Background: Stroke remains a global health challenge, with its burden disproportionately affecting developing nations, including Iran. Rapid access to medical care is crucial for improving outcomes. However, spatial and temporal factors often leads to delays, adversely impacting survival. This study investigated predictors of in-hospital mortality among stroke patients in Mashhad, Iran, with a novel focus on spatial directionality using circular statistical methods. Study Design: A retrospective cohort study. Methods: The data of 1,171 stroke patients transported to Ghaem Hospital (2018-2019) were analyzed in this study. Pre-hospital delays, demographics, and clinical factors were assessed alongside spatial directionality, represented by the bearing angle between patients' residences and the hospital. Circular logistic regression was used to model in-hospital mortality, incorporating both linear and circular predictors. Results: The in-hospital mortality rate was 14.3%. Independent predictors included age (OR: 1.03, 95% CI: 1.01-1.04), length of stay (OR: 1.02, 95% CI: 1.01-1.04), triage level (OR: 2.31, 95% CI: 1.20-4.45), ambulance accessibility (OR: 0.97, 95% CI: 0.96-0.99), and the sine of the bearing angle (OR: 1.37, 95% CI: 1.02-1.83). Mortality was higher along the north-south axis, potentially reflecting disparities in healthcare access and population characteristics. Gender and final diagnosis were not significant predictors. Conclusion: Overall, age, length of stay, triage level, ambulance accessibility, and spatial directionality were significant predictors of in-hospital stroke mortality. The circular statistical approach provided added value by detecting directional disparities not captured through conventional methods, underscoring the need for spatially informed interventions to reduce inequities in stroke outcomes.
Background: Drug abuse is a public health problem that leaves morbidity, disability and premature mortality in the society. This study investigated the epidemiological features, socioeconomic disparities, and geographic distribution of drug abuse-related deaths across Iran in 2020. Study Design: An ecological study. Methods: Data on drug abuse deaths were obtained from the Iranian Legal Medicine Organization (LMO). The Theil index, between-group variance (BGV), concentration index, and concentration curve (CC) were used to assess mortality inequality. Finally, spatial inequality was analyzed using Results: In 2020, the drug abuse mortality rate was 49.91 per million people in Iran. Opium (24.89%), methamphetamine (21.23%), and heroin (16.58%) were the most common substances involved in this respect. High-high clusters, including Hamadan, Markazi, Lorestan, and Ilam, had high drug abuse death rates and were surrounded by similar provinces. The concentration index of 0.10 indicated higher drug-related deaths in provinces with a higher human development index (HDI). Moreover, the Theil index and BGV revealed considerable regional inequality in drug abuse mortality rates. Conclusion: Overall, drug-related deaths in Iran predominantly affected males, particularly in the 30-39 age group. Victims had low educational attainment and were self-employed. Provinces with lower HDIs, such as Kermanshah, Hamedan, and Lorestan, had the highest mortality rates. Thus, these regions need targeted prevention and treatment. Addressing the links between substance use and suicidal behavior requires integrated mental health and addiction treatment services. In addition, policymakers should prioritize educational, preventive, and treatment programs in high-risk areas.
Background: Poisson and negative binomial (NB) regression models are commonly used to investigate the association between air pollution and hospital admissions for cardiovascular and respiratory diseases. This study utilized the new Poisson-generalized Lindley (NPGL) regression model to evaluate the relationship between air pollutants and daily hospital admissions for these diseases among elderly individuals. Study Design: An ecological cross-sectional study. Methods: The data related to daily air pollutant concentrations, meteorological parameters, and the number of hospitalizations for cardiovascular and respiratory patients were gathered from the Environmental Protection Organization, the General Directorate of Meteorology, Farshchian Heart Hospital, and Shahid Beheshti Hospital in Hamadan. Then, the relationship between air pollution and daily hospital admissions was assessed using Poisson, NB, and NPGL models. Results: The findings indicated that the accuracy of the regression coefficients estimated in the NPGL model was higher than that in the NB and Poisson models for most pollutants. Specifically, the relative risk for carbon monoxide (CO) was calculated at 1.307 (95% confidence interval: 1.270-1.345). Cardiovascular hospitalization increased by 30.7% for each unit increase in CO concentration. A significant and direct association was found between exposure to all pollutants, except for PM2.5, and hospitalization for respiratory diseases (P< 0.05). Conclusion: Overall, there was a significant relationship between air pollution and hospital admissions for cardiovascular diseases (CVDs) and respiratory diseases among the elderly, particularly regarding CO. This study indicates the need for policymakers to implement health programs to mitigate the effects of air pollution on vulnerable elderly populations.
Background: Illicit drug use is a serious multi-factorial public health challenge globally, especially in the Eastern Mediterranean Region (EMR). In 2019, the disability-adjusted life year rate for drug use disorders in the EMR rose by approximately 40%, whereas the global rate increased by less than 25%. Despite this growing burden, limited data exist on gender patterns of drug-related mortality and its associated socio-economic factors at the national level in Iran. This study evaluated socioeconomic factors contributing to gender disparities in illicit drug-related mortality across provinces of Iran. Study Design: A national ecological study. Methods: A secondary analysis of data from the Iranian Forensic Medicine Organization's national registry was conducted from March 2022 to March 2024. Descriptive statistics were calculated for socioeconomic indicators (happiness, life satisfaction, literacy rate, unemployment, economic participation, and gross domestic product) across provinces of Iran to assess gender disparities in illicit drug-related mortality. Bivariate and multivariate regression analyses were performed to examine the relationship between these indicators and the sex ratio of illicit drug-related deaths. Results: The sex ratio of illicit drug-related deaths was 7.20, indicating a considerable gender disparity. According to the final model, greater female economic participation ((3=-0.517, P = 0.018) and higher GDP ((3=-1.196, P = 0.002) were significantly correlated with a lower gender gap in illicit drug-related mortality across provinces in Iran. Conclusion: At the provincial level, there were noticeable correlations between a narrower gender gap in illicit drug-related mortality and both greater female economic participation and higher GDP in Iran.
Background: Data on mortality from Diabetes Mellitus (DM) in the United States (US) are available from various sources, including the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) death certificate data and the Global Burden of Disease Study (GBD). This study aimed to compare DM mortality reporting between the CDC WONDER and GBD datasets. Methods: In this retrospective cohort study, we calculated the absolute number of deaths and crude mortality rates attributed to DM as the underlying cause of death in CDC WONDER and GBD in the US from 1999 to 2021 (CMR with 95% Confidence Intervals (CI) or Uncertainty Intervals (UI)) per 100 000 population. Because of methodological differences between datasets, results were also evaluated based on the inclusion and exclusion of mortality from DM with renal complications. Results: The reported CMR for DM increased from 34 (95% CI: 34 to 35) to 41 (95% CI: 41to 42) in CDC WONDER but decreased from 36 (95% UI: 32 to 37) to 29 (95% UI: 27 to 31) in GBD from 1999 to 2021. When deaths from DM with renal complications were excluded from CDC WONDER to mirror GBD reporting, CMRs in 1999 and 2021 from CDC WONDER were 33 (95% CI: 33 to 34) and 29 (95% CI: 28 to 29), respectively, and trends were generally similar. Conclusion: Estimates of DM mortality rates and temporal trends in the US vary across commonly utilized sources of mortality data. These results have important implications for epidemiological efforts to understand and interpret DM mortality reporting.
Background: Visceral leishmaniasis (VL) is a fatal parasitic disease endemic to tropical regions and associated with severe complications and high mortality. Persistent challenges such as delayed diagnosis and limited treatment options highlight the urgent need for robust predictive epidemiological models. Study Design: This study was a secondary analysis conducted using cross-sectional data. Methods: Sex-specific VL epidemiological data from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) database and analyzed globally and across 98 endemic countries and regions. An enhanced illness-death model (IDM), incorporating remission, was applied to estimate the age-standardized prevalence rate (ASPR) of VL by 2040. Results: Globally, the global ASPR of VL decreased by 94.68% between 1990 and 2021. It is projected to decrease by an additional 72.55% by 2040, declining from 0.108 in 2021 to 0.030 (95% CI: 0.020, 0.043) per 100,000 population. In 2040, ASPR is expected to remain higher in males than in females (0.041 vs. 0.019). Tropical Latin America is projected to have the highest regional ASPR at 0.583 (95% CI: 0.565, 0.602). Western Sub-Saharan Africa is the only region expected to experience an increase, rising by 417.12%. Of 83 nations, 27 are expected to exhibit increasing trends, with Djibouti demonstrating the highest projected ASPR at 20.32 (95% CI: 5.25, 78.67), a 2050.59% increase from 2021 to 2040. Conclusion: Despite global declines in VL prevalence, significant increases are expected in Western Sub-Saharan Africa and countries such as Djibouti, highlighting the need for targeted interventions. Strengthening healthcare systems, improving vector control, and addressing sexspecific risks are crucial to maintain global progress.
Background: Low birth weight (LBW) remains a serious global public health challenge, with more than 20 million babies born annually. Although maternal nutritional status during pregnancy is a major determinant of LBW, desirable perceptions and knowledge do not always lead to appropriate nutritional behavior without adequate health motivation. Accordingly, this study aimed to investigate the role of health motivation in pregnant women's perceptions of nutritional compliance behaviors for LBW prevention. Study Design: A cross-sectional study. Methods: This study was conducted among 220 pregnant women, selected using cluster random sampling. The required data were collected through a validated questionnaire based on the health motivation, and nutritional compliance behavior among pregnant women as an effort to prevent LBW. Eventually, path analysis was processed using AMOS 29. Results: Perceived susceptibility (Z = 0.2866; P= 0.009), perceptions of benefits (Z= 0.443; P = 0.001), and perceptions of barriers (Z = -2.938, P = 0.003) had a significant indirect effect on the nutritional compliance behavior of pregnant women. However, perceived severity exerted no significant indirect impact on pregnant women's nutritional compliance behavior (Z = 1.787, P = 0.074) through healthy motivation. The study model demonstrated excellent fit (chi 2 = 0.295, Conclusion: In general, health motivation is an important mediator in bridging perceptions to actual actions because it builds and strengthens the motivation of pregnant women through a more personal, communicative, and experience-based approach.
Background and Objectives: Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system with increasing prevalence in Iran. Identifying modifiable environmental and lifestyle risk factors is essential for disease prevention and public health strategies. Therefore, this study aimed to evaluate environmental, lifestyle, and medical factors associated with multiple sclerosis in Kermanshah, Iran Methods: This case-control study was conducted on 300 MS patients and 300 matched healthy controls. Data on demographics, substance use, sun exposure, medical and psychiatric history, family history, and major life stressors were collected using questionnaires. Univariate and multivariable logistic regression analyses were utilized to estimate crude and adjusted odds ratios and 95% confidence intervals. Results: MS patients were more likely to be female, with lower educational attainment compared to controls. In addition, reduced sun exposure in adolescence and adulthood was strongly associated with MS (P < 0.05). Moreover, passive smoking during adolescence and maternal smoking during pregnancy were related to higher odds of MS (aOR 1.54, 95% CI: 1.05-2.72 and aOR 3.70, 95% CI: 1.19-11.52, respectively). A history of depression (aOR 3.17, 95% CI: 1.95- 5.13) and migraine (aOR 1.94, 95% CI: 1.14-3.30) were also significantly associated with MS. Additionally, a family history of MS in first-degree relatives was more frequent among cases (aOR 2.31, 95% CI: 1.36-3.94). All models were adjusted for gender, ethnicity, and education level. Conclusion: The findings indicated that MS in Kermanshah is shaped by reduced sunlight exposure, passive and maternal smoking, psychiatric comorbidities, and family history, highlighting several modifiable environmental determinants that may guide targeted prevention efforts and inform public health strategies in high-prevalence regions.
BACKGROUND:Health literacy includes cognitive and social skills that enable individuals to understand and use health information effectively. In addition, it significantly influences health outcomes in society. Women with gestational diabetes mellitus (GDM) often have low health literacy and need better education. Therefore, this study explored the link between health literacy and general health in these women. Study Design: A cross-sectional study. METHODS:This study involved 200 women with GDM referred to the Diabetes Clinic in Hamadan, Iran. The participants were selected through consecutive sampling, and the required data were collected using self-reported questionnaires, a health literacy questionnaire, and a general health questionnaire. The obtained data were analyzed using SPSS with a 95% confidence level. RESULTS:The mean age of women was 29.63 years, and the mean±standard deviation (SD) of health literacy score was 77.41±16.44. Further, the mean±SD of the general health questionnaire score was 21.02±6.01. There was a positive correlation between health literacy and general health (P<0.001), as well as between health literacy and education (P<0.05). Moreover, a positive correlation was found between general health and education (P<0.05). Eventually, a significant negative correlation was observed between age and general health (P<0.05). CONCLUSION:Health literacy plays an essential role in managing GD and promoting general health for pregnant women. This subsequently leads to reduced postpartum complications for the mother and baby, as well as reduced healthcare costs.
BACKGROUND:Opium consumption is a prevalent health concern in Iran, with conflicting evidence regarding its association with chronic conditions such as diabetes mellitus (DM) and hypertension (HTN).The present study aimed to investigate the association between opium consumption and the risk of diabetes mellitus (DM) and hypertension (HTN) among male participants aged 35-70 years in the Tabari Cohort Study (TCS). Study Design: A cross-sectional study. METHODS:This study examined male participants from the TCS. Blood samples were collected after a 12-hour fasting period. HTN and DM were defined based on blood pressure (BP) measurements, history of diagnosis, and use of antihypertensive or glucose-lowering medications. The obtained data were analyzed using chi-squared and independent t-tests. A multivariate logistic regression analysis was used to adjust for potential confounders. RESULTS:The study examined 4,149 male participants, with a mean fasting blood sugar (FBS) of 110.34±3 3.89 mg/dL, systolic BP of 115.70±13.60 mm Hg, and diastolic BP of 73.87±7.77 mm Hg. No significant difference was found in the frequency of HTN and DM among participants who consumed opium compared to those who did not consume it (P=0.588 and P=0.705, respectively). However, FBS levels were significantly higher among opium users (110.77±34.14 vs. 107.73±21.19, P=0.048). Multivariable regression analysis revealed no significant change in the risk of developing HTN (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82, 1.35, P=0.667) and DM (OR: 1.22, 95% CI: 1.57, P=0.116) among opium users. CONCLUSION:The findings of this study demonstrate no significant difference in the likelihood of developing DM and HTN between opium users and non-users.
BACKGROUND:Indonesia has one of the highest smoking rates globally. Smoking cessation is critical for reducing smoking-related diseases, particularly in areas with limited healthcare access. This study explored factors associated with smoking cessation in underdeveloped areas of Indonesia. Study Design: This study was conducted using a cross-sectional design. METHODS:Data were obtained from the 2018 Indonesia Basic Health Research survey. We used information from 16,989 ever-smokers aged 10 years or older living in underdeveloped areas of Indonesia. Binary logistic regression analyses were performed to identify factors associated with smoking cessation. RESULTS:Overall, 8.1% of ever-smokers in underdeveloped areas of Indonesia had stopped smoking cigarettes at the time of the survey. Increased odds of smoking cessation were were observed among respondents living in urban areas (aOR=1.50, 95% CI: 1.13-2.00), females (aOR=2.59, 95% CI: 1.85-3.62), aged over 45 years (aOR=2.60, 95% CI: 2.13-3.17), the unemployed or students (aOR=1.60, 95% CI: 1.24-2.01), and heads of households (aOR=1.84, 95% CI: 1.45-2.32). Non-daily smokers (aOR=6.84, 95% CI: 5.68-8.24) and those who started smoking before age 18 (aOR=1.34, 95% CI: 1.10-1.62) were more likely to have quit smoking. CONCLUSION:Public health interventions should focus on supporting younger populations, informal workers, and daily smokers in rural areas to improve cessation rates.
BACKGROUND:Anxiety and depression are major public health concerns due to their high prevalence and associated suffering, dysfunction, and socioeconomic impact, particularly among young individuals. Identifying factors associated with anxiety and depression is crucial for the prevention and promotion of mental health in youth. The present analysis aims to identify factors associated with anxiety and depression among youth, based on a youth health survey undertaken in Kolar district, India. Study Design: This study employed a cross-sectional design. METHODS:A secondary data analysis was conducted using data from the Kolar Youth Health Survey, which collected data on various health-related behaviors and conditions from 5,072 youth (aged 15-30 years). Anxiety and depression were screened using standardized tools (GAD-7 and PHQ-9, respectively). Multivariable logistic regression was conducted to identify associated factors. The model's goodness of fit was evaluated using the Hosmer-Lemeshow test and the area under the curve. RESULTS:Socio-demographic characteristics (marital status, taluka, age), self-reported diagnosed health conditions, sleep issues, suicide and non-suicidal self-harm, tobacco dependence, time spent on phone/computer, family relationships (loving/affectionate relationships vs. serious conflicts), friendships, belief in God, and injury (physical violence, road traffic injuries) were significantly associated with anxiety and/or depression among youth in the study area. CONCLUSION:Selected sociodemographic characteristics, health-impacting behaviors, and health issues were found to be significantly associated with anxiety and/or depression among youth. Considering these risk factors will enable health care providers and policymakers to develop and implement tailored interventions.
BACKGROUND:Road traffic accidents (RTAs) are a major cause of death, especially in developing countries. This study analyzed RTA patterns and trends in Hamadan province, Iran, from 2011 to 2024. Study Design: A cross-sectional study. METHODS:Data on 6,488 road traffic fatalities, excluding non-road transport deaths, were obtained from the Forensic Medicine Organization. Demographics, injury type, location, and mode of transport were analyzed. Then, spatial clustering was performed using the K-prototype algorithm, with cluster quality assessed via the Silhouette Score. Finally, mortality trends were forecasted using the Prophet model with 95% prediction intervals and evaluated using RMSE, MAE, MASE, and MAPE. RESULTS:The mean age of victims was 49 ± 21 years, with most deaths observed in the 15-44 age group. Most victims were male (75%), urban residents (60%), married (69%), and had not completed secondary education (41%). Fatalities mainly occurred at the scene (48%) or en route to the hospital (43%), with head/face injuries and hemorrhage as the leading causes. Spatial analysis revealed three clusters, with Famenin having the highest mortality (73.7 per 100,000). Mortality was projected to decline from 18.27 (16.01, 20.55) in 2025 to 9.57 (7.37, 11.69) in 2028, rising slightly to 13.94 (11.83, 16.17) in 2029. CONCLUSION:Overall, the findings emphasize the need for targeted regional interventions (e.g., road safety education, enhanced emergency services, and infrastructure upgrades) to reduce RTA mortality in the high-risk areas of Hamedan Province.
BACKGROUND:Despite long-standing efforts to improve water, sanitation, and hygiene (WASH) infrastructure in Indonesia, childhood diarrhea remains a pressing public health concern. This study focuses on the gaps between infrastructure and health equity by examining the intertwined effects of child, household, and environmental factors on the risk of diarrhea. Study Design: A cross-sectional study. METHODS:In this study, data from the 2017 Indonesia Demographic and Health Survey (IDHS) were analysed using a multilevel logistic regression model. The survey included 16632 children, with children nested within households and households within a cluster (environment). All child, household, and environmental-level variables were included as fixed effects. Cross-level interactions were examined with sanitation, maternal education, and household wealth in terms of the prevalence of diarrhea. RESULTS:Children aged 12-23 months (AOR=4.24; 95% CI: 3.23, 5.43), those with low birth weight [AOR=1.33 (95% CI: 1.04-1.70)], and those born to mothers with low education (AOR=1.74; 95% CI: 1.25, 2.44) had significantly higher odds of experiencing diarrhea. A significant interaction revealed that the impact of poor sanitation on children with less-educated mothers (AOR=1.68; 95% CI: 1.19, 2.37) and among educated mothers in children from low-income households (AOR=1.6; 95% CI: 1.12, 2.29) remained elevated. Children in non-Java-Bali regions also had persistently higher rates of diarrhea. CONCLUSION:Access to sanitation is insufficient to guarantee health equity. Maternal education plays a crucial moderating role in translating infrastructure into better health outcomes. To accomplish Sustainable Development Goals 6 and 10, integrated equity-focused sanitation programs, including poverty reduction and maternal empowerment, are of great importance.
BACKGROUND:Individual alcohol consumption depends on living conditions at different territorial and environmental levels. This study examined the influence of regional living conditions on individual alcohol consumption based on the results of a large Russian nationwide study (2012-2022). Study Design: A cross-sectional multicenter observational study. METHODS:Individual data from three stages of the Russian nationwide study, including the Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Regions of the Russian Federation (ESSE-RF1) (2012-2014), ESSE-RF2 (2017-2018), and ESSE-RF3 (2020-2022), were used for investigation. The study samples included 53,902 men and women aged 25-74 years from 31 regions. Individual data were combined with the annual values of four regional indices that characterize economic, demographic, social, and industrial environmental conditions. The analyzed outcomes included any alcohol consumption and binge drinking. RESULTS:The industrial development of regions was associated with an increased likelihood of any alcohol consumption (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.59-1.72) and binge drinking (OR: 1.31, CI: 1.22-1.40). Improved economic (OR: 0.75, 95% CI: 0.72-0.78), demographic (OR: 0.73, 95% CI: 0.71-0.76), and social (OR: 0.55, 95% CI: 0.53-0.56) living conditions exhibited inverse associations with any alcohol consumption. Similar inverse associations of binge drinking were noted with the economic (OR: 0.84, 95% CI: 0.76-0.92), demographic (OR: 0.91, 95% CI: 0.85-0.98), and social (OR: 0.78, 95% CI: 0.73-0.82) indices. CONCLUSION:In general, our findings revealed the associations of alcohol consumption and binge drinking with the regional characteristics of living conditions.
BACKGROUND:The present study was designed to assess the mortality rate and years of life lost due to suicide in Khuzestan province . Study Design: A cross-sectional study. METHODS:In this study, data on all deaths caused by suicide in Khuzestan province were obtained from the population-based Electronic Death Registration System (EDRS). Crude and age-standardized suicide mortality rates (ASR) were calculated based on gender and year of death over the study period. Subsequently, the number of years of life lost (YLL) was calculated based on age and gender. Joinpoint regression analysis was used to examine the trends in crude mortality rates, age-standardized rates (ASRs), and YLL rates. RESULTS:During the study years, 1904 suicide deaths occurred in Khuzestan province . Of these deaths, 1157 (60.8%) occurred in men. The highest number of deaths in both genders occurred due to hanging. According to the joinpoint regression, the 12-year trend of YLL rate due to premature mortality was stable. The average annual percentage change (AAPC) was -0.4% (95% CI -4.5 to 7.9, P=0.986) for males, and it was 2.4% (95% CI -1.6 to 7.5, P=0.222) for females. There were 1 joinpoint and 2 time periods for males (2012-2014 (non-significant decreases) and 2014-2023 (significant increases)), and there were 1 joinpoint and 2 time periods for females (2012-2016 (significant decreases) and 2016-2023 (significant increases)). CONCLUSION:The findings revealed a significant increase in age-standardized mortality rate among women and a stable trend among men, and a slight rise in crude mortality rate in men. To address these concerns, it is recommended that targeted region-specific prevention programs be strengthened.
BACKGROUND:The increasing prevalence of hypertension (HTN), accompanied by a decreasing quality of life (QoL), requires appropriate interventions to avoid its impacts and the occurrence of chronic conditions. The purpose of this study was to assess the effect of the intervention model education on the QoL of hypertensive patients compared to HTN self-management training and no intervention. Study Design: A quasi-experimental study. METHODS:The sample consisted of 138 hypertensive patients, divided into an HTN intervention model education group (n=46), an HTN management training group (n=46), and a group without treatment (n=46). The study used a quasi-experimental design with a control group. All groups received a pre-test, and after 6 weeks, they all received a post-test with the WHOQOL-BREF questionnaire. RESULTS:The HTN intervention model education group and the HTN self-management training group had a significant effect on the QoL of hypertensive patients (P=0.0001), while the control group showed no effect (P=0.310). The Kruskal-Wallis test demonstrated a significant difference in the three interventions, and the highest difference was observed in the HTN intervention model education group. CONCLUSION:The HTN intervention model education was the main choice because it involved not only the patient himself but also policies, health workers, cadres, and families, as well as the presence of booklets.
BACKGROUND:Tuberculosis (TB) remains a global health concern with high mortality despite treatment options. Understanding the underlying risk factors for TB mortality is essential for guiding effective control strategies. This study examined sociodemographic and clinical factors related to TB mortality in Hamadan province, Iran, to inform control strategies. Study Design: A cross-sectional study. METHODS:This study evaluated data (March 2011-March 2022) obtained from a provincial TB surveillance database, encompassing smear-positive pulmonary TB (SPT), smear-negative pulmonary TB (SNT), and extrapulmonary TB (EPT) patients. Demographic and clinical characteristics were investigated, and the death rate for each group was calculated by dividing the number of TB-related deaths by the total number of diagnosed TB cases for that group during the study period. Logistic regression was applied to computed unadjusted and adjusted odds ratios (ORs) with a 95% confidence interval for the death rate using Stata 17 (P<0.05). RESULTS:Among the 942 patients included in the study, 49%, 21%, and 30% were diagnosed with SPT, SNT, and EPT, respectively. The risk of mortality was the highest among SPT patients, with EPT cases showing significantly lower odds of death (OR: 0.38, P<0.001) compared to SPT. Among SPT patients, mortality was associated with older age (OR: 1.04, P<0.001) and positive sputum smear at month 2 (OR: 19.72, P<0.001). Human immunodeficiency virus (HIV) positivity significantly increased the death rate in SNT patients (P=0.037). In EPT patients, mortality was linked to male gender (P=0.042), referral unit (P=0.023), TB hospitalization (P=0.018), and advanced age (P<0.001). CONCLUSION:Targeted interventions focusing on early diagnosis, HIV management, and care for high-risk groups (e.g., elderly) are essential to reduce TB mortality in Hamadan province. However, the findings should be interpreted with caution due to limitations, such as reliance on retrospective registry data, potential information bias, and missing data, particularly regarding HIV status.
BACKGROUND:Tuberculosis (TB) remains a significant global health crisis, regaining its status as the leading cause of death in 2023. Quantifying its economic burden is essential for crafting effective public health strategies. This study aimed to estimate the economic burden of TB in Iran. Study Design: This study employed a cross-sectional design. METHODS:A prevalence-based approach was used to estimate the economic burden of TB in Iran, accounting for cost variations across TB types and cost categories. Costs were categorized as direct medical, direct non-medical, and indirect, and were calculated for suspected TB patients as well as for those with drug-sensitive TB, multidrug-resistant TB, and extensively drug-resistant TB. Data were extracted from various sources, including the National Tuberculosis Registration System, national TB diagnosis and treatment guidelines in Iran, official medical service tariffs, and previous studies. RESULTS:Of 210,544 individuals screened, 7,221 were diagnosed with TB, of whom 81.0% had pulmonary TB and 19.0% had extrapulmonary TB. Drug-sensitive TB accounted for 99.4% of cases, multidrug-resistant TB 0.6%, and extensively drug-resistant TB 0.0%. Diagnostic costs represented 48.0% of the total economic burden (approximately Int'l$4.71 million), while post-diagnosis costs totaled Int'l$5.15 million. Overall, economic burden, including all diagnostic and treatment expenses, amounted to approximately Int'l$9.86 million. CONCLUSION:This study underscores the significant economic burden of TB in Iran, encompassing both pre-diagnosis and post-diagnosis expenses, with direct medical costs representing the largest component. Effective healthcare strategies and comprehensive public health approaches are crucial to reducing these costs and improving patient outcomes.
BACKGROUND:Substance use is common among street adolescents and is strongly associated with sexual risk behavior as well as vulnerability to sexually transmitted infections. Therefore, this study was conducted to explore patterns of substance use and the association with sexual risk behavior among street adolescents in Central Java, Indonesia. Study Design: A cross-sectional study. METHODS:In this cross-sectional study, data were collected from 248 street adolescents through face-to-face interviews using a validated questionnaire. Data analysis was conducted using descriptive statistics, chi-square tests, and multivariate logistic regression in SPSS version 25.0. RESULTS:More than a quarter of adolescents reported engaging in high-risk sexual behavior. Heavy smoking, alcohol use, and frequent exposure to pornography were prevalent. Alcohol use was significantly associated with sexual risk behavior, with adjusted odds ratios ranging from 3.26 to 4.38 across Models I-III. Furthermore, frequent exposure to pornography showed a strong association, with odds ratios of 3.02 (Model I) and 4.20 (Model II). These associations remained significant after adjusting for demographic and behavioral variables. CONCLUSION:Substance use, particularly alcohol consumption, and frequent exposure to pornography were significantly associated with sexual risk behavior among street adolescents. Therefore, interventions should be developed to address the specific needs of this population. Adolescents engaged in high-risk behavior, such as substance use and sexual risk behavior, required high attention and specific treatment options.
