the 16 countries, although differences exist. The differences observed between countries can be attributed to a myriad of determinants, including social, cultural, ethnic, religious, political, economic, and environmental factors as well as the performance of the health system. Investigating the differences between countries can inform more effective health policy and resource allocation. Concerted efforts at national and regional levels are required to tackle the emerging burden of non-communicable diseases and injuries in Iran and its neighbors.
BACKGROUND: Summary measures of health are essential in making estimates of health status that are comparable across time and place. They can be used for assessing the performance of health systems, informing effective policy making, and monitoring the progress of nations toward achievement of sustainable development goals. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) as main summary measures of health. We assessed the trends of health status in Iran and 15 neighboring countries using these summary measures. METHODS: We used the results of GBD 2015 to present the levels and trends of DALYs, life expectancy (LE), and HALE in Iran and its 15 neighboring countries from 1990 to 2015. For each country, we assessed the ratio of observed levels of DALYs and HALE to those expected based on socio-demographic index (SDI), an indicator composed of measures of total fertility rate, income per capita, and average years of schooling. RESULTS: All-age numbers of DALYs reached over 19 million years in Iran in 2015. The all-age number of DALYs has remained stable during the past two decades in Iran, despite the decreasing trends in all-age and age-standardized rates. The all-cause DALY rates decreased from 47,200 in 1990 to 28,400 per 100,000 in 2015. The share of non-communicable diseases in DALYs increased in Iran (from 42% to 74%) and all of its neighbors between 1990 and 2015; the pattern of change is similar in almost all 16 countries. The DALY rates for NCDs and injuries in Iran were higher than global rates and the average rate in High Middle SDI countries, while those for communicable, maternal, neonatal, and nutritional disorders were much lower in Iran. Among men, cardiovascular diseases ranked first in all countries of the region except for Bahrain. Among women, they ranked first in 13 countries. Life expectancy and HALE show a consistent increase in all countries. Still, there are dissimilarities indicating a generally low LE and HALE in Afghanistan and Pakistan and high expectancy in Qatar, Kuwait, and Saudi Arabia. Iran ranked 11th in terms of LE at birth and 12th in terms of HALE at birth in 1990 which improved to 9th for both metrics in 2015. Turkey and Iran had the highest increase in LE and HALE from 1990 to 2015 while the lowest increase was observed in Armenia, Pakistan, Kuwait, Kazakhstan, Russia, and Iraq. CONCLUSIONS: The levels and trends in causes of DALYs, life expectancy, and HALE generally show similarities between the 16 countries, although differences exist. The differences observed between countries can be attributed to a myriad of determinants, including social, cultural, ethnic, religious, political, economic, and environmental factors as well as the performance of the health system. Investigating the differences between countries can inform more effective health policy and resource allocation. Concerted efforts at national and regional levels are required to tackle the emerging burden of non-communicable diseases and injuries in Iran and its neighbors.
Authors: Elsa F Ronningstam; Shian-Ling Keng; Maria Elena Ridolfi; Mohammad Arbabi; Brin F S Grenyer Journal: Curr Psychiatry Rep Date: 2018-03-26 Impact factor: 5.285