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. 2009 Jun 15:7:9.
doi: 10.1186/1478-7954-7-9.

The burden of disease and injury in Iran 2003

Mohsen Naghavi  1 , Farid Abolhassani, Farshad Pourmalek, Moradi Lakeh, Nahid Jafari, Sanaz Vaseghi, Niloufar Mahdavi Hezaveh, Hossein Kazemeini
Affiliations

The burden of disease and injury in Iran 2003

Mohsen Naghavi et al. Popul Health Metr. .

Abstract

Background: The objective of this study was to estimate the burden of disease and injury in Iran for the year 2003, using Disability-Adjusted Life Years (DALYs) at the national level and for six selected provinces.

Methods: Methods developed by the World Health Organization for National Burden of Disease (NBD) studies were applied to estimate disease and injury incidence for the calculation of Years of Life Lost due to premature mortality (YLL), Years Lived with Disability (YLD), and DALYs. The following adjustments of the NBD methodology were made in this study: a revised list with 213 disease and injury causes, development of new and more specific disease modeling templates for cancers and injuries, and adjustment for dependent comorbidity. We compared the results with World Health Organization (WHO) estimates for Eastern Mediterranean Region, sub-region B in 2002.

Results: We estimated that in the year 2003, there were 21,572 DALYs due to all diseases and injuries per 100,000 Iranian people of all ages and both sexes. From this total number of DALYs, 62% were due to disability premature deaths (YLD) and 38% were due to premature deaths (YLL); 58% were due to noncommunicable diseases, 28% - to injuries, and 14% - to communicable, maternal, perinatal, and nutritional conditions. Fifty-three percent of the total number of 14.349 million DALYs in Iran were in males, with 36.5% of the total due to intentional and unintentional injuries, 15% due to mental and behavioral disorders, and 10% due to circulatory system diseases; and 47% of DALYs were in females, with 18% of the total due to mental and behavioral disorders, 18% due to intentional and unintentional injuries, and 12% due to circulatory system diseases. The disease and injury causes leading to the highest number of DALYs in males were road traffic accidents (1.071 million), natural disasters (548 thousand), opioid use (510 thousand), and ischemic heart disease (434 thousand). The leading causes of DALYs in females were ischemic heart disease (438 thousand), major depressive disorder (420 thousand), natural disasters (419 thousand), and road traffic accidents (235 thousand). The burden of disease at the province level showed marked variability. DALY estimates by Iran's NBD study were higher than those for EMR-B by WHO.

Conclusion: The health and disease profile in Iran has made the transition from the dominance of communicable diseases to that of noncommunicable diseases and road traffic injuries. NBD results are to be used in health program planning, research, and resource allocation and generation policies and practices.

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Figures

Figure 1
Figure 1
Burden of disease groups by DALYs, all ages and both sexes, Iran 2003.
Figure 2
Figure 2
Top 21 disease and injury causes of ICD-10 with the highest burden, all ages and both sexes, Iran 2003. (1) Natural disasters: Exposure to forces of nature (including the Bam earthquake of 26 December 2003); (2) Bipolar disorders I, II, and cyclothymia; (3) COPD: Chronic Obstructive Pulmonary Disease; (4) Exposure to mechanical forces of the nature; (5) Upper Respiratory Infections and otitis media; (6) Respiratory and cardiovascular disorders specific to the perinatal period. Note: The rationale for presenting the 21 highest burden of disease and injury causes in this figure is that if the Bam earthquake is omitted – since such a huge disaster is not to be repeated every year – still the 20 highest burden disease and injury causes are presented.
Figure 3
Figure 3
Sex differentials in burden of disease by age, Iran 2003. The orange shaded area under the YLD curve for females between ages 15–69 shows the extra burden of disability for this group. The blue shaded area under the YLL curve for males between ages 5–69 shows the extra burden of mortality in this group.
Figure 4
Figure 4
Share of YLL by three GBD disease groups and age, Iran 2003. Figures in black indicate the percent of YLL due to injuries to total YLL in each age group.
Figure 5
Figure 5
Share of YLD by three GBD disease groups and age, Iran 2003. Figures in blue indicate the percent of YLD due to noncommunicable diseases to total YLD in each age group.
Figure 6
Figure 6
Share of DALYs by three GBD disease groups, Iran 2003. Figures in blue indicate the percent of DALYs due to noncommunicable diseases to total DALYs in each age group.
Figure 7
Figure 7
Total YLD and YLL rates per 100,000 in six provinces of Iran in 2003.
Figure 8
Figure 8
Total DALY rates per 100,000 by sex, all ages, Iran 2003, EMR Sub-region B (EMRB) 2002, and Eastern Mediterranean Region (EMR) 2002.
Figure 9
Figure 9
DALY rates per 100,000, by three disease groups of GBD, all ages and both sexes, Iran 2003, EMR Sub-region B (EMRB) 2002, and Eastern Mediterranean Region (EMR) 2002. C.M.P.N.: Communicable, Maternal, Perinatal, and Nutritional conditions; NCD: Noncommunicable Diseases.
Figure 10
Figure 10
DALY rates per 100,000 from road traffic injuries by sex, all ages, Iran 2003, EMR Sub-region B (EMRB) 2002, and Eastern Mediterranean Region (EMR) 2002.
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