Current Inequities in Smoking Prevalence on District Level in Iran: A Systematic Analysis on the STEPS Survey

Temporal trends in cardiovascular disease risk factors attributed burden in Iran, 1990-2021

Evaluation of Cardiovascular diseases (CVDs), the leading cause of death worldwide, and their risk factors is critical for developing effective healthcare interventions, especially in developing countries like Iran, where economic and demographic challenges may impact healthcare outcomes. This study aimed to evaluate the temporal trends in the burden of CVDs risk factors Iran, a developing country in the Middle East, using the Global Burden of Disease (GBD) study 2021. The data from GBD 2021 was used for extraction, processing, and presentation of results. Deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) and attributable burden to all risk factors, in addition to metabolic, behavioral, and environmental/occupation risk factors were reported for Iran from 1990 to 2021. All burden metrics were reported as point estimates and 95% uncertainty intervals (UIs). From 1990 to 2021, the total number of deaths and DALYs attributed to CVDs risk factors increased by 99.28% (95% UI 85.93-112.36%) and 65.85% (55.88 to 77.01), respectively. However, the age-standardized rates of deaths and DALYs decreased significantly by 43.16% (- 46.34% to - 39.97%) and 45.82% (- 48.82 to - 42.71), respectively. Metabolic risk factors were the leading contributors to deaths and DALYs (189.98 [166.38 to 209.83] and 3575.8 [3206.1 to 3928.27], respectively), with high systolic blood pressure (SBP) accounting for the highest burden. Males, particularly in older age groups (≥ 80 years), experienced a higher burden compared to females. Although there was no clear relationship between Iran provinces' sociodemographic index (SDI) and the burden of CVDs risk factors, regions with higher SDIs tend to have a lower burden of disease. Our findings indicate that while age-standardized burden rates have decreased, Iran still faces a significant burden of CVDs and associated risk factors. In this regard, high SBP needs special attention. These findings highlight the urgent need for subnational, risk-specific policies targeting high-risk populations and low-SDI provinces to reduce disparities and CVD burden. Immediate and targeted interventions are necessary to reduce disparities, lower healthcare costs, and address the high burden attributed to these risk factors.

Evaluation of the hypercholesterolemia care cascade and compliance with NCEP-ATP III guidelines in Iran based on the WHO STEPS survey

INTRODUCTION

Noncommunicable diseases (NCDs), particularly cardiovascular disease (CVD), are the leading cause of death worldwide, with hypercholesterolemia being a major risk factor for CVD. This study evaluated the hypercholesterolemia care cascade in Iran-including prevalence, diagnosis, treatment coverage, and effectiveness-using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines.

METHODS

This cross-sectional study drew on data from the 2021 Iran STEPS survey, which employed a systematic cluster sampling of adults aged ≥ 18 years across all provinces in Iran. Hypercholesterolemia was defined per NCEP-ATP III thresholds (LDL ≥ 160 mg/dL, total cholesterol ≥ 240 mg/dL, HDL ≤ 40 mg/dL, or ongoing lipid-lowering therapy). Weighted descriptive statistics were calculated, and Poisson regression with robust variance estimated crude and adjusted prevalence ratios for optimal lipid control among those treated. The 10-year CVD risk was determined using the Framingham Risk Score, stratifying participants into low (< 10%), intermediate (10-20%), and high (> 20%) risk categories.

RESULTS

Out of 18,074 participants, 10,582 (55.32%, 95% CI: 54.29-56.35) met NCEP-ATP III criteria for hypercholesterolemia. Among these, only 20.61% (19.55-21.72) were receiving pharmacological treatment. Treatment coverage was notably lower in males (13.15%, 11.98-14.40) than females (29.12%, 27.35-30.96). Statins were the most commonly used medication (11.43% of males, 25.87% of females). Of those receiving treatment, 52.85% (females) and 53.93% (males) achieved optimal LDL, while 76.98% (females) and 81.06% (males) attained total cholesterol < 200 mg/dL. However, only 19.89% (females) and 3.97% (males) met the HDL > 60 mg/dL goal. The 10-year CVD risk was < 10% in 57.79% of participants, 10-20% in 33.27%, and > 20% in 8.94%.

CONCLUSION

Despite a high prevalence of hypercholesterolemia in Iran, treatment coverage remains suboptimal, particularly among males and working-age adults. Although most treated individuals achieve favorable LDL and total cholesterol levels, gaps persist in achieving optimal HDL targets. These findings underscore the need for strengthened screening, treatment, and adherence strategies-alongside broader preventive measures-to reduce the burden of hypercholesterolemia and CVD in Iran.

Modeling the determinants of cigarette consumption in Iranian households with children under 5 years of age using the Income and Expenditure Survey 2021

BACKGROUND

Cigarette smoking remains a significant public health concern, with detrimental effects on both smokers and those exposed to secondhand smoke. This study investigates the factors influencing smoking behaviors in Iranian households, focusing on households with children under five years old.

METHODS

We conducted a cross-sectional analysis of 8751 Iranian households using data from the Iranian Household Income and Expenditure Survey (HIES) collected by the Statistical Center of Iran (SCI) in 2021. A variety of count regression models were examined, including Poisson (P), Negative Binomial (NB), Generalized Poisson (GP) and their zero-inflated counterparts. The best fitting model was selected based on goodness-of-fit indices.

RESULTS

Approximately 87% of households were non-smokers, with a mean daily cigarette consumption of 14.29 (SD = 8.64) among smokers. The three-level Zero-Inflated Generalized Poisson (TL-ZIGP) model was considered a suitable model for the interpretation of the data. Key predictors of smoking included older age, male gender, lower education, higher income, and larger homes. Homeownership was negatively associated with smoking. Considerable geographic variation in smoking prevalence was observed.

CONCLUSIONS

Socioeconomic and demographic factors, including lifestyle and geographic regions, are associated with smoking behavior among Iranian households. A three-level ZIGP regression model is appropriate for analyzing these complex relationships. This study reveals different patterns of smoking prevalence in different population subgroups and emphasizes the need for targeted interventions to effectively reduce smoking rates.

Patterns of case fatality and hospitalization duration among nearly 1 million hospitalized COVID-19 patients covered by Iran Health Insurance Organization (IHIO) over two years of pandemic: An analysis of associated factors

BACKGROUND

Different populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients.

METHODS

In this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models.

RESULTS

A total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% [95% CI: 25.75-26.27]). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 [1.34-1.37]) and among ICU admitted patients (1.12 [1.09-1.12]). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 [1.91-2.22]) and in ICU (aOR = 1.71 [1.51-1.92]). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 [1.51-1.54]) and at ICU (median ratio = 1.17 [1.16-1.18]). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 [1.32-1.48]), Alborz (aOR = 1.28 [1.22-1.35]), and Khorasan Razavi (aOR = 1.24 [1.20-1.28]) were the provinces with the highest risk of mortality in hospitalized patients.

CONCLUSION

Hospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.

Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021

Smoking is recognised as a critical public health priority due to its enormous health and economic consequences. Constant monitoring of the effectiveness of tobacco control programs calls for timely population-based data. This study reports the national and sub-national patterns in tobacco consumption among Iranian adults based on the results from the STEPwise approach to chronic disease risk factor surveillance (STEPS) survey 2021. This study was performed through an analysis of the results of the STEPS survey 2021 which had been conducted as a nationally representative cross-sectional study. Participants included Iranian adults aged ≥ 18 years in all provinces of Iran, who were selected via multistage cluster sampling method. Data were analyzed via survey analysis while considering population weights. The total number of participants was 27,874, including 15,395 (55.23%) women and 12,479 (44.77%) men. The all-ages prevalence of current tobacco smoking was 14.01% overall, 4.44% among women, and 25.88% among men. The all-ages prevalence of current cigarette smoking was 9.33% overall, 0.77% among women, and 19.95% among men. The all-ages prevalence of current hookah smoking was 4.5% overall, 3.64% among women, and 5.56% among men. The mean (SD) number of cigarettes smoked per day was 12.41 (10.27) overall, 7.65 (8.09) among women, and 12.64 (10.31) among men. The mean (SD) monthly times of hookah use was 0.42 (7.87) overall, 2.86 (23.46) among women, and 0.3 (6.2) among men. The national all-ages prevalence of second-hand smoking at home was 24.64% overall, 27.38% among women, and 20.26% among men. The national all-ages prevalence of second-hand smoking at work was 19.49% overall, 17.33% among women, and 22.94% among men. The tobacco consumption in Iran remains alarmingly high, indicating the current tobacco control policy implementation level is ineffective and insufficient. This calls for adopting, implementing, and enforcing comprehensive packages of evidence-based tobacco control policies.

Physical Inactivity, Inequalities, and Disparities Across Districts of Iran: A STEPs Survey-Based Analysis

BACKGROUND

We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures.

METHODS

Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran.

RESULTS

All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%-47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%-64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively.

CONCLUSIONS

The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden.