Health transition in Iran toward chronic diseases based on results of Global Burden of Disease 2010.
BACKGROUND
Drawing on the results of the country-level Global Burden of Diseases, Injuries, and Risk Factors 2010 Study, we attempted to investigate the drivers of change in the healthcare system in terms of mortality and morbidity due to diseases, injuries, and risk factors for the two decades from 1990 to 2010.


METHODS
We decomposed trends in mortality, cause of death, years of life lost due to disability, disability-adjusted life years (DALYs), life expectancy, health-adjusted life expectancy, and risk factors into the contribution of total increase in population size, aging of the population, and changes in age-specific and sex-specific rates.


RESULTS
We observed a decrease in age-specific mortality rate for both sexes, with a higher rate for women. The ranking of causes of death and their corresponding number of years of life lost remained unchanged between 1990 and 2010. However, the percentages of change indicate patterns of reduction for most causes, such as ischemic and hemorrhagic stroke, hypertensive heart disease, stomach cancer, lower respiratory infections, and congenital anomalies. The number of years lost due to disability caused by diabetes and drug use disorders has significantly increased in the last two decades. Major causes of DALYs, such as injuries, interpersonal violence, and suicide, showed increasing trends, while rates of communicable diseases, neonatal disorders, and nutritional deficiencies have declined significantly. Life expectancy and health-adjusted life expectancy increased for both sexes by approximately 7 years, with the highest rate of increase pertaining to females over the age 30.


CONCLUSIONS
Time trend information presented in this paper can be used to evaluate problems and policies specific to medical conditions or risk factors. Despite recent improvements, implementing policies to reduce the number of deaths and years of life lost due to road traffic injury remains the highest priority for Iranian policymakers. Immediate action by Iranian researchers is required to match Iran's decreasing mortality rate due to liver and stomach cancers to a rate comparable to the global level. Prevention and treatment plans for mental disorders, such as major depressive disorder, anxiety disorder, and particularly drug use disorders, should be considered in reforms of the health, education, and judiciary systems in Iran.
Institute for Health Metric and Evolution, Seattle, WA, USA. shahraz@brandeis.edu.
Mohsen
M
Naghavi
Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA.
Saeid
S
Shahraz
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Sadaf G
SG
Sepanlou
Institute for Health Metric and Evolution, Seattle, WA, USA.
Daniel
D
Dicker
Institute for Health Metric and Evolution, Seattle, WA, USA.
Paria
P
Naghavi
School of Population and Public Health, University of British Columbia, BC, Canada.
Farshad
F
Pourmalek
Institute for Health Metric and Evolution, Seattle, WA, USA.
Ali
A
Mokdad
Institute for Health Metric and Evolution, Seattle, WA, USA.
Rafael
R
Lozano
Institute for Health Metric and Evolution, Seattle, WA, USA.
Theo
T
Vos
Oncopathology Research Centre, Ministry of Health and Medical Education, Tehran, Iran.
Mohsen
M
Asadi-Lari
Health deputy, Ministry of Health and Medical Education, Iran.
Ali-Akbar
AA
Sayyari
Institute for Health Metric and Evolution, Seattle, WA, USA.
Christopher J L
CJ
Murray
Institute for Health Metric and Evolution, Seattle, WA, USA.
Mohammad Hossein
MH
Forouzanfar
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D017281:Cost of Illness; D005260:Female; D019456:Health Transition; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D055815:Young Adult