Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Iran Collaborators

A report published in the medical Journal Lancet (April 6 2022) shows that sanctions imposed on Iran have had a major effect on population health in the country. Deaths from diseases otehr than infections have risen over the years.

A systematic analysis, published in the Lancet present national and subnational estimates of the burden of disease in Iran using the Global Burden of Disease Study 2019.

They report trends in demographics, all-cause and cause-specific deathrates, as well as years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by major diseases and risk factors. The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.

Findings

Iran, which had 84·3 million inhabitants in 2019, had a life expectancy of 79·6 years (95% uncertainty interval 79·2–79·9) in females and 76·1 (75·6–76·5) in males, an increase compared with 1990.

The number of DALYs remained stable and reached 19·8 million (17·3–22·6) in 2019, of which 78·1% were caused by non-communicable diseases (diseases other than infection) compared with 43·0% in 1990. During the study period, age-standardised DALY rates and YLL (years of life lost) rates decreased considerably; however, YLDs (years lived with disability) remained nearly constant.

The share of age-standardised YLDs contributing to the DALY rate steadily increased to 44·5% by 2019. With regard to the DALY rates of different provinces, inequalities were decreasing.

From 1990 to 2019, although the number of DALYs attributed to all risk factors decreased by 16·8%, deaths attributable to all risk factors substantially grew by 43·8%. The regression results revealed a significant negative association between sanctions and health status.

Interpretation

The Iranian health-care system is encountering non communicative diseases (NCDs) as its new challenge, which necessitates a coordinated multisectoral approach. Although the Iranian health-care system has been successful to some extent in controlling mortality, it has overlooked the burden of morbidity and need for rehabilitation.

The data suggests that the sanctions imposed on the country appear to be associated with increased deaths of Iranians caused by diseases other than infections.

Note that this study was performed before the global Covid pandemic.

See full article in Lancet April 06, 2022: DOI:https://doi.org/10.1016/S0140-6736(21)02751-3