Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 23;399(10335):1625-1645.
doi: 10.1016/S0140-6736(21)02751-3. Epub 2022 Apr 6.

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

GBD 2019 Iran Collaborators
Collaborators

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

GBD 2019 Iran Collaborators. Lancet. .

Abstract

Background: 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.

Methods: 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.

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 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.

Interpretation: 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.

Funding: Bill & Melinda Gates Foundation.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests MA-L reports leadership or fiduciary roles in a board, society, committee, or advocacy groups, paid or unpaid with International Affairs in the Ministry of Health, Iran as Director General, all outside the submitted work. SBor reports support for the present manuscript from medical writing. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Life expectancy at birth (years) among provinces of Iran in male and female individuals, 2019
Figure 2
Figure 2
Breakdown of life expectancy in Iran and provinces between 1990 and 2019, for both sexes
Figure 2
Figure 2
Breakdown of life expectancy in Iran and provinces between 1990 and 2019, for both sexes
Figure 2
Figure 2
Breakdown of life expectancy in Iran and provinces between 1990 and 2019, for both sexes
Figure 3
Figure 3
Ranking of age-standardised rates of disability-adjusted life-years caused by level 3 non-communicable diseases at national and subnational levels, 2019
Figure 4
Figure 4
Time trend of the unconditional probability of death at national and subnational levels, 1990–2019
Figure 5
Figure 5
Timeline of major events in Iranian history from 1990 to 2019 DALY=disability-adjusted life-years. PHC=primary health care.
See this image and copyright information in PMC

Comment in

References

    1. Danaei G, Farzadfar F, Kelishadi R, et al. Iran in transition. Lancet. 2019;393:1984–2005. - PubMed
    1. The World Bank GDP per capita (current US$)—Iran, Islamic Rep. 2021. https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?end=2018&locations=I...
    1. Sajadi HS, Ehsani-Chimeh E, Majdzadeh R. Universal health coverage in Iran: where we stand and how we can move forward. Med J Islamic Rep Iran. 2019;33:9. - PMC - PubMed
    1. Kokabisaghi F. Assessment of the effects of economic sanctions on Iranians' right to health by using human rights impact assessment tool: a systematic review. Int J Health Policy Manag. 2018;7:374–393. - PMC - PubMed
    1. Nasseri K, Sadrizadeh B, Malek-Afzali H, et al. Primary health care and immunisation in Iran. Pub Health. 1991;105:229–238. - PubMed