Date Published: February 14, 2019
Publisher: Public Library of Science
Author(s): Fatemeh Khosravi Shadmani, Farshad Farzadfar, Bagher Larijani, Moghadameh Mirzaei, Ali Akbar Haghdoost, Olalekan Uthman.
Following the epidemiologic and demographic transition, non-communicable disease mortality is the leading cause of death in Iran. Projecting mortality trend can provide valuable tools for policy makers and planners. In this article, we have estimated the trend of non-communicable disease mortality during 2001–2015 and have projected it until 2030 at national and subnational levels in Iran.
The data employed was gathered from the Iranian death registration system and using the Spatio-temporal model, the trends of 4 major categories of non-communicable diseases (cancers, cardiovascular diseases, asthma and COPD, and diabetes) by 2030 were projected at the national and subnational levels.
The results indicated that age standardized mortality rate for cancers, CVDs, and Asthma and COPD will continue to decrease in both sexes (cancers: from 81.8 in 2015 to 45.2 in 2030, CVDs: 307.3 to 173.0, and Asthma and COPD: from 52.1 to 46.6); however, in terms of diabetes, there is a steady trend in both sexes at national level (from 16.6 to 16.5). Age standardized mortality rates for cancers and CVDs, in males and females, were high in all provinces in 2001. The variation between the provinces is clearer in 2015, and it is expected to significantly decrease in all provinces by 2030.
Generally, the age standardized mortality rate from NCDs will decrease by 2030. Of course, given the experience of the past two decades in Iran, believing that the mortality rate will decrease may not be an easy notion to understand. However hard to believe, this decrease may be the result of better management of risk factors and early detection of patients due to more comprehensive care in all segments of society, as well as improved literacy and awareness across the country.
Due to the epidemiologic and demographic transition around the world, paying attention to non-communicable diseases (NCDs) is now considered a priority. As a result of prioritizing NCDs, target 3–4 of the sustainable development goals (SDGs) was introduced to reduce the total NCDs mortality rate by one third by 2030 .
According to the data gathered through Iranian Death Registry System (DRS) and by using the Spatio-temporal model, the trends of 4 major categories of NCDs (cancers, cardiovascular diseases, asthma and COPD, and diabetes) were projected at the national and subnational levels by 2030.
The results indicated that age standardized mortality rate for cancers, CVDs and asthma, and COPD will decrease in males, females and both sexes combined in the course of 2015 to 2030 (Fig 2). However, diabetes in males and females will increase substantially whereas the trend of this condition in both sexes will remain steady at national level (Fig 2). The amount of this reduction is not the same for the 3 categories; the percent change in age standardized mortality rate from cancer is expected to be -44.7 (age standardized mortality rate would decrease from 81.8 (75.5–88.7) in 2015 to 45.2 (41.4–49.4) in 2030) (Table 1). Furthermore, the percent change in age standardized mortality rate from CVDs is expected to be -43.6 (age standardized mortality rate would decrease from 307.3 (284.2–332.4) to 173.0 (158.5–189.0)) (Table 1). Also, the percent change in age standardized mortality rate from asthma and COPD is expected to be -10.6 (age standardized mortality rate would decrease from 52.1 in 2015 (47.4–57.3) to 46.6 (42.0–51.6) in 2030) (Table 1). However, age standardized mortality rate from diabetes in both sexes would be steady during the same period of time (from 16.6 (14.6–18.8) to 16.5(14.4–18.9), indicating zero percent change) (Table 1). At subnational level, Zanjan and Hormozgan provinces, respectively, will have the highest and lowest percent change from cancers and CVDs, (Table 1). Zanjan and Semnan provinces, respectively, will have the highest and lowest percent change for asthma and COPD and finally, Zanjan and Chaharmahal &Bakhtiari provinces, respectively, will have the highest and lowest percent change for diabetes (Table 1).
According to the results of this study, the trend of cancers and cardiovascular disease mortalities in Iran is expected to decrease moderately, while there will be a substantial decrease in asthma and COPD. Also, the trend of diabetes will slowly increase. The mortality rate of cancers, cardiovascular diseases, and asthma and COPD will be higher in males than in females, and this trend will continue until 2030. However, in terms of diabetes, the mortality rate will be higher in females and it will continue. At subnational level, cancers in the southern, northern, and central provinces will decrees slowly in both sexes; whereas, cardiovascular diseases in the southeastern, northwest, and central province will have a higher decrease in both sexes. The mortality rate for asthma and COPD will be higher in southern provinces and metropolitan areas. Mortality rate for diabetes in most provinces is high; whereas mortality rate will be even higher in the southern, central and Northern provinces. Also, cardiovascular diseases and diabetes have the highest and lowest proportional mortality rates respectively. At national and subnational levels, by 2030, proportional mortality trend for cardiovascular diseases is expected to decrease while this trend for diabetes and asthma and COPD will increase.
Based on the results, cancers and cardiovascular diseases are expected to continue to decrease until 2030. Also, asthma and COPD will decrease substantially; whereas, the diabetes trend will be on the rise. In general, the long path to reduce all four diseases is yet to be paved. It is recommended, therefore, that policymakers and planners, along with early detection and treatment, focus more on primary prevention and community education through mass media because these interventions will be more cost-effective.