Iranian Journal of

Background and Objective: Air pollution is a leading environmental risk factor on health and it is the major cause of death and disease at global level. Air pollution has been shown to have a significant share in the non-communicable diseases (NCDs) burden. After smoking, it is the second cause of deaths due to NCDs, associated with an increased risk of developing acute and chronic diseases and mortality.
Materials and Methods:  In this study, a review was initially conducted on the basis of indices conducted in the world, the status of ambient air pollution and its effects on health in Iran and other countries, and then the status of ambient air quality and its effects on health in Tehran metropolitan between 2006 and 2017 were shown, based on the results of the studies conducted by the Environmental Research Institute of Tehran University of Medical Sciences.
Results: The results showed that the annual mean of ambient air population-weighted PM_2.5 exposure concentration in Iran was about 48 μg/m³, which is relatively lower than its global mean concentration (51 μg/m³). Based on the most recent study (in 2018) about 8.9 (7.5-10.3) million deaths in those aged above 25 years were attributed to exposure to outdoor air PM_2.5 in the world. Although there are substantial differences between the results of studies have been done regarding the number of air pollution attributed deaths, numerous studies showed that air pollution is a major cause of death. Results regarding temporal variations of air quality in Tehran that is performed by the Institute for Environmental Research (IER) of Tehran University of Medical Sciences (TUMS), indicated that PM concentration had an increasing trend from 2006 to 2011. The maximum mean concentration of PM_2.5 over the past 12 years has occurred in 2011, which was 38 μg/m³. The PM concentration had a decreasing trend from 2012 to 2015, reaching about 30 μg/m³. However, in the years 2016 and 2017, the annual mean PM_2.5 concentration in Tehran was increased compared to its corresponding value in 2015. Furthermore, results of this study demonstrated that, in Tehran, not even one day was classified as "good” (AQI=0-50) from 2011 to 2017 based on the air quality index (AQI), but the number of days in which AQI was “moderate” (AQI=51-100) was increased from 2011 to 2015, and the number of days with the AQI of “moderate” reached 80 in 2015, while the rest of the days having an unhealthy air quality. In 2017, AQI was “moderate” in 20 days, “unhealthy for sensitive groups” in 237 days, “unhealthy” in 107 days, and "very unhealthy” in 1 day. The obtained results indicated that about 4878 (3238, 6359( of deaths due to all (natural) causes were attributable to long-term exposure to PM_2.5 in Tehran in 2017.
Conclusion: Studies showed that air pollution has a considerable share in the number of attributed deaths. Moreover, there were substantial differences between the results of national and international studies in the burden of disease attributed to air pollution. Therefore, there is a crucial need for accessing to reliable data on air pollution as well as baseline mortality and morbidity in order to study the status of air quality and its effects on health over the country. 

Background and Objective: Environmental burden of disease (EBD) studies are one of the most important needs for determining the current situation, increasing the effectiveness of health policies and programs and prioritizing environmental health interventions. This review article was evaluated the status of the EBD in Iran based on the results of the latest Global Burden of Disease (GBD) Study, other international studies and national estimates in the country.
Materials and Methods: In this study, the researches on the EBD in Iran were identified by searching in the international and national scientific databases and the search results were studied and analyzed.
Results: The review of the EBD studies showed that based on the results of the GBD study, the share of environmental risk factors in the total burden of diseases in the country in 2017 according to the disability-adjusted life years (DALYs) and deaths were about 8 and 13%, respectively. According to the results of the GBD study, the contributions of environmental risk factors in the attributable DALYs in the country in 2017 (a total value of 1,648,329) were as follows: ambient air PM_2.5 for 45.0%, occupational risk factors for 25.1%, exposure to lead for 19.4%, unsafe water source for 5.0%, tropospheric ozone for 1.7%, lack of access to handwashing facility for 1.5%, unsafe sanitation for 1.4%, residential radon for 0.6%, and household air pollution from solid fuels for 0.3%. The total DALY rate and death rate attributable to solar ultraviolet radiation in Iran in 2000 were estimated to be 46.2 and 0.7, respectively. The DALY and the DALY rate attributable to elevated levels of fluoride in drinking water due to dental fluorosis in the country in 2017 were 3,443 and 4.14, respectively. The evaluation of the effect of water fluoridation as an environmental protective factor showed that the intervention by reducing the risk of dental caries could fall the DALY and DALY rates in the country by 14,971 and 18.73, respectively. In the period of 2005-2017, the DALY rate (per 100,000 people) attributable to ambient air PM_2.5, tropospheric ozone, residential radon, and occupational risk factors rose that the result increases the importance of the preventive measures and controls of these risk factors.
Conclusion: There was a considerable difference in the burden of disease attributed to each risk factor in various international studies as well as between national and international studies. The results of national studies on the burden of diseases attributable to environmental risk factors are considered to be more reliable and practical due to the application of more detailed data and conducting subnational evaluations; therefore, the strengthening and continuing these studies at the national and sub-national levels with regard to priorities, needs, and spatiotemporal trends using domestic reliable data and information are necessary and strictly recommended.