Tobacco Smoking Status and the Contribution to Burden of Diseases in Iran, 1990- 2010: Findings from the Global Burden of Disease Study 2010

Tobacco smoking and exposure to second-hand smoke in the indoor environment are major public health risks worldwide. The aim of this paper is to report and critique a global assessment of smoking prevalence, smoking-attributable deaths, and disability adjusted life years (DALYs) extracted from GBD study 2010, by sex and age in Iran from 1990 to 2010. The Global Burden of Disease (GBD) Study 2010 estimated the distributions of exposure and relative risks per unit of exposure by systematically reviewing and analyzing published and unpublished data. These assessments were used, together with estimates of death and DALYs due to specific risk factors, to calculate the attributed burden for each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of attributable mortality and burden. Our aim was to reformulate the GBD data, produce new graphs, and explain the results for Iran in greater detail. Between 1990 and 2010, the prevalence of tobacco smoking at all ages increased by 1% in men and declined by 2% in women in Iran, but the overall prevalence in the general population was unchanged (12%). A reduction was observed in the age-standardized death and DALY rates (per 100,000 population) attributed to tobacco smoking, including second-hand smoke. The attributed DALY rate was greater for Iranian men than for Iranian women. The highest rates of DALYs because of tobacco smoking were found in smoker men and women aged 70+, but exposure to second-hand smoke had the most significant burden in children under 5 years old. In 1990, the three leading disease burdens attributed to tobacco smoking, including second-hand smoke, were ischemic heart disease; communicable, maternal, neonatal, and nutritional disorders; and chronic respiratory disease. In 2010, the leading disease burdens were ischemic heart disease, chronic respiratory disease, and cerebrovascular disease. Despite a reduction in the rate of tobacco smoking, including second-hand smoke, since 1990, smoking exposure remained the fifth leading risk factor for death and DALYs in Iran in 2010. Overall, our data clearly show the need for new efforts in Iran to reduce the mortality and disease burden attributed to tobacco smoking.