National and sub-national environmental burden of disease in Iran from 1990 to 2013-study profile.
BACKGROUND
Development of national evidence-based public health strategies requires a deep understanding of the role of major risk factors (RFs) and the burden of disease (BOD). In this article, we explain the framework for studying the national and sub-national Environmental Burden of Disease (EBD) in Iran as a part of the National and Sub-national Burden of Disease (NASBOD) study.


METHODS
The distribution of exposures to environmental RFs and their attributable effect size over 1990-2013 will be estimated through comprehensive reviews of either published or unpublished sources. Statistical modeling will be used to impute missing data in the distribution of RFs exposures for each district-year. National and sub-national BOD attributable to these RFs will be estimated in the following metrics: Prevalence, death, years of life lost due to premature death (YLL), years of life lost due to disability (YLD), and disability-adjusted life years lost (DALYs). The BOD attributable to the current distribution of exposures will be compared with a counterfactual exposure distribution scenario-here, the theoretical-minimum-risk exposure distribution. Inequalities in the distribution of exposure to RFs will be analyzed and manifested nationwide using geographic information systems.


CONCLUSIONS
The EBD study aims to provide an official report to Iranian Ministry of Health and Medical Education, to publish a series of articles on the exposure trends of the selected environmental RFs, to estimate the BOD attributable to these RFs, and to assess inequalities and its determinants in the distribution of exposure to RFs. Iran's territory is large with diverse population, socioeconomic, and geographic areas. Results of this comparative risk assessment study may pave the way for health policy makers to plan more comprehensive and cost-effective evidence-based strategies.
Kurdistan Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran. yunesian@tums.ac.ir, f-farzadfar@tums.ac.ir.
Hassan
H
Amini
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Mansour
M
Shamsipour
Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
Mohammad Hossein
MH
Sowlat
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Mahboubeh
M
Parsaeian
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Med.
Amir
A
Kasaeian
Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences.
Mohammad Sadegh
MS
Hassanvand
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Homa
H
Kashani
Department of Public Health, Faculty of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Reza
R
Saeedi
Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran. Department of Environmental Health Engineering, School of Health, Tabriz University of Medical Sciences, Tabri.
Mohammad
M
Mosaferi
Department of Environmental Health Engineering, School of Public Health, Shahid Beheshti University of Medical Science, Tehran, Iran.
Parviz
P
Nowrouz
Department of Disaster and Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Teh.
Elham
E
Ahmadnezhad
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Katayoun
K
Rabiei
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Department of Public Health, Faculty of Health, Safety and Environment, Shahid Beheshti Univers.
Alireza
A
Mesdaghinia
Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran Uni.
Masud
M
Yunesian
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute.
Farshad
F
Farzadfar
D004781:Environmental Exposure / Q000706:statistics & numerical data*; D018876:Environmental Illness / Q000453:epidemiology*; D006291:Health Policy; D006801:Humans; D007492:Iran / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors