Metabolic Syndrome and Ischemic Stroke in Iran: Incidence and Disability-Adjusted Life Years 1990 to 2019

Introduction: Metabolic syndrome (MS) is one of the conditions that may increase the risk of ischemic stroke (IS). This study focuses on factors of MS related to the incidence, years of life lost (YLL), and years of life disability (YLD) caused by IS. Materials and Methods: The age-adjusted data (incidence, YLL, and YLD) related to four factors of MS [fasting plasma glucose, body mass index (BMI), low-density lipoprotein, and systolic blood pressure, SBP] were extracted as risk factors for IS during the years 1990 to 2019 from global burden of disease study. ARC GIS V.10 software was used to investigate the geographical distribution and the Cochran-Armitage test was used to investigate the trend of these indices. Results: The highest incidence of IS was reported in Golestan provinces in 2019 [women: 180 (95% UI 153-213), men: 163 (95% UI 141-191), and both genders: 172 (95% UI 149-201)]. High SBP has the highest impact on YLD (96-102 per 100,000 population in some provinces) and YLL (688-824 per 100,000 population in some provinces) in men and women (YLD: 126-156, YLL: 586-785 per 100,000 population in some provinces). High BMI has increased YLD caused by IS from 1990 (35 per 100,000 population) to 2019 (53 per 100,000 population). Conclusion: Considering the importance of IS and the impact that MS has on this disease, it seems that one of the most effective possible measures is to eliminate MS. The factors of MS are mostly related to lifestyle, and MS can be controlled with a suitable plan, which can be considered as primary prevention for IS.

Population Size Estimation of Tramadol Misusers in Urban Population in Iran: Synthesis of Methods and Results

Background

Estimating the population who use drugs is essential for planning, monitoring, and evaluation of substance use prevention and treatment. This study aims to estimate the population who misuse tramadol in urban population in Iran.

Methods

We used the wisdom of the experts (WOTE) and network scale-up (NSU) methods to calculate the population of tramadol misusers in 10 provincial capitals of Iran, in 2016. The WOTE was conducted among pharmacists in drugstores and the personnel of traditional medicinal herbs stores. They guessed the best estimation of tramadol misusers population in their cities. The NSU method was conducted among the general population and participants were questioned about ever and daily, non-medical use of tramadol during last 12 months in their network. The median of the methods was used to calculate the proportion of the adult population (15-49 years old).

Findings

The population size of tramadol misusers in studied cities was 83300 [95% uncertainty limits (UL): 47960-256220]. This corresponded to 6.6 per 1000 (95% UL: 3.88-20.30) of the 15-49-year-old population. The projected number of tramadol misusers for all 31 provincial capitals was 118290 (95% UL: 68100-363130840) and 212440 (95% UL: 122310-653410) for all urban areas. NSU also estimated the number of people who misuse tramadol on daily basis. These numbers were 52000 (95% UL: 19940-176570) for studied cities, 73840 (95% UL: 28320-250740) for all 31 provincial capital cities, and 132610 (95% UL: 50860-450310) for all urban areas in Iran.

Conclusion

This study presents information on high prevalence of tramadol misuse in urban population. We need national control measures and demand reduction programs to control tramadol misuse.