Iranian Journal of Epidemiology

Indirect Estimation of Dementia Prevalence and Its Geographical Variation Using the Claim Data in Iran

AA Haghdoost

Background and Objectives: Dementia is a chronic disease that imposes a huge financial and social burden on the health system. Knowledge of the prevalence of dementia is essential for healthcare planning and ensuring that there is an adequate service for people with the condition. Considering that the prevalence and geographical variation of dementia are not well known in Iran, the present study was conducted to investigate the prevalence of dementia and its geographic variations in Iran.
Methods: In this study, the prevalence of dementia was estimated indirectly using the frequency of prescribed specialized medicines in one year by generic and brand names in each province. Choropleth maps were used to visually assess the geographical variation of dementia prevalence at the provincial level. Moran I and Getis-Ord Gi (Gi) geographical tests were used to investigate the spatial autocorrelation and geographical variability of dementia prevalence at a significant level of 0.05, respectively.
Results: In this study, the prevalence of dementia was 49.6 and 508.9 in 100000 in the general and over 60-year population, respectively. In the general population, the lowest prevalence was in Hormozgan Province (9.4/100000) and the highest prevalence was in East Azarbayjan Province (96.4/100000). In the over 60-year population, the lowest prevalence was in Hormozgan Province (141.5/100000) and the highest in Isfahan Province (862.5/1000000). According to Moran I and Getis-Ord Gi (Gi) tests, spatial autocorrelation and geographical variability of dementia prevalence were not significant.
Conclusion: The prevalence of dementia in the Iranian over 60-year population is lower compared to western countries; however, it is comparable with the reported dementia prevalence from developing countries. It should be noted that the dementia prevalence is high, similar to developed countries, in some developed provinces of Iran.

Investigating the Challenges of Death Registration and Classification Program and Providing a Solution: A Qualitative Study

F Rajabi

Background and Objectives: The distribution of causes of death indicates the distribution of risk factors for death, and is a basis of planning and intervention to reduce risk factors. The quality of the registered information has problems due to the weakness of the processes of completing and issuing the death certificate or the coding method. The purpose of this study was to explain the challenges of death registration and to provide a solution in this regard.
Methods: This qualitative study was conducted in the second half of 2019 in Guilan University of Medical Sciences. The target population was the directors and experts of the death registration program. Sampling was done purposefully by counting. Data was collected through in-depth interviews using a questionnaire and simultaneous contractual content analysis to identify key themes. To ensure the validity and acceptability of the data, the participants and two research colleagues reviewed the data frequently.
Results: According to the content analysis of 24 interviews, the main challenges of death registration included manpower, organizing the death registration system in the country, and death registration software system and its implementation. These themes were abstracted from 45 subcategories and 13 main categories.
Conclusion: Considering the challenges described by death registration managers and experts, the main proposed interventions to improve the death registration system include recruiting appropriate staff, empowering and motivating various human resources departments, developing internal and external cooperation, increasing public participation, monitoring and continuous assessment to identify the strengths and weaknesses of the death registration system and adressing them, attention to the development of death registration software and its required infrastructure such as Internet access and equipment, attention to the multiplicity of systems, and efforts to integrate them.

Lifestyle of Women Living with HIV (Case Study: Women Living with HIV in the Positive Club of Kerman)

AA RafieiRad

Background and Objectives: Although everyone needs to adopt a healthy lifestyle, it is absolutely important for people living with chronic diseases like HIV/AIDS to lead a positive lifestyle because these people are more vulnerable than others. Considering this fact, the present study was conducted to investigates the lifestyle of women living with HIV/AIDS in Kerman.
Methods:The Health-promoting Lifestyle Profile II (HPLP-II) was used in this survey, which includes six aspects as follows: responsibility, moral development, workout, nutrition, individual relations and stress management. Statistical population included 35 women living with HIV/AIDS in Kerman in 2019.
Results: According to the findings of this study, 34.14% of people who participated in this study had a positive lifestyle and the remaining 62.86% had a negative lifestyle. Based on the findings related to the women’s lifestyle, there was a significant difference in family income and job status. No significant difference was found in other variables such as marital status, age group, education and years living with HIV.
Conclusion: As economic variables (family income and job status) play an important role in adopting a positive lifestyle for people living with HIV/AIDS, it is necessary to help them become self-employed or support them financially so that they can lead a healthy lifestyle.

Changes in Cause of Death among the Older Adults and Its Effect on Increasing Life Expectancy in Iran

M Sasanipour

Background and Objectives: The rate of the increase in life expectancy has slowed down during the last two or three decades in Iran. In this study, we examined the role of change in thecause of death older adults in increasing life expectancy in Iran between 2006 and 2016.
Methods: Death data by age, sex, and cause in Iran between 2006 and 2016 were obtained from the death registration and classification system of the Ministry of Health and Medical Education. Using the Brass-Trussell and generalized Benett-Horiuchi method, underreporting of child and adult death registration was corrected. Then, using the Arriaga decomposition method, the role of age groups and causes of death of Iranian older adults in increasing life expectancy at birth was calculated.
Results: Men’s life expectancy at birth increased by 3.7 years during 2006 to 2016, and the contribution of older adult’s death changes on this increase was estimated at 2 years. Out of the total increase of 3.1 years in women’s life expectancy, 1.57 years was related to changes in the older adults’ cause of death. Furthermore, 74% and 57% of the role of change in the cause of death among older men and women in increasing the life expectancy was related to cardiovascular diseases.
Conclusion: Considering the transition of age structure in the coming decades, transition of death trend to older ages is expected to continue. The results of this study showed that it is necessary to pay more attention to diseases that affect older people in policy priorities.

Study of Determinants of Self-Assessed Health of Elderly People in Tehran Using Generalized Structural Equation Model

M Saadati

Background and Objectives: Considering the growing trend of aging in Iran, it is necessary to study the factors affecting the health of elderly people. The main purpose of this study was to investigate demographic, social, and economic determinants of self-assessed health of elderly people in Tehran using generalized structural equation model (GSEM).
Methods: The data of the present study was obtained from a cross-sectional study in which 598 elderly people aged 60 years and over were selected from 22 districts of Tehran in 20151394 using stratified multi-stage sampling method and a researcher-made questionnaire was completed for them. The reliability of the questionnaire was also confirmed using and time consistency. To study the determinants of self-assessed health of elderly people, WLSMV and ULSMV estimators of GSEM were compared in Mplus (7.3).
Results: Based on the goodness-of-fit indices, the ULSMV estimator was selected to evaluate factors affecting the self-assessed health of elderly people (RMSEA=0.02, CFI=0.951 and TLI=0.962). The self-assessed health ranks of married and employed elderly people were higher than single (P-value=0.022) and unemployed (P-value=0.048) ones, respectively. An increase in spirituality (P-value=0.016), physical and mental health (P-value=0.001), and health-oriented behavior (P-value=0.016) increased the standard score of self-assessed health of elderly people. Physical and mental health played a complete mediating role in relationships of gender (P-value=0.014), marital status (P-value=0.040), education level (P-value=0.039), self-reported socio-economic status (good/ P-value=0.013 and middle/P-value=0.017) and number of diseases (P-value=0.001) with self-assessed health of elderly people.
Conclusion: According to the results, for policy-making in the field of geritrics, special attention should be paid to structural variables like gender, marital status, education level, and self-reported socio-economic status in addition to physical and mental health.

Iranian Adolescents' Experiences of Domestic Violence: A Qualitative Study

Z Hosseinkhani

Background and Objectives: Children, especially adolescents, are one of the main victims of domestic violence, who have received less attention despite their vulnerability to this social problem. This study was conducted to determine the adolescents' perspectives and experiences of domestic violence and parental disputes in order to improve our understanding of the various aspects of this social problem for planning the necessary measures to reduce it.
Methods: The present qualitative study was performed with a content analysis approach. The data were collected using semi-Structural interviews. The participants were students aged 12 to 16 years. Purposeful sampling with maximum variation in terms of socioeconomic status, age and gender was performed. In total, 33 interviews were conducted by two interviewers.
Results: A total of 4 categories, 11 subcategories and 120 themes were extracted as the adolescents' experiences. By summarizing and combining similar themes, the main categories included adolescents' psychological reactions and activities at home and in the school, domestic violence outcomes and cause of violence. The most important cause of violence was socio-economic status of the family, especially father's unemployment. Adolescents who had experienced domestic violence had higher tendencies toward high-risk behavior and academic failure.
Conclusion: According to adolescents' views, socio-economic factors play an important role in the occurrence of domestic violence and can lead to unpleasant social experiences and social harms in their future lives. Therefore, it is necessary for parents, teachers, and policy makers to adopt effective measured to reduce this social problem.

Comparison of Personality Types and Alexithymia between Opiates Dependents, Concurrent Opiates and Methamphetamine Users and Control Group Referred to Drug Abuse Treatment Centers in Kerman City in 2020

A Shahesmaeili

Background and Objectives: This study was conducted to compare the personality type and alexithymia between opiates dependents, concurrent opiates and methamphetamine users and control groups presenting to drug abuse treatment centers in Kerman in 2020.
Methods: In this cross-sectional analytical study, three groups with a sample size of 130 participants were recruited through convenience sampling from six drug abuse treatment centers (two governmental and four private centers) in Kerman, 2020. The first group comprised opiates-only users. The second group included concurrent opiates and methamphetamine users. The third group included never-drug users. The data were collected using three questionnaires including a demographic questionnaire, the Friedman and Rosenman personality types questionnaire and Toronto Alexithymia Scale. Comparison of variables between the three groups was done using multivariable multinomial logistic regression.
Results: The research outcomes indicated a higher chance of type A personality in the opiates with methamphetamine dependents (adjusted odds ratio (AOR):1.97; 95% confidence interval (95% CI): 3.64, 1.06) compared to the control group. The chance of severe alexithymia was higher among opiates dependents (AOR: 1.86; 95% CI: 3.27, 1.06) and concurrent opiates and methamphetamine users (AOR: 2.7; 95% CI: 4.83, 1.51) compared to the control group. The concurrent opiates and methamphetamine users were more likely to be male (AOR: 3.1; 95% CI: 6.25, 1.53), single (AOR: 2.6; 95% CI: 4.72, 1.43) and unemployed (AOR: 4.01; 95% CI: 9.09, 1.77) compared to the control group. Compared to the control group, the opiates dependents (AOR: 4.14; 95% CI: 7.71, 2.22) and the opiates with methamphetamine dependents (AOR: 1.95; 95% CI: 3.69, 1.03) were more likely to have education levels lower than secondary school diploma.
Conclusion: Considering the relationship between the personality type and alexithymia with opiates and methamphetamine use, early screening, continuous care, and necessary trainings are required to prevent drug dependency in high-risk people, especially at younger ages.

Analysis of Trend of Death Rate and Leading Cause of Death among Young People in Eastern Mediterranean Countries during 1990-2019

M Heydari

Background and Objectives: One of the important basis of health planning in any society is to identify the causes of death and the trend of each cause in that country over time. The purpose of this study is to investigate the trend of youth mortality and causes od death among young population of the Eastern Mediterranean region.
Methods: The present study conducted based on a secondary longitudinal analysis of death data to analyze the trend of youth mortality aged 15-24 and causes of death based on the ICD-10 in Eastern Mediterranean Region between 1990 and 2019. Study data were collected from the IHME Global Burden of Disease (GBD) website and analyzed using descriptive statistical and linear regression analysis. Death rate or cause is the dependent variable and time is the independent variable.
Results: The mortality rate of young people (15 to 24 years old) in all the countries of the Eastern Mediterranean region decreased from 1990 to 2019 except in Syria and Libya. Syria was the only country with a significant increase in the death rate. The most common cause of death was accidents; in general, the death rate related to this cause decreased during 30 years. Among the sub-groups of death causes among young people, the highest rate until 2010 was due to road accidents, which decreased over the study years. From 2010 onwards, death due to self-harm and interpersonal violence had the first rank.
Conclusion: Although a declining trend was observed during the last three decades among young people of Eastern Mediterranean region, deaths due to accidents are still considerable. It seems that the interventions to reduce death due to road accidents were successful; however, any policy and intervention to reduce death due to self-harm and interpersonal violence has a high priority.