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

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 84middot3 million inhabitants in 2019, had a life expectancy of 79middot6 years (95% uncertainty interval 79middot2-79middot9) in female individuals and 76middot1 (75middot6-76middot5) in male individuals, an increase compared with 1990. The number of DALYs remained stable and reached 19middot8 million (17middot3-22middot6) in 2019, of which 78middot1% were caused by non-communicable diseases (NCDs) compared with 43middot0% 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 44middot5% 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 16middot8%, deaths attributable to all risk factors substantially grew by 43middot8%. 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. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.