title: Equity Chasm in Megacities: Five Leading Causes of Death in Tehran.
abstract: BACKGROUND
  Inequity in megacities is a real concern in public health perspective. Tehran is a megacity with more than 8 million population that is divided into 22 regions (counties) with considerable diversity in socioeconomic status. On the other hand, spatial cluster detection is an important tool in disease surveillance to identify areas of elevated risk and to generate hypotheses about disease or mortality etiology. The present research aims to identify high or low-risk clusters for five non-communicable leading causes of death in 22 regions of Tehran province.
  
  
  METHODS
  Cause-specific mortality rates were extracted from Behesht-e-Zahra registry system for Tehran province in 2011. Spatial scan statistic as a most common method in spatial cluster detection was chosen to detect clusters with elevated risk of death. Given the observed and expected number death in each region, a log likelihood ratio (LLR) criterion was used to test whether a cluster is significant.
  
  
  RESULTS
  Two high-risk and two low-risk clusters were detected for each cause of death. All these clusters were statistically significant with P value less than 0.05. Mapping these clusters shows substantial differences between regions in Tehran. For mortality due to ischemic heart diseases, cerebrovascular diseases, hypertensive diseases, respiratory diseases, and stomach cancer, the high-risk clusters concentrated in southern half of Tehran and low-risk clusters were in northern half of Tehran. In the most situations, regions 2, 3 and 5 seemed to have lower rate of death comparing with other regions. On the other hand, regions, 16, 19 and 20 were in the high rate clusters.
  
  
  CONCLUSIONS
  There was substantial disparity between regions of Tehran for five non-communicable causes of death studied in this article. Identifying factors affecting the observed differences is useful to set effective preventive interventions and can be investigated in future researches.
authors.affiliation: 1)Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Kimiya
authors.initials: K
authors.lastname: Gohari
authors.affiliation: 3)Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahboubeh
authors.initials: M
authors.lastname: Parsaeian
authors.affiliation: 1)Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Sheidaei
authors.affiliation: 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran. 4)Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shadi
authors.initials: S
authors.lastname: Rahimzadeh
authors.affiliation: Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Baghestani
authors.affiliation: Research Center for Gastroenterology and Liver diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohamad Amin
authors.initials: MA
authors.lastname: Pourhoseingholi
authors.affiliation: 1)Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Forough
authors.initials: F
authors.lastname: Pazhuheian
authors.affiliation: 1)Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sahar
authors.initials: S
authors.lastname: Saeedi Moghaddam
authors.affiliation: 1)Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Anita
authors.initials: A
authors.lastname: Mansouri
authors.affiliation: 6)Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2) Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Naderimagham
authors.affiliation: Department of Basic Sciences, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Kavousi
authors.affiliation: 2)Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran. 6)Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.6).
authors.forename: Farshad
authors.initials: F
authors.lastname: Farzadfar
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002947:Cities; D003710:Demography; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D011634:Public Health; D012042:Registries; D012140:Respiratory Tract Diseases / Q000401:mortality; D012307:Risk Factors; D017678:Sex Distribution; D012923:Social Class; D062206:Spatial Analysis; D013274:Stomach Neoplasms / Q000401:mortality