Burden of musculoskeletal disorders in Iran during 1990-2017: estimates from the Global Burden of Disease Study 2017.

Musculoskeletal diseases (MSDs) are the leading cause of disability and facing them demands updated reports on their burden for efficient policymaking. We showed Iran had the highest female-to-male ratio and highest increase in the burden of musculoskeletal diseases, in the past three decades, worldwide. We further confirmed the role of population aging as the main cause. PURPOSE: MSDs comprise most of the top causes of years lived with disability (YLDs) worldwide and are rapidly increasing in lower- and middle-income countries. Here, we present disability and mortality due to MSDs in Iran at the national level from 1990 to 2017. METHODS: We used Global Burden of Disease (GBD) 2017 Study data and standard methodology and presented the burden of MSDs in rates of years of life lost (YLLs), YLDs, and disability-adjusted life years (DALYs) during 1990-2017, for population aged ≥ 5 years old. We further explored attributable risk factors and decomposed the changing trend in DALYs to assess underlying causes. RESULTS: In Iran, MSDs were responsible for 1.82 million (95%uncertainty interval [UI] 1.3-2.4) DALYs, in 2017. During the past 28 years, with 1.75% annualized percentage change (APC), Iran had the highest percentage increase in the all-ages MSD DALYs rate worldwide, while the age-standardized DALYs APC was negligible. Low back pain was the greatest contributor to DALYs and caused 4.5% of total DALYs. The female population is experiencing considerably higher burden of MSDs, with 115% and 48% higher all-ages YLLs and YLDs rates per 100,000, respectively (YLLs 28.7; YLDs 2629.1), than males (YLLs 13.2; YLDs 1766.1). However, due to wide UIs, difference was not significant. Only 17.6% of MSD YLDs are attributable to assessed risk factors. CONCLUSION: Despite that MSDs are rising as an important cause of disability in Iran, these conditions are not sufficiently addressed in health policies. There is urgent need for cross-sectoral engagement, especially addressing the MSDs in females.

What has Iran achieved in under-five mortality in terms of equity and efficiency in the past decades?

OBJECTIVE: Iran has made remarkable progress in reducing child mortality over the past few decades. However, this promising profile is mainly average driven, and inequalities are not counted in judgments about the progress. In the present study, we used an achievement index approach to combine average and inequalities to provide a better picture of Iran's achievement in under-five mortality over the last two decades. STUDY DESIGN: The study had a cross-sectional design. METHODS: Data gathered in the two recent national demographic health surveys (DHSs) in 2000 and 2010 were used to conduct the analyses. Accordingly, 45,646 live births covered by DHS 2000 and 10,604 live births covered by DHS 2010 were investigated. An achievement index was constructed by incorporating some extensions to the concentration index, namely by incorporation of the average into the index. RESULTS: The standard concentration index showed that under-five mortality was unequally distributed, hurting the poor, across all provinces and Iran overall in 2000 (concentration index = -0.1311 [standard error {SE} = 0.0139]) and 2010 (-0.1367 [SE = 0.0381]). The achievement index revealed that Iran has had achievements in under-five mortality (relative change in the mean has decreased from 29.5% to 25.8%), but the achievement was mostly due to reductions in the average mortality and not in its unequal distribution. The same result applied to a considerable number of provinces, and only a few have made achievements in both inequality and average. CONCLUSIONS: Considering the lack of progress in the reduction of inequalities in under-five mortality over the past decades, equity-oriented policies should be of prime importance for Iran's healthcare system.