Search

Background The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran. Methods The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT. Results A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = − 0.064; 95% confidence interval [CI), − 0.066 to − 0.063). Socioeconomic status, being male, older age and being a widow or divorced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults. Conclusions It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease.

Background Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. Methods Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. Results Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074–0.087) and obesity (0.027, 95% CI; 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. Conclusions Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.

Little evidence is available on the epidemiological and economical dimensions of certain foodborne diseases such as wild mushroom poisoning. This study aimed to investigate the epidemiology and estimate the costs of poisoning with cyclopeptide-containing mushrooms in Kermanshah province in 2018. In this study, poisoning was investigated in different subgroups. The cost of illness method with a bottom-up approach was used to estimate the poisoning costs. Both direct and indirect costs of the poisoning were included in the analysis. The perspective of the study was society. Required data were obtained from the medical records of Imam Khomeini hospital and completed through a line survey with the patients. Two hundred eighty-three patients were poisoned in Kermanshah due to poisoning with cyclopeptide-containing mushrooms. Of 283 patients, 143 (50.53%) were men and 59.01% of patients were rural residents. About 43% of admissions were out-patient cases and ~40% of patients were hospitalized within 1–3 days. Also, eight patients were pronounced dead in the area. The total cost of poisoning with cyclopeptide-containing mushrooms in Kermanshah province was $ 1,259,349.26. Of that, $ 69,281.65 was related to direct medical costs and $ 10,727.23 was direct non-medical costs. The indirect costs of death were estimated to be $ 1,125,829.7. The current study revealed that there is a significant financial burden due to cyclopeptide-containing mushrooms on patients, the health system, and society as a whole. Further studies are recommended to clarify the epidemiological and economic burden of foodborne illnesses related to wild mushroom poisonings. Sharing the outputs with health authorities, and informing the general public are warranted to reduce the burden of such diseases.

Objectives Knowing about accurate customer expectations is the most important step in defining and delivering high-quality services. This study aimed to evaluate the preferences of patients referring to two hospitals in Kermanshah, Iran. Method Discrete choice experiment (DCE) method used to elicit preferences of 328 patients who were admitted in two hospitals of Kermanshah city in the west of Iran. Literature review and experts opinion were used to identify a candidate list of attributes related to the quality of cares in hospitals. The final study attributes were quality of physician care, quality of nursing care, waiting time for admission, cleaning of wards and toilets, and behavior of staff. Experimental design applied to extract choice sets of hospitals. The data was analyzed by a conditional logit regression. Results The regression results showed the most important predictors of hospital selection by respondents was the good quality of physician care (aOR: 3.18, 95% CI 2.61, 3.87), followed by friendly behavior of staffs (aOR: 2.03, 95% CI 1.81, 2.27), cleanness of wards and toilet (aOR: 1.61, 95% CI 1.40, 1.85), and finally quality of nursing cares (aOR: 1.13, 95% CI 0.89, 1.44). However, increasing waiting time made disutility in the study participants (aOR: 0.69, 95% CI 0.60, 0.80). Conclusions Our study finding emphasized some potential opportunity of quality augmentation in hospital sector by paying attention to different quality attributes including quality of physician, friendly behavior of staffs, cleanness of hospital environment and finally quality of nursing cares. Considering patients preferences in decision making process could lead to substantial satisfaction improvement.

Objective People with disabilities are more likely to experience poorer health status, compared to the general population; however, their health issues do not receive enough attention from policymakers. This article aimed to identify the factors that hinder the health problems of people with disabilities to be on the national agenda in Iran. Materials & Methods This phenomenological qualitative research was conducted in Tehran City, Iran, from September 2015 to March 2017. We conducted 22 quasi-structured face to face interviews with relevant policymakers at the national level. Snowball sampling method was applied to identify the interviewees. The interviewees were well-informed and had long and valuable experiences in the field of policymaking for people with disabilities. The policymakers from a verity of public organizations, ministries, non-governmental organizations, Islamic Consultative Assembly, Tehran municipality and the health insurance organizations participated in the study. We used an interview guide in data collection process which covered the main study questions. On average, the interviews lasted about 30 minutes to 1.5 hours. The validity of the study was assessed through member checking. Thematic analysis was performed in three steps to identify the main concepts of the study. In open coding, identifying, naming and describing phenomena in the text were performed. Following open coding, codes were grouped into several subcategories. Then, the main concept of the study was created by formulating a general description of generated subcategories. We used MAXQDA to analyze the obtained data. Results We found three main categories and 13 subcategories. In the influence category, three subcategories were created; low influence in the policy process, the lack of structural independence, the inferiority of associations and nongovernmental organizations’ positions for policymakers and the low ability in lobbying and networking. In the minority category, we found 6 subcategories consisting of more attention to public health issues by policymakers, neglect of the specific needs of minority groups by health policymakers, policymakers’ unattractiveness in the health problems of people with disabilities, the lack of significant financial and political benefits for policymakers, the lack of awareness about the health issues of people with disabilities, and the inferiority of disability issues for policymakers. In the category of lack of integrated voice, three subcategories were created, including a lack of integration among people with disabilities, inattention to personal and group interests and the lack of coherent communication networks. Conclusion To meet their requirements, it is essential to enhance the influence of people with disabilities, associations and the welfare organization in the policymaking process. This can be achieved by increasing the interaction of significant individuals in the disability area with other key policymakers in other sectors. Running campaigns, engaging with celebrities as well as experienced and influential managers, and the systematic use of media and social networks may improve policymakers' attention to prioritizing health issues of people with disabilities.

Clinical Breast Examination (CBE) is utilized as a screening modality in many low income countries without widespread mammography capability. The aim of the current study was to evaluate the impact of socio-economic status (SES) on CBE screening rates in Iranian Kurdish women. A cross-sectional study was conducted in the western region of Iran. A sample of 5,289 Iranian Kurdish women aged 35-65 years old was analyzed. Data were collected from July 2014 to September 2018. The Concentration Index-CI and Concentration Curve were used to estimate the socioeconomic inequalities in CBE rate. The analysis of data was done by STATA software (Version 14). 12.3% of the women had received CBE at least once. CBE rates in the 46-50 age group were higher than in other age groups (OR = 2.06; 95% CI = 1.56-2.71). Women with 6-9 years of education had higher odds ratio of receiving CBE (OR = 1.41; 95% CI = 1.02-1.94). Women living in rural areas were less likely to have received CBE compared to those living in urban areas (OR=0.54; 95% CI = 0.42-0.61). The overall concentration index for receipt of CBE was 0.188. In countries without widespread mammography programs, strategies for the promotion of CBE should focus on the lower SES population.br /.

Ali Kazemi-Karyani,1 Abraha Woldemichael,2 Moslem Soofi,3 Behzad Karami Matin,1 Shahin Soltani,1 Jafar Yahyavi Dizaj4 1Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia; 3Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; 4Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IranCorrespondence: Jafar Yahyavi DizajHealth Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IranEmail jyahyavi@razi.tums.ac.irObjective: Ensuring fair financial contribution is one of the main goals of the Health Transformation Plan (HTP) of Iran. This study aims to estimate socioeconomic inequality differences in catastrophic health expenditure (CHE) between urban and rural areas of Iran after the implementation of the HTP during 2017.Materials and Methods: Data from a representative survey of households’ income and xpenditure from the Iran Statistical Center (ISC) were used for the analysis. We applied the World Health Organization (WHO) cut-off of 40% payment for CHE, and Wagstaff’s normalized concentration index (C) to measure and decompose the inequality. Also, Blinder–Oaxaca decomposition analysis was used to decompose contributors of inequality differences between rural and urban areas.Results: The overall incidence of CHE among Iranian households during the year 2017 was 3.32% with a standard deviation (SD) of 17.91%, and the mean (SD) levels of CHE in rural and urban areas of Iran were 4.37% (20.45%) and 2.97% (16.99%), respectively. The aggregate socioeconomic status (SES)-related inequality in CHE was significantly (p< 0.001) different from zero (C=− 0.238) and there was a significant (p< 0.05) difference between rural (C=-0.150) and urban (C=0.218) areas. SES was the highest contributor to inequality in both rural (130.09) and urban (144.17) areas. The Blinder–Oaxaca decomposition revealed that SES (175.01%) followed by outpatient services (120.29%) were the main contributors to differences in inequality in rural and urban areas. Sex (− 101.42%) and health insurance coverage were among negative contributors to this inequality difference.Conclusion: Our findings revealed a significant pro-rich inequality in CHE. Also, some variables, such as sex and region, made different contributions in rural and urban areas. However, SES, itself, made the highest contribution in both areas and explained the greatest share of difference in inequality between the two areas. This issue calls for revision of the HTP to further address the risk of CHE and socioeconomic disparity among Iranian households, especially those with lowSES.Keywords: inequality, catastrophic health expenditure, Health Transformation Plan, Iran

Background The clients’ willingness to accept (WTA) and willingness to pay (WTP) for a given good or service can help elicit the monetary value of that good or service. This study aims to assess the WTA and WTP of mothers attending primary health centers for vaccines to their children during 2019 in Kermanshah city, western Iran. Methods We conducted a cross-sectional study on a total of 667 mothers attending primary health centers for vaccines to their children aged two to 18 months. A multistage sampling technique was employed to involve the mothers in the study, and data were collected using a self-administrated open-ended questionnaire. The multivariate linear regression model was used to identify the factors associated with the mothers’ WTP and WTA for vaccines to their children. Results The study indicated that 94.2 and 93.1% of the mothers respectively had WTA and WTP values greater than zero, with their corresponding mean values of US$ 6.8 and US$ 4.4. The mothers in the higher monthly household income category, mothers born in the urban areas, and being a female child showed statistically significant positive associations with the mothers’ WTA for the vaccines. While there was a statistically significant positive relationship between monthly household income and the mothers’ WTP; a statistically significant negative relationship exists between the mothers’ age and their WTP for the vaccine to their children. Conclusions The findings indicated the mothers’ WTA to WTP ratio of greater than one for the vaccines to their children. The most important factor associated with the mothers’ WTA and WTP was the monthly household income. Thus, improving the socio-economic standards of women in the study area might contribute to reinforcing their immunization services seeking behavior to their children.

Background Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. Methods The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. Results The estimated E for poor mental health was − 0.012 (95% CI: − 0.0144, − 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. Conclusion There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.

Background Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran. Methods A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (Cn) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors. Results Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated Cn of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence. Conclusion A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.

Background: Dental health care is not only an effective strategy for the prevention, early diagnosis and treatment of oral diseases but also contributes to the general health of communities. This study aimed to investigate the situation of dental health-care service utilisation and its determinants in Kermanshah city, western Iran, in 2015. Methods and materials: A cross-sectional study on a total of 894 household heads was conducted. The participants were selected using a multistage sampling technique. A self-administered questionnaire was used to collect the data. Multiple logistic regression was performed to assess factors associated with utilisation of dental-care services and a negative binomial regression was carried out to identify the main factor associated with the frequency of visiting a dentist for dental health care. A statistically significant association was considered at a value of P < 0.05. All the analyses were performed using STATA version 12. Finding: Of the total household heads who participated in the study, 60.3% and 9.9% reported visiting a dentist for dental treatment in the past year and for 6-monthly dental check-ups, respectively. The average ± standard deviation number of visits by a respondent was 2.08 ± 2.97. Of the total number of respondents, 281 (31.4%) reported visiting a dentist once or twice in the last 12 months for dental health-care services, while 28.9% reported visiting a dentist more than twice in the same time period. Ageing, having dental insurance, higher income, being a university graduate, self-rated poor oral health and not regularly brushing own teeth were the main factors associated with utilisation of dental health-care services. Conclusion: Our study indicates that dental health-care utilisation among households in the study area was influenced by a number of factors, including being socio-economically disadvantaged, self-rated poor oral health and not regularly brushing own teeth. Therefore, in this setting, dental-intervention programmes, including dental health insurance, should focus on mechanisms that can strengthen utilisation of preventive dental health-care services among disadvantaged households.

Background: Burn is one of the public health problems, especially in low-income and middle-income countries, and this problem is far more important for pregnant women and their fetus. There was no a systematic study to comprehensively review the epidemiology of Maternal and Fetal`s Burn inIran, this study was conducted for this purpose. Materials and Methods: In this systematic review and meta-analysis study, all related studies (Published in 2017 and earlier) extracted by two independent groups from national and international databases (Magiran, SID, Web of Science, Medline, Scopus, etc.). Meta-analysis has been applied to obtain the overall outcomes of maternal and fetal mortality in pregnant women in Iran. Forest plot, τ2, and I2 tests are applied to evaluate heterogeneity, significance and its percentage, respectively. The analysis of meta-regression is applied because of the existence of heterogeneity. Publication bias is investigated by Funnel plot and Egger test. Results: The range of maternal and fetal mortality was 29.2% to 66.67% and 38.5% to 72.8%, respectively. Also, 48.4% and 54.2% were the overall outcome of maternal and fetal mortality based on meta-analysis, respectively. The highest maternal mortality is reported for pregnant women with Total Body Surface Area (TBSA) over 50%, intentional burns, and acute respiratory failures. Finally, reduction of maternal mortality had a statistically significant relationship with passing time based on the univariate analysis. Conclusion:It can be inferred from our results that some hazards of burn in pregnant women are average age of 22-27 years, living in rural areas, low levels of socio-economic, low education level and being housewife. Also, according to meta-analysis results, about half of mothers and fetuses died in pregnant women as a result of burns in Iran.

Objective: The prevalence of burn in children is more than other age groups. This study aimed to "investigate the factors associated with the burn degree and total body surface area (TBSA) in under five-year-old children of Kermanshah ".Methods: We studied under five-year-old children hospitalized in the burn center of Imam Khomeini hospital in Kermanshah from September 2014 until March 2016 for 18 months. Required Information extracted by trained staff based on existing data. Researcher-made checklist was used to obtain information. The ordinal regression has been applied to evaluate factors related to TBSA and burn degree in children. Result: In general, 262 children were input of the study so that 226 cases (86.3%) were in under two-year-old group. The majority of cases were boys by 66.8% (175 cases). Hot liquid was the most reported cause of burns by 68.7% of all cases. Most of the burn incidents (43.1%) with high burn degree occurred at 7 am to 2 pm. Girls were exposed to higher burn degrees more than boys. Factors such as being boy (OR=2.83), less than 2 years old age (OR=4.91) significantly increased TBSA. Also, living in rural (OR=5.17) and delay of treatment (OR=41.35) significantly increased burn degree. Conclusion: To reduce the incidence and complications of burns in children, interventions should be considered to change the environmental and individual factors.

Background: Smoking is recognized as one of the main public health problems worldwide and is accounted for a high financial burden to healthcare systems and the society as a whole. This study was aimed at examining the effect of smoking status on cost of hospitalization among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014. Methods: A total of 1,271 patients (consisting of 415 LC, 427 COPD and 429 IHD patients) were included in the study. Data on age, sex, and insurance status, length of hospital stay and cost of hospitalization were extracted from the medical records of the patients. The smoking status of the patients was obtained through a telephone survey. A generalized linear model (GLM) was used to compare the costs of hospitalization of current, former and never smokers. The analysis was done using Stata v.12. Results: The mean±SD cost of hospitalization per patient was 45.6 ± 41.8 million IR for current smokers, 34.8±23 million IR for former smokers and 27.6±24.6 million IR for never smokers, respectively. The findings indicated that the cost of hospitalization for current and former smokers was 65% and 26% in the unadjusted model and 35% and 24% in the adjusted model higher than for never smokers. Conclusion: The findings revealed that smoking drains a large hospital resource and imposes a high financial burden on the health system and the society. Therefore, efforts should focus on reducing the prevalence of smoking and the negative economic consequences of smoking.

Objective To investigate the effect of the health sector evolution plan (HSEP) on hospitalization and cesarean section (C-section) rates in Kermanshah province in the western region of Iran. Design Interrupted time series analysis. Setting Hospital care system in Kermanshah province. Study Participants Fifteen hospitals affiliated to Ministry of Health and Medical Education (MoHME) in Kermanshah province. Intervention(s) Health sector evolution plan. Main Outcome Measures Hospitalization rate and C-section rate. Results We observed a statistically significant increase in the hospitalization rate (12.9 hospitalizations per 10 000 population, P < 0.001) in the first month after the implementation of the HSEP. Compared with the monthly trend in hospitalization rate before the intervention, we found a significant increase of 0.70 hospitalizations per 10 000 population (P < 0.001) in monthly trend in hospitalization rate after the HSEP. Although the proportion of C-section from total deliveries decreased by 11% (P = 0.044) in the first month after the implementation of the HSEP, the proportion of C-section from total deliveries increased at the rate of 0.0017% (P = 0.001) per month during post-intervention period. Conclusion We found an increase in the hospitalization rate after the intervention of HSEP. Although the C-section rate in the first month after the HSEP decreased, we observed an increasing trend in C-section rate over the study period; this implies that the HSEP did not promote vaginal delivery in Iran, which is outlined as one of the objectives of the intervention.

Objectives We sought to determine the main factors related to relapse in patients with substance-related disorders (SRDs) who received methadone maintenance therapy (MMT) using decision tree (DT) analysis. Methods We conducted a cross-sectional study of 4175 patients referred to the 45 MMT centers in Kermanshah province, west of Iran. We included all patients who were under MMT for at least one year. All information was collected through an interview by a psychologist. Descriptive statistics and univariate and multiple regression models were used in statistical analysis. The Gini index was calculated to determine the cut-off point of nodes. We used the Classification and Regression Trees algorithm to create the DT. Results The relapse rate was 76.6% for all participants, with no significant gender differences. The DT resulted in a five-level model of significant factors affecting substance abuse relapse. These included lower cost for buying substances, lower age at first substance use, history of quitting substances without medication, frequency of substances utilization per month, and frequency of methadone therapy. Conclusions Knowing the main factors associated with substance abuse relapse could be important for health care providers to make better decisions for improving the treatment outcomes of SRDs.

Background Cancer is currently one of the main public health problems all over the world and its economic burden is substantial both for health systems and for society as a whole.To inform priorities for cancer control, we here estimated years of potential life lost (YPLL) and productivity losses due to cancer-related premature mortality in Iran from 2006 to 2010. Materials and methods The number of cancer deaths by sex and age groups for top ten leading cancers in Iran were obtained from the Ministry of Health and Medical Education. To estimate theYPLL and the cost of productivity loss due to cancer-related premature mortality, the life expectancy method and the human capital approach were used, respectively. Results There were 138,228 cancer-related deaths in Iran (without Tehran province) of which 76 % (106,954) were attributable to the top 10 ranked cancers. Some 63 % of total cancer-related deaths were of males. The top 10 ranked cancers resulted in 106,766,942 YPLL in total, 64,171,529 (60 %) in males and 42,595,412 (40%) in females. The estimated YPPLL due to top 10 ranked cancers was 58,581,737 during the period studied of which 32,214,524 (54%) was accounted for in males.The total cost of lost productivity caused by premature deaths because of top 10 cancers was 1.68 billion dollars (US$) from 2006 to 2010, ranging from 251 million dollars in 2006 to 283 million dollars in 2010. Conclusions This study showed that the economic burden of premature mortality attributable to cancer is significant for Iranian society. The findings provide useful information about the economic impact of cancer for health system policy/ decision makers and should facilitate planning of preventive intervention and effective resource allocation.

The associations between socioeconomic status (SES) and tobacco use, alcohol consumption and drug use are poorly understood in the Islamic Republic of Iran.To measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption in Kermanshah Province, Islamic Republic of Iran.We used baseline data from the Ravansar Noncommunicable Disease (RaNCD) study. The study collected information on socioeconomic and demographic characteristics, cigarette and hookah smoking, alcohol consumption and illicit drug use of 10 015 adults aged ≥ 35 years between 2014 and 2016. The relative concentration index and absolute concentration index were used to measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption.Cigarette smoking was concentrated among less-educated and less-wealthy men and women. Similarly, illicit drug use was concentrated among lower-SES men. In contrast, hookah smoking and alcohol consumption were more prevalent among higher-SES men.There were education- and wealth-related inequalities in tobacco, alcohol and illicit drug use in the west of the Republic of Iran. Future studies should aim to identify the main socioeconomic determinants of these inequalities in Kermanshah Province and generally in the Islamic Republic of Iran.ارتباط تعاطي التبغ والمُسكرات وتعاطي المخدِّرات غير المشروع بتفاوت الحالة الاجتماعية الاقتصادية: بيّنات من الأكراد الإيرانيين.فريد نجفي، محمد حجيزاده، يحيى باسدار، يحيى سليمي، بهروز حمزة، بهزاد كرامي ماتين، بختيار بيروزي، ستار رضايي.ثَمَّة عدم فهم جيد للروابط بين الحالة الاجتماعية الاقتصادية وتعاطي التبغ والمُسكرات والمخدِّرات في جمهورية إيران الإسلامية.قياس أوجه التفاوت في التعليم والثروة فيما يتعلق بتدخين السجائر، وتدخين النرجيلة، وتعاطي المخدِّرات غير المشروع، وتعاطي المُسكرات في محافظة كرمانشاه بجمهورية إيران الإسلامية.استخدمنا البيانات المرجعية المُستمَدة من دراسة رافانسار للأمراض غير السارية. وجمعت الدراسة معلوماتٍ عن الخصائص الاجتماعية الاقتصادية والديموغرافية، وتدخين السجائر والنرجيلة، وتعاطي المُسكرات وتعاطي المخدِّرات غير المشروع لدى 10015 بالغاً عُمر كلٍّ منهم 35 عاماً في الفترة بين عامَيْ 2014 و2016. واستُخدم كلٌ من مؤشر التركيز النسبي ومؤشر التركيز المُطلَق لقياس أوجه التفاوت في التعليم والثروة فيما يتعلق بتدخين السجائر، وتدخين النرجيلة، وتعاطي المخدِّرات غير المشروع، وتعاطي المُسكرات.يتركَّز تدخين السجائر بين الرجال والنساء الحاصلين على قدرٍ متدنٍ من التعليم والأقل ثراءً. وبالمثل، يتركَّز تعاطي المخدِّرات غير المشروع بين الرجال ذوي الحالة الاجتماعية الاقتصادية المتدنية. وعلى النقيض من ذلك، كان تدخين النرجيلة وتعاطي المُسكرات أكثر انتشاراً بين الرجال الذين يتمتعون بحالة اجتماعية اقتصادية رفيعة.ثَمَّة أوجه تفاوت في التعليم والثروة فيما يتعلق بتعاطي التبغ والمُسكرات وتعاطي المخدِّرات غير المشروع في غرب جمهورية إيران. وينبغي أن تهدف الدراسات المستقبلية إلى الوقوف على المُحدّدات الاجتماعية الاقتصادية الرئيسية لهذه التفاوتات في محافظة كرمانشاه، وبصفةٍ عامة في جمهورية إيران الإسلامية.Inégalités socio‐économiques en matière de tabagisme, de consommation d’alcool et de drogues illicites : témoignages des Kurdes iraniens.Les associations entre le statut socio-économique et la consommation de tabac, d’alcool et de drogues sont mal comprises en République islamique d’Iran.La présente étude avait pour objectif de mesurer les inégalités en matière d’éducation et de niveau de vie liées au tabagisme par cigarette, à l’usage de la houka, à la consommation de drogues illicites et d’alcool dans la province de Kermanshah, en République islamique d’Iran.Nous avons utilisé les données de référence de l’étude menée à Ravansar sur les maladies non transmissibles. L’étude a permis de recueillir des informations sur les caractéristiques socio-économiques et démographiques, le tabagisme par cigarette et l’utilisation de la houka, la consommation d’alcool et de drogues illicites chez 10 015 adultes âgés de 35 ans et plus entre 2014 et 2016. L’indice de concentration relative et l’indice de concentration absolue ont été utilisés pour mesurer les inégalités en matière d’éducation et de niveau de vie liées au tabagisme par cigarette, à l’utilisation de la houka et à la consommation de drogues illicites et d’alcool.Le tabagisme par cigarette concernait principalement les hommes et les femmes moins instruits et moins aisés. De même, la consommation de drogues illicites concernait essentiellement les hommes présentant un statut socio-économique plus faible. Par contre, l’utilisation de la houka et la consommation d’alcool étaient plus fréquentes chez les hommes dont le statut socio-économique était plus élevé.Il existe des inégalités liées à l’éducation et au niveau de vie en matière de consommation de tabac, d’alcool et de drogues illicites dans l’ouest de la République islamique d’Iran. Les études futures devraient viser à identifier les principaux déterminants socio-économiques de ces inégalités dans la province de Kermanshah et en général en République islamique d’Iran.

BACKGROUND: The study aimed to investigate the associations between life and health satisfaction with health-related quality of life (HRQoL), body mass index (BMI) and chronic disease among people who are covered by health insurance schemes in Tehran city, Iran. METHODS: A cross-sectional study was conducted in Tehran city, Iran, from May to June 2016. A total of 600 people were included in the study using a cluster sampling technique. The questionnaire that used for data collection included demographic and socioeconomic variables, questions about health variables such as chronic disease, weight, height, smoking status, and EQ-5D-3L questionnaire. Two univariate and multivariate regression models performed to examine affecting factors on life and health satisfaction. RESULTS: The univariate regression showed that on average female have 0.22 and 0.69 score lower than males with their life and health satisfaction, respectively. Explanatory variables of gender, age, level of education, and employment status were not significantly associated with life and health satisfaction in multiple regression models. However, marital status was correlated with life satisfaction. Furthermore, HRQoL, BMI and chronic disease and smoking were associated with dependent variables (P < 0.001). CONCLUSIONS: The result showed that there was a strong association between BMI, HRQoL, chronic disease, and life and health satisfaction among participants. Therefore, the Iranian policymakers need to consider these factors on life and health satisfaction of adults and design health-promoting programs to improve health outcomes of them. Further studies should assess the associations between BMI, HRQoL, chronic conditions, and life and health satisfaction among Iranian adults.

Purpose In Iran, the most common cause of injuries and the second leading cause of deaths are traffic accidents, and those problems impose a substantial financial burden on the society. This study aims to determine traffic accident mortality trends and their epidemiologic characteristics in the Kermanshah province, west of Iran. Methods In a cross sectional study, road traffic fatality data from 2004 to 2013 were analyzed to determine the epidemiological pattern of traffic accident mortality. Trend assessment was performed to ascertain the decreasing or increasing status. Chi-square and one-way analysis of variance (ANOVA) tests, as well as Poisson regression were used to determine the significance of the data in time. Data were analyzed using Excel and statistical package of SPSS version 19. Results Out of 5110 people that died in traffic accidents, 4024 (78.7%) were males. The state of accidents indicated that 404 (43.8%) female pedestrians died as a result of car crashes, and 1330 (41.4%) males died because of car collisions. 1554 (31.9%) deaths happened to pedestrians and 1556 (32.1%) to vehicle drivers, and the rest belonged to vehicle passengers. Head trauma was the cause of death for as much as 3400 (69.9%) cases. Fatal crashes in which pedestrians were involved mostly occurred between the hours 13:00 to 15:00, while the time for vehicle drivers was between 16:00 to 18:00. 2882 people (59.1%) died before reaching to health care facilities. Traffic crash mortality trend for pedestrians follows a linear pattern with a gentle downward slope, but the trend shows various swings when it comes to vehicle drivers. Conclusion The number of traffic crash deaths from 2004 to 2013 indicates a decreasing trend in two groups of road users: vehicle drivers and car occupants. This can be due to some interventions such as modification of traffic rules and enhancement of police control which has been implemented in recent years. Moreover, more attention should be paid to promote the optimal health care services to save the lives of the injured from traffic accidents.

Introduction: During the last few decades, healthcare expenditures (HCEs) have increased significantly in Iran and throughout the world. Understanding the determinants of such increases is essential to health policymakers in finding the best policies to manage healthcare costs. This study aimed to determine the impact of some of the key explanatory variables on household healthcare expenditures across the provinces of Iran. Methods: A panel data econometric model was used to determine the main factors that affected household healthcare expenditures (HHCEs) across the provinces of Iran from March 21, 2006 to February 19, 2013. The data on household healthcare expenditures per capita, number of physicians per 10,000 population, the degree of urbanization, the proportion of the population that was 65 or older, household income per capita, and literacy rate were obtained from the Household Expenditure and Income Survey (HEIS) data in the Statistical Center of Iran. F-Limer and Hausman tests were used to choose the panel data, and Stata V.12 was used to analyze the data. Results: Our findings indicated that income per capita, physicians per 10,000 population, and the degree of urbanization had significant impacts on healthcare expenditures. Also, the results of the study showed the elasticity of income, physicians, urbanization, proportion of the population 65 or older, and the literacy rate were 0.25 (p < 0.002), 0.37 (p < 0.001), 5.01 (p < 0.001), -0.1 (p < 0.73), and -1.02 (p < 0.082), respectively. Conclusion: The results of the study indicated that the income elasticity of healthcare expenditures was less than 1; health expenditures were considered to be a “necessity good” across the provinces of Iran during the period that was studied. In addition, there were some other factors that affected healthcare expenditures that were not considered in the study, such as the advancement of new technology and the costs of dying. However, it is recommended that future research examine the effect of these factors on HCEs in Iran.

This study was aimed at assessing any association between smoking and health-related quality of life (HRQoL) among adults aged 18 years and above living in Kermanshah city, western Iran. A cross-sectional study was conducted on a total sample of 1,543 participants obtained by convenient sampling during the period from February 1st to May 30th, 2017. Data were collected using a self-administrated questionnaire. The HRQoL of the study participants was assessed with reference to the EuroQol 5-dimensions-3-level (EQ-5D-3L). The impact of smoking behavior of the participants on HRQoL with controls for potential confounders was examined by multiple regression. Out of the total of 1,543 participants, current smokers, past smokers, and never smokers accounted for 19.7%, 4.2% and 76.1%, respectively. The mean EQ-5D indices were 0.69 ±SD 0.20, 0.70 ± SD 0.22, and 0.78 ± SD 0.16. The highest proportion of self-reported problems (including both ‘some’ and ‘severe’) were related to current, heavy smokers, with high nicotine dependence. Regression analysis indicated that current smokers had a significantly lower HRQoL compared to past smokers and never smokers (p < 0.05). The heavy smokers also had a significantly lower HRQoL score than moderate and light smokers (p < 0.05) and there was an inverse relationship between the HRQoL score and nicotine dependence (p

AIMS To estimate the 1-year period prevalence of medication errors and the reporting rate to nurse managers among nurses working in hospitals in Iran. BACKGROUND Medication errors are one of the main factors affecting the quality of hospital services and reducing patient safety in health care systems. METHOD A literature search from Iranian and international scientific databases was developed to find relevant studies. Meta-regression was used to identify which characteristics may have a confounding effect on the pooled prevalence estimates. RESULTS Based on the final 22 studies with 3556 samples, the overall estimated 1-year period prevalence of medication errors and its reporting rate to nurse managers among nurses were 53% (95% confidence interval, 41%-60%) and 36% (95% confidence interval, 23%-50%), respectively. The meta-regression analyses indicated that the sex (female/male) ratio was a statistically significant predictor of the prevalence of medication errors (p

Background: burn injuries are a major public health in the world, especially in developing countries. The aim of this study was investigate to the epidemiological data and cost of hospitalization due to burn in pediatrics in Kermanshah provinces from 2011 to 2013.Material and Methods: this was a retrospective cross sectional study. The study subject was all of patient lee than 15 years who admitted in Burns Center at Imam Khomeini Hospital in Kermanshah, Iran, from 21 March 2011 to March 2013 (two years). The data including age, gender, cause of burn, burn degree, place of burn, length of stay (LOS), burned body surface (BBS) and cost of hospitalization was obtained from hospital data and analyzed by SPSS version 18. Results: the overall mean age was 5.27 ± 4.52 years; the ages ranged from less than 1 year to 15 years. The mean BBS % and LOS was 22.8 % and 7.48 day, respectively. The mean cost per patient, per hospitalization day and per % BBS were 15000000 IRR, 657981 IRR and 20045348 IRR, respectively. Conclusion: The current study showed the main cause of burn and mortality in the pediatric population was hot liquids and flame, respectively. An important point is that most of burn injuries in pediatric population are preventable and avoidable if the necessary training about cause of these burns provides for their parent.

BACKGROUND: Road Traffic Injuries (RTIs) as a result of road traffic crashes (RTCs) rank as the leading cause of death, disability and property loss worldwide, especially in low- and middle-income countries. This study aims to analyze the costs of RTCs in Iran. METHODS: A standard human capital approach was used to estimate the costs. Costs included medical, administrative and funeral costs, property damage, production lost and intangible costs. Data about the number of deaths and injuries resulting from RTIs between 20 March 2009 and 20 March 2010 was obtained from two national databases designed at the Center for Disaster Management and Medical Emergencies (CDMME) and the Legal Medicine Organization (LMO), respectively. The severity and medical costs of injuries were identified by reviewing 400 medical records that were selected randomly from patients who were admitted to two large trauma centers in Shariati and Sina hospitals in Tehran province. Moreover, information about production lost, property damage, rehabilitation cost, intangible costs and administration costs were collected by review of current evidence and consulting with expert opinion. RESULTS: In total 806,922 RTIs and 22,974 deaths resulted from the RTCs in the study period. The total cost of RTCs was about 72,465 billion Rials (7.2 billion US Dollars), which amounts to 2.19% of Iran’s Gross Domestic Production (GDP). Direct costs were 3,516 billion Rials (around 48.6 % of the total costs), following by 24,785 billion Rials (around 34.2 % of the total costs) for production lost and 12,513 billion Rials (around 17.2 % of the total costs) for intangible costs. CONCLUSIONS: This study indicated that the burden of both RTCs and RTIs in Iran is substantial. Moreover, RTCs have significant economic consequences and are a large drain on healthcare resources. © 2013 KUMS, All rights reserved

Background: In developing countries, people with disabilities (PWD) are more likely to have unequitable access to health care services than their counterparts without disabilities. Access to health care is a multidimensional concept and PWD experience various barriers to use health care. This quantitative study explored the predictors and determents of access to health care for PWD in an Iranian context. Methods: Data were collected from a cross sectional study conducted in Tehran in 2017. A total of 403 adults with physical and/or intellectual disabilities were selected using census method. The data on PWD were collected from 14 rehabilitation centers affiliated to Welfare Organization and Red Crescent Organization. The self–report World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to collect data on disability status. T test, ANOVA, and multiple linear regressions were used to determine factors influencing access to health care for PWD. Significance level was set at 5%. Also, SPSS software version 20.0 was used for data analysis. Results: The mean of access to health care among people with intellectual disabilities (mean: 61.77, 95% confidence interval (CI):59.20, 64.35) was significantly lower than their counterparts with physical disabilities (Mean: 67.97, 95% CI: 65.26, 70.69). The results of multiple linear regression analysis showed that in the affordability dimension, type of disability, marital status, and supplemental health insurance could predict access to health services for PWD. In availability dimension, only location predicted the outcome variable significantly. Also, location and type of disability were considered to be potential predictors of access to health services in acceptability dimension. Conclusion: The results indicate that various factors can limit access to health services for PWD. To achieve universal health coverage, vulnerable groups and their needs should be identified to increase equitable access to health care services. Also, the health care system should pay more attention to demographic differences when planning and providing affordable and acceptable health care for PWD. Finally, the role of the government as the heath stewardship is vital to promote health care access for PWD in Iran.

Smoking is recognized as a main leading preventable cause of mortality and morbidity worldwide. It is responsible for a considerable nancial burden both on the health system and in society. This study aimed to examine the effect of smoking on cost of hospitalization and length of stay (LoS) among patients with lung cancer in Iran in 2014.A total of 415 patients were included in the study. Data on age, sex, insurance status, type of hospitals, type of insurance, geographic local, length of stay and cost of hospitalization was extracted by medical records and smoking status was obtained from a telephone survey. To compare cost of hospitalization and LoS for different smoking groups, current smokers, former smokers, and never smokers, a gamma regression model and zero-truncated poisson regression were used, respectively.Compared with never smokers, current and former smokers showed a 48% and 35% increase in hospitalization costs, respectively. Also, hospital LoS for current and former smokers was 72% and 31% higher than for never smokers, respectively.Our study indicated that cigarette smoking imposes a signi cant nancial burden on hospitals in Iran. It is, however, recommended that more research should be done to implement and evaluate hospital based smoking cessation interventions to better increase cessation rates in these settings.

Background: Economic burden due to premature mortalities is significant both on health system and on the society as a whole. This study aimed to determine the productivity costs and years of potential life lost associated with five leading causes of death in Iran from 2006 to 2010. Methods: Data on mortality by sex and age-groups due to five main leading causes of death (myocardial infarction (MI), cerebral vascular diseases (CVD), transport accidents (TA), hypertensive heart disease (HHD) and gastric cancer (GC)) were obtained from the Ministry of Health and Medical Education from 2006 to 2010 for 29 providences of Iran (data on Tehran province was not available). Three measures including years of potential life lost (YPLL), years of potential productive life lost (YPPLL) and the cost of productivity loss (CPL) due to premature mortality were used. To estimate the CPL and YPLL, the human capital approach and life expectancy method were used, respectively. Results: There were 518,815 deaths due to the five main leading causes of death; of which, 58% occurred in males. The estimated YPPLL resulted in 209,552,135 YPPLL from 2006 to 2011; of which, 141,966,592 (67%) were in males and 67,585,543 (33%) in females. The total cost of productivity loss caused by premature deaths due to the five leading causes of death was 7.86 billion dollars (US$) from 2006 to 2010, ranging from 1.63 billion dollars in 2006 to 1.31 billion dollars in 2010. Conclusion: This study revealed that the economic burden of premature mortalities due to the five main causes of death is substantial, and that these five leading causes should be considered in policy/decision making and prevention programms. The allocation of financial resources to control these causes may decrease their economic burden, resulting in higher level of health and well-being.

Asian Pacific Journal of Cancer Prevention, 17, 9

This article developed an approached model of congestion, based on relaxed combination of inputs, in stochastic data envelopment analysis (SDEA) with chance constrained programming approaches. Classic data envelopment analysis models with deterministic data have been used by many authors to identify congestion and estimate its levels; however, data envelopment analysis with stochastic data were rarely used to identify congestion. This article used chance constrained programming approaches to replace stochastic models with ‘‘deterministic equivalents”. This substitution leads us to non-linear problems that should be solved. Finally, the proposed method based on relaxed combination of inputs was used to identify congestion input in six Iranian hospital with one input and two outputs in the period of 2009 to 2012.

Backgrounds: Drug abuse is one of the most serious social problems in many countries. College students, particularly at their first year of education, are considered as one of the at risk groups for drug abuse. The present study aimed to determine cognitive factors related to drug abuse among a sample of Iranian male medical college students based on the social cognitive theory (SCT). Method: This cross-sectional study was carried out on 425 Iranian male medical college students who were randomly selected to participate voluntarily in the study. The participants filled out a self-administered questionnaire. Data were analyzed by the SPSS software (ver. 21.0) using bivariate correlations, logistic and linear regression at 95% significant level. Results: Attitude, outcome expectation, outcome expectancies, subjective norms, and self-control were cognitive factors that accounted for 49% of the variation in the outcome measure of the intention to abuse drugs. Logistic regression showed that attitude (OR=1.062), outcome expectancies (OR=1.115), and subjective norms (OR=1.269) were the most influential predictors for drug abuse. Conclusions: The findings suggest that designing and implementation of educational programs may be useful to increase negative attitude, outcome expectancies, and subjective norms towards drug abuse for college students in order to prevent drug abuse.

Substance abuse is one of the most complicated social problems. Understanding socio-demographic characteristics of those who abuse substances could help deal with this problem more efficiently. The main objective of this study was to determine socio-demographic characteristics associated with alcohol drinking, cigarettes smoking and drug abuse among a sample of male medical university students in Iran.This cross-sectional study was conducted in 2014 among 425 male medical college students randomly selected with the proportional to size among different faculties in Isfahan and Kermanshah medical universities in Iran. A self-report written questionnaire was applied to collect data. Data were analyzed by the SPSS-20.Mean age of the respondents was 19.9 yr (ranging from 18 to 22 yr). About 19.4%, 3.9%, and 10.1% of the respondents had history of cigarette smoking, drug use, and alcohol drinking during the past three months, respectively. Logistic regression showed that mother's educational level, living place, economic status, and parents' divorce were the most influential predictive factors on substance abuse.Considering the high prevalence of substance abuse (especially smoking and alcohol drinking), it seems essential to design educational interventions to prevent substance abuse, paying attention to predictive factors mentioned above, among college students.

Quality of Life (QOL) in opiate-addicted patients who are receiving methadone maintenance therapy is one of the important issues to be considered in the treatment of addiction. To determine a needs assessment using the PRECEDE model to find out factors related to QOL among Iranian male opiate addicts. This cross-sectional study was conducted in Kermanshah, Iran in 2013. A total of 762 male opiate addicts, who were referred to addiction treatment centers for receiving methadone maintenance treatment, were randomly selected to participate voluntarily in the study. SF-12, predisposing factors, enabling factors, reinforcement factors, and methadone maintenance treatment intention were used to find the related factors. Data were analyzed by the SPSS software (ver. 21.0) using the t-test, one-way analysis of variance (ANOVA), bivariate correlations, and linear regression at 95% significant level. Linear regression analysis showed the determinant variable accounted for 17% of the variation in QOL. Our findings suggest, providing social support for addicts could be beneficial results for the increasing quality of life among them.

BACKGROUND: Burns are among the most common injuries affecting a great number of people worldwide annually. In Iran, especially in its western region and in Kermanshah province, burns have a relatively high incidence. The present study was aimed at investigating epidemiological characteristics in Western Iran. METHODS: Within a cross-sectional study, the data on all patients attending the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during 2010-2011 and 2011-2012 (24 months) were collected. Then, age, gender, cause of burns, total body surface area, and time of the occurrence were extracted from the hospital records. The data were analyzed using the SPSS statistical package (Version 19, for Windows). We used chi-squared test when we compared the categorical responses between two or more groups. For comparing means between two groups we used t-test. In addition, trends were investigated using linear regression. RESULTS: Overall 13 248 people were referred to the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during the period of study, including 328 cases of self-immolation. The mean age of the patients was 27±19 years and 29±13 years for unintentional burns and self-immolation respectively. Out of the total number of unintentional cases, 6 519 (50.5%) were men, while the corresponding percentage of men among the self-immolation cases was 16.6% (p less than 0.001). Trends in the number of cases were cyclic, with the highest and lowest number of burns cases being in March and May. Overall, hot liquids and flammable materials were the two most important causes of unintentional burns. However, flammable materials were the main cause of burns among self-immolation cases. During hospital admission, 168 (51%) self-immolation victims and 43 (0.33%) unintentional burn victims died. CONCLUSIONS: While major preventive measures are not adequately used in developing countries, burns and their burden can be significantly reduced by increasing public awareness and by applying simple preventive measures. © 2013 KUMS, All rights reserved. Language: en