Tobacco Smoking Status and the Contribution to Burden of Diseases in Iran, 1990-2010: findings from the Global Burden of Disease Study 2010.
BACKGROUND
Tobacco smoking and exposure to second-hand smoke in the indoor environment are major public health risks worldwide. The aim of this paper is to report and critique a global assessment of smoking prevalence, smoking-attributable deaths, and disability adjusted life years (DALYs) extracted from GBD study 2010, by sex and age in Iran from 1990 to 2010.


METHODS
The Global Burden of Disease (GBD) Study 2010 estimated the distributions of exposure and relative risks per unit of exposure by systematically reviewing and analyzing published and unpublished data. These assessments were used, together with estimates of death and DALYs due to specific risk factors, to calculate the attributed burden for each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of attributable mortality and burden. In this study, our aim was to reformulate the GBD data, produce new graphs, and explain the results for Iran in greater detail.


RESULTS
Between 1990 and 2010, the prevalence of tobacco smoking at all ages increased by 1% in men and declined by 2% in women in Iran, but the overall prevalence in the general population was unchanged (12%). A reduction was observed in the age-standardized death and DALY rates (per 100,000 population) attributed to tobacco smoking, including second-hand smoke. The attributed DALY rate was greater for Iranian men than for Iranian women. The highest rates of DALYs because of tobacco smoking were found in smoker men and women aged 70+, but exposure to second-hand smoke had the most significant burden in children under 5 years old. In 1990, the three leading disease burdens attributed to tobacco smoking, including second-hand smoke, were ischemic heart disease; communicable, maternal, neonatal, and nutritional disorders; and chronic respiratory diseases. In 2010, three leading burden of diseases attributed to tobacco smoking belonged to ischemic heart disease, chronic respiratory disease, and, and cerebrovascular disease, respectively.


CONCLUSIONS
Despite a reduction in the rate of tobacco smoking, including second-hand smoke, since 1990, smoking exposure remained the fifth leading risk factor for deaths and DALYs in Iran in 2010. Overall, our data clearly show the need for new efforts in Iran to reduce the mortality and burden attributed to tobacco smoking.
1)Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.2)Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
Anoosheh
A
Ghasemian
1)Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 3)Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute,Tehran University of Medical Sciences, Tehran, Iran.
Nazila
N
Rezaei
4)Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.1)Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Sahar
S
Saeedi Moghaddam
4)Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.1)Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Anita
A
Mansouri
1)Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 5)Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Mahboubeh
M
Parsaeian
Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Alireza
A
Delavari
School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hamid Reza
HR
Jamshidi
1)Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 8)Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Farshad
F
Sharifi
3)Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 1)Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute,Tehran University of Medical Sciences, Tehran, Iran.
Shohreh
S
Naderimagham
D000293:Adolescent; D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D009748:Nutrition Disorders / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000706:statistics & numerical data; D055815:Young Adult
D014028:Tobacco Smoke Pollution