Trends of Diabetes Mortality in Iran at National and Sub-National Levels from 1990 to 2015 and Its Association with Socioeconomic Factors.

Background: Following global commitments to prevent and control non-communicable diseases, we sought to estimate national and sub-national trends in diabetes mortality in Iran and assess its association with socioeconomic factors. Methods: In a systematic analytical study, to assess the correlation between diabetes mortality and socioeconomic factors, we used data obtained from the Death Registration System (DRS), the Spatio-temporal model and Gaussian Process Regression (GPR) levels and the diabetes mortality trends, which were estimated by sex, age and year at national and sub-national levels from 1990 to 2015. Results: Between the years 1990 and 2015, the age-standardized diabetes mortality rate (per 100,000) increased from 3.40 (95% UI: 2.33 to 4.99) to 7.72 (95% UI: 5.51 to 10.78) in males and from 4.66 (95% UI: 3.23 to 6.76) to 10.38 (95% UI: 7.54 to 14.23) in females. In 1990, the difference between the highest age-standardized diabetes mortality rate among males was 3.88 times greater than the lowest (5.97 vs. 1.54), and in 2015 this difference was 3.96 times greater (14.65 vs. 3.70). This provincial difference was higher among females and was 5.13 times greater in 1990 (8.41 vs. 1.64) and 5.04 times greater in 2015 (19.87 vs. 3.94). The rate of diabetes mortality rose with urbanization yet declined with an increase in wealth and years of schooling as the main socio-economic factors. Conclusion: The rising trend of diabetes mortality rate at the national level and the sub-national disparities associated with socioeconomic status in Iran warrant the implementation of specific interventions recommended by the '25 by 25' goal.

A nationwide study of metabolic syndrome prevalence in Iran; a comparative analysis of six definitions.

INTRODUCTION: To integrate and execute a proper preventive plan and reduce the risk of non-communicable diseases (NCDs), policy makers need to have access to both reliable data and a unique definition of metabolic syndrome (MetS). This study was conducted on the data collected by cross-sectional studies of WHO's STEPwise approach to surveillance of NCD risk factors (STEPs) to estimate the national and sub-national prevalence rates of MetS in Iran in 2016. MATERIALS AND METHODS: The prevalence of MetS was estimated among 18,414 individuals aged ≥25 years living in urban and rural areas of Iran using various definition criteria; National Cholesterol Education Program Adult Treatment Panel III 2004 (ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), Joint Interim Statement (JIS). Regional IDF (RIDF) and JIS (RJIS) were defined using ethnicity-specific values of waist circumference for the country. RESULTS: National prevalence rate of MetS based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS criteria were 38.3% (95% CI 37.4-39.1), 43.5% (42.7-44.4), 40.9% (40.1-41.8), 47.6% (46.8-48.5), 32.0% (31.2-32.9), and 40.8% (40.0-41.7), respectively. The prevalence was higher among females, in urban residents, and those aged 65-69 years. MetS was expected to affect about 18.7, 21.3, 20.0, 23.3, 15.7, and 20.0 million Iranians, respectively, based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS. The two most common components noted in this population were reduced high-density lipoprotein cholesterol (HDL-C) levels and central obesity. CONCLUSION: High prevalence rate of MetS among Iranian adults is alarming, especially among females, urban residents, and the elderly. The JIS definition criteria is more appropriate to determine higher number of Iranians at risk of NCDs. Proper management and prevention of MetS is required to adopt multiple national plans including lifestyle modifications, medical interventions, and public education on NCDs risk factors.

Mortality Attributable to Nutritional Deficiencies among Iranian Children under the Age of Five at National and Subnational Level: 1995-2015.

BACKGROUND: Under-five mortality is considered an indicator of population well-being and health equality in societies. Under-five mortality caused by nutritional deficiencies is a public health concern in developing countries. In this study, we aimed to report the trend and mortality rate of nutritional deficiencies from 1995 to 2015 in children aged under five years. METHODS: In this study, we used the death registration system (DRS) data to estimate age- and sex-specific nutritional deficiency mortality rates at national and sub-national levels in Iran from 1995 to 2015. The Iranian DRS used the 10th revision of International Classification of Diseases (ICD-10) but we report our results based on Global Burden of Diseases (GBD) study codes. We used the average annual percent change (AAPC) to quantify trend in under-five mortality rate attributable to nutritional deficiencies from 1995 to 2015. RESULTS: At national level, mortality rates in both sexes were 8.53 (95% uncertainty interval [UI]: 7.69-9.47), 1.04 (0.86-1.36), and 0.37 (95% UI: 0.28-0.57) per 100,000 in 1995, 2005, and 2015, respectively. AAPC was estimated between 1995 and 2015. At sub-national level, the highest and lowest mortality rates across provinces ranged from 17.7 per 100000 in 1995 to 1.1 per 100000 in 2015. In the latest years, protein-energy malnutrition (PEM) was the most frequent cause of mortality among other nutritional deficiencies. CONCLUSION: The results show a substantial reduction in terms of mortality caused by nutritional deficiencies at national, as well as provincial, level among children under-five years of age.

National and sub-national patterns of mortality from stroke in the Iranian population (1990-2015): Complementary results from the NASBOD study.

BACKGROUND: Iran lacks a population level comprehensive assessment of stroke epidemiology. Using data from the NASBOD Study, we estimated the mortality of stroke among the Iranian population from 1990 to 2015. METHODS: Data were collected from all the available sources including the national death registration system and two major cemeteries. After addressing incompleteness of child and adult death data and by using mixed effect model, spatio-temporal model and Gaussian Process Regression, levels and trends of child and adult mortality were estimated. By considering cause fraction to these estimates; cause specific mortality was estimated. In these process wealth index, urbanization, and years of schooling were used as covariates. RESULTS: In 2015, the age-standardized stroke mortality rate due was 47.76 (95% UI: 34.68-65.03) for males and 40.16 (30.38-5 2.72) for females, per 100,000 population. Stroke occurrence for both ischemic and non-ischemic strokes showed decreasing trends in both sexes after 2001-2002, at national and sub-national levels. The highest and lowest mortality rates between provinces ranged from 52.11 (40.3-66.66) to 24.47 (18.71-31.79) in men and from 65.51 (47.13-89.41) to 30.43 (21.95-41.82) in women per 100,000 population. CONCLUSION: Although age-standardized rates of stroke mortality are falling, in the past three decades, the absolute number of people who have had a stroke has increased. Stroke mortality remains high in Iran.

Physical activity profile of the Iranian population: STEPS survey, 2016.

BACKGROUND: Insufficient physical activity (IPA) is one of the leading causes of premature mortality through the increased burden of non-communicable diseases. From 1990 to 2017, the percentage of low physical activity attributable disability-adjusted life years (DALY) increased globally by 1.5 times and 2-fold in Iran, causing more than 1.2 million deaths worldwide and 18,000 deaths in Iran in 2017. Reports suggest that Iran, a developing middle-income country, suffers from a high level of IPA. Socioeconomic and cultural alterations along with the country's developments expose the population to IPA risk. We aimed to describe IPA prevalence in Iran's adult population, categorized by demographics, geographical region, and activity domains to assess the present pattern of physical inactivity and its domains in the country. METHODS: In 2016, in order to represent Iran's adult population, adult participants (n: 30541) from 30 provinces were selected using systematic proportional to size cluster sampling. Physical activity (PA) was assessed via the Global Physical Activity Questionnaire, calculating the Metabolic Equivalent of Task (MET) value in minutes per week for work, recreation, and transport domains. Insufficient physical activity (IPA) was defined according to WHO's recommendation (less than 600 METs per week). Adjusted odds ratios of IPA associates for sociodemographic, lifestyle related variables, and metabolic risk factors were reported. RESULTS: A high prevalence of IPA was seen in the total population (54.7%, 95%CI: 54.0-55.3) with a considerable difference between the two genders (males: 45.3% (95%CI: 44.3-46.3); females: 61.9% (95%CI: 61.0-62.7)). Work-related activity was the domain with the greatest percentage of total PA, whereas, both genders lacked recreational activities. In our findings, being female, a housekeeper, younger and living in urban areas were significantly associated with higher levels of IPA. Moreover, insufficient fruit and vegetable consumption, lack of alcohol consumption, having a personal vehicle, and finally, having a medical history of diabetes were significantly associated with the presence of IPA in our population. Among the study population, 33.6% (95%CI: 33.0-34.2) had at least 4 h of sedentary behavior in a typical day. CONCLUSIONS: Widespread IPA among the Iranian adult population is of major concern. In our findings, we observed a considerable gap in the prevalence and pattern of IPA between the two genders. Additionally, IPA was associated with living in urban areas, unhealthy lifestyle habits and a history of other metabolic risk factors. Thus, a prompt initiative for population-specific actions should be taken.