Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019
Authors: Farshad Farzadfar, Mohsen Naghavi, Sadaf G Sepanlou, Sahar Saeedi Moghaddam, William James Dangel, Nicole Davis Weaver, Arya Aminorroaya, Sina Azadnajafabad, Sogol Koolaji, Esmaeil Mohammadi, Negar Rezaei, Jaffar Abbas, Behzad Abbasi, Mitra Abbasifard, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Amir Abdoli, Mohammad Abdollahi, Sina Abdollahzade, Hassan Abolhassani, Zahra Abrehdari-Tafreshi, Soodabeh Aghababaei, Bahman Ahadinezhad, Ali Ahmadi, Sepideh Ahmadi, Hamid Ahmadieh, Mohammad Esmaeil Akbari, Yousef Alimohamadi, Vahid Alipour, Hesam Alizade, Saba Alvand, Saeed Amini, Sohrab Amiri, Ali Arash Anoushirvani, Fereshteh Ansari, Jalal Arabloo, Morteza Arab-Zozani, Zahra Aryan, Armin Aryannejad, Mehran Asadi-Aliabadi, Ali A Asadi-Pooya, Zatollah Asemi, Samaneh Asgari, Saeed Asgary, Babak Asghari, Mohammad Asghari Jafarabadi, Elham Ashrafi, Zahra Atafar, Seyyed Shamsadin Athari, Abolfazl Avan, Abbas Azadmehr, Hiva Azami, Mohammadreza Azangou-Khyavy, Samad Azari, Amirhossein Azari Jafari, Ghasem Azarian, Alireza Badirzadeh, Elham Bahrami, Mohammad Amin Bahrami, Nastaran Barati, Mohsen Bayati, Gholamreza Bazmandegan, Masoud Behzadifar, Ali Bijani, Somayeh Bohlouli, Shiva Borzouei, Parnaz Daneshpajouhnejad, Abdollah Dargahi, Ahmad Daryani, Jalal Davoodi Lahijan, Mojtaba Didehdar, Shirin Djalalinia, Saeid Doaei, Fariba Dorostkar, Leila Doshmangir, Mohammadreza Edraki, Amir Emami, Babak Eshrati, Sharareh Eskandarieh, Firooz Esmaeilzadeh, Shahriar Faghani, Mahdi Fakhar, Hamid Reza Farpour, Hossein Farrokhpour, Majid Fasihi Harandi, Mohammad Fereidouni, Masoud Foroutan, Mansour Ghafourifard, Azin Ghamari, Seyyed-Hadi Ghamari, Ahmad Ghashghaee, Fariba Ghassemi, Ali Gholami, Asadollah Gholamian, Abdolmajid Gholizadeh, Salime Goharinezhad, Pouya Goleij, Mostafa Hadei, Nima Hafezi-Nejad, Sanam Hariri, Edris Hasanpoor, Hossein Hassanian-Moghaddam, Soheil Hassanipour, Hadi Hassankhani, Mohammad Heidari, Reza Heidari-Soureshjani, Mohammad Hoseini, Mohammad-Salar Hosseini, Mostafa Hosseini, Seyed Kianoosh Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Soodabeh Hoveidamanesh, Pooya Iranpour, Seyed Sina Naghibi Irvani, Jalil Jaafari, Roxana Jabbarinejad, Morteza Jafarinia, Hamed Jafari-Vayghan, Mohammad Ali Jahani, Nader Jahanmehr, Mahsa Jalili, Roksana Janghorban, Fatemeh Javanmardi, Farahnaz Joukar, Ali Kabir, Leila R Kalankesh, Rohollah Kalhor, Zahra Kamiab, Naser Kamyari, Behzad Karami Matin, Amirali Karimi, Salah Eddin Karimi, Ali Kazemi Karyani, Leila Keikavoosi-Arani, Maryam Keramati, Pedram Keshavarz, Mohammad Keykhaei, Ali Khaleghi, Mohammad Khammarnia, Javad Khanali, Maryam Khayamzadeh, Sajad Khosravi, Mina Khosravifar, Omid Khosravizadeh, Neda Kianipour, Ali-Asghar Kolahi, Amirhosein Maali, Mokhtar Mahdavi Mahdavi, Afshin Maleki, Mohammad-Reza Malekpour, Kamyar Mansori, Borhan Mansouri, Mohammad Ali Mansournia, Mohammad Reza Maracy, Abdoljalal Marjani, Sahar Masoudi, Seyedeh Zahra Masoumi, Hossein Masoumi-Asl, Mahsa Mayeli, Entezar Mehrabi Nasab, Fereshteh Mehri, Mohammad Miri, Seyyedmohammadsadeq Mirmoeeni, Hamed Mirzaei, Maryam Mirzaei, Roya Mirzaei, Ashraf Mohamadkhani, Heidar Mohammadi, Seyyede Momeneh Mohammadi, Shadieh Mohammadi, Abdollah Mohammadian-Hafshejani, Noushin Mohammadifard, Reza Mohammadpourhodki, Mohammad Mohseni, Amin Mokari, Sara Momtazmanesh, Abdolvahab Moradi, Masoud Moradi, Yousef Moradi, Mohammad Moradi-Joo, Farhad Moradpour, Maliheh Moradzadeh, Rahmatollah Moradzadeh, Abbas Mosapour, Shandiz Moslehi, Simin Mouodi, Mehdi Naderi, Homa Naderifar, Zhila Najafpour, Javad Nazari, Seyed Aria Nejadghaderi, Leila Nemati-Anaraki, Amin Reza Nikpoor, Marzieh Nojomi, Maryam Noori, Hasti Nouraei, Ali Nowroozi, Morteza Oladnabi, Fatemeh Pashazadeh Kan, Majid Pirestani, Meghdad Pirsaheb, Mohammadreza Pourahmadi, Hadis Pourchamani, Hadi Pourjafar, Akram Pourshams, Mohammad Rabiee, Navid Rabiee, Alireza Rafiei, Sima Rafiei, Fakher Rahim, Amir Masoud Rahmani, Sina Rashedi, Vahid Rashedi, Amirfarzan Rashidi, Mahsa Rashidi, Mohammad-Mahdi Rashidi, Ramin Ravangard, Reza Rawassizadeh, Iman Razeghian-Jahromi, Mohammad Sadegh Razeghinia, Sofia B Redford, Maryam Rezaei, Nazila Rezaei, Nima Rezaei, Saeid Rezaei, Hossein Rezaei Aliabadi, Mohsen Rezaeian, Mohammad Sadegh Rezai, Aziz Rezapour, Hossein Rezazadeh, Sahba Rezazadeh-Khadem, Morteza Rostamian, Ehsan Sadeghi, Erfan Sadeghi, Masoumeh Sadeghi, Reihaneh Sadeghian, Saeid Sadeghian, Hamid Safarpour, Mahdi Safdarian, Sare Safi, Maryam Sahebazzamani, Amirhossein Sahebkar, Mohammad Ali Sahraian, Sarvenaz Salahi, Payman Salamati, Hossein Samadi Kafil, Yaser Sarikhani, Maryam Sarkhosh, Arash Sarveazad, Maryam Seyed-Nezhad, Omid Shafaat, Zahra Shaghaghi, Saeed Shahabi, Sarvenaz Shahin, Elaheh Shaker, Saeed Shakiba, MohammadBagher Shamsi, Erfan Shamsoddin, Kiomars Sharafi, Sakineh Sharifian, Maryam Shaygan, Abbas Sheikhtaheri, Amir Shiani, Kiarash Shirbandi, Reza Shirkoohi, Parnian Shobeiri, Azad Shokri, Soraya Siabani, Ali Reza Sima, Ahmad Sofi-Mahmudi, Amin Soheili, Shahin Soltani, Mohammad Sadegh Soltani-Zangbar, Moslem Soofi, Seidamir Pasha Tabaeian, Mohammadreza Tabary, Alireza Tahamtan, Majid Taheri, Amir Taherkhani, Masih Tajdini, Hamed Tavolinejad, Arash Tehrani-Banihashemi, Amir Tiyuri, Seyed Abolfazl Tohidast, Alireza Vakilian, Sahel Valadan Tahbaz, Bay Vo, Seyed Hossein Yahyazadeh Jabbari, Vahid Yazdi-Feyzabadi, Zabihollah Yousefi, Taraneh Yousefinezhadi, Mazyar Zahir, Telma Zahirian Moghadam, Maryam Zamanian, Hamed Zandian, Alireza Zangeneh, Hadi Zarafshan, Fariba Zare, Ali Zare Dehnavi, Kourosh Zarea, Ahmad Zarei, Zahra Zareshahrabadi, Arash Ziapour, Sina Zoghi, Nizal Sarrafzadegan, Vafa Rahimi-Movaghar, Hamid Reza Jamshidi, Ali H Mokdad, Simon I Hay, Christopher J L Murray, Ardeshir Khosravi, Maziar Moradi-Lakeh, Mohsen Asadi-Lari, Reza Malekzadeh, Bagher Larijani
Journal: The Lancet (2022)

Better evaluation of existing health programmes, appropriate policy making against emerging health threats, and reducing inequalities in Iran rely on a comprehensive national and subnational breakdown of the burden of diseases, injuries, and risk factors.In this systematic analysis, we present the national and subnational estimates of the burden of disease in Iran using the Global Burden of Disease Study 2019. We report trends in demographics, all-cause and cause-specific mortality, 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. A multi-intervention segmented-regression model was used to explore the overall impact of health sector changes and sanctions. For this analysis, we used a variety of sources and reports, including vital registration, census, and survey data to provide estimates of mortality and morbidity at the national and subnational level in Iran.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 female individuals and 76·1 (75·6-76·5) in male individuals, 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 (NCDs) compared with 43·0% in 1990. During the study period, age-standardised DALY rates and YLL rates decreased considerably; however, YLDs 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.The Iranian health-care system is encountering 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. We did not capture alleviation of the burden of diseases in Iran following the 2004 and 2014 health sector reforms; however, the sanctions were associated with deaths of Iranians caused by NCDs.Bill & Melinda Gates Foundation.