Iranian Journal of

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Background and objectives: Malnutrition is a major health problem in Iran. A nationwide survey (ANIS) in 1998 revealed that over 800 000 children in this country were suffering from moderate or severe malnutrition. The southern province of Hormozgan is one of the most severely affected regions, so there is a need to determine disease associations and risk factors for child malnutrition in this area.
Methods: In this case-control study, we selected 1725 children aged 6 to 30 months from both rural and urban areas of Hormozgan. Data for the study were obtained by filling questionnaires and studying family health files. Using the weight-for-age Z score (WAZ) as outcome measure, we examined the effects of 21 different variables, including putative risk factors, confounders, and background variables.
Results: Father's job (p<0.004), parents' education, interval between pregnancies, urban versus rural residence (p<0.001), family size (p<0.03), and misconceptions regarding the growth chart were recognized as risk factors for malnutrition. Moreover, the mean age of the cases was 2.3 years higher than that of the controls (p<0.001). Complete vaccination (p<0.018) and attending day care centers (p<0.005) emerged as protective factors.
Conclusions: Poverty (low-income jobs, rural residence, large family size, etc) is an important factor causing malnutrition among children in Hormozgan. In contrast, immunization and mother's knowledge of the child's growth chart are major protective factors. Therefore, the health system must continue its support for the current immunization program. It should also try to improve the quality of its health education programs targeted at mothers attending state-run health and medical clinics

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Background & Objectives: Ecstasy is a methamphetamine derivative becoming increasingly popular throughout the world, particularly among adolescents and young adults. Iran, situated between eastern and western societies, can serve as a significant source of information on ecstasy use and on the users' profile. The purpose of this study was to determine the prevalence of ecstasy use and high-risk behavior among high school students in Lahidjan.
Methods: We conducted a cross-sectional study of a representative sample drawn from high school students of Lahidjan in 2005, using multi-stage stratified random sampling. The study questionnaire was administered to 2345 students in grades 8 through 12. The questionnaire was adapted from that used in "Monitoring the future" projects in the United States and ESPAD (The European School Survey Project on Alcohol and other Drugs). It included questions on demographic characteristics, family profile, social contacts, school life and the use of drugs. Data analysis was done with the SPSS software (version11.5), using χ2 tests and logistic regression methods.
Results: Of the 2345 students selected for the study, 2328 (92%) responded. Of these, 1327 (57.8%) were males and 970 (42.2%) were females. Lifetime prevalence of ecstasy use was 2.4% (55 students) 31 subjects had used ecstasy within the past month and 24 students reported using the substance in the preceding year. Ninety-two subjects (4.2%) had experience with other drugs. In χ2 tests, ecstasy use was significantly associated with gender, use of other substances, cigarette smoking, partying with friends, family structure and poor school performance in the past. There was no association with age, type of school (private or public) or the family's education level. In logistic regression, factors influencing ecstasy use were the use of other drugs, cigarette smoking and partying with friends (p< 0.0001).
Conclusions: Ecstasy use appears to be a serious problem in high schools. Whatever the causes behind the rise in ecstasy use, personalized and informative educational interventions should be organized in all schools.

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Background & Objectives: There is no shortage of evidence linking coronary heart disease (CHD) to various genetic and environmental factors. Nonetheless, exploring the familial aggregation of major risk factors in the Iranian population could add valuable information to the existing body of knowledge.
Methods: We received data on 656 families (1614 individuals) from the Provincial Health Authority in Kerman. The data had been originally collected in a nationwide non-communicable disease control project, under the auspices of the Health Ministry's Public Health Department. In this study, we divided subjects into high- and low-risk groups based on the 75th percentiles of risk factor levels. Using a random-effect Poisson regression model, we looked at the association between risk factors within families. In all models, the risk ratios (RR) were adjusted for the age gap between parents and children.
Results: Excessive weight in children showed a stronger association with overweight in the father than with the same problem in the mother (RR: 2.35 versus 1.59). Risk of high blood pressure in the father was significantly related to the risk in the mother and the child. The risk of high blood glucose showed a significant association only between parents. Similarly, hypercholesterolemia did not show a significant association between parents and children, but its RR in parent-parent associations was around 2. We did not find any significant familial aggregation for smoking. However, physical exercise in mothers doubled the rate of exercise in other family members.
Conclusions: Although our sample size was relatively small, we found stronger associations within parent couples than between parents and children. This implies that common lifestyle may be a more prominent factor than genetic make-up.

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Background & Objectives: Considering the lack of adequate basic information on risk factors for road traffic injuries in Iran, a study was conducted to determine the association between potential risk factors and the incidence of injuries in motor vehicle drivers.
Methods: We performed a population-based case-control study on Qazvin-Loshan road. Risk factors related to injury incidence were compared between 175 cases and 175 controls. Cases were drivers recently injured in road accidents. Controls did not have any injury and were selected systematically while the study was being conducted. Injury was defined as trauma needing medical or surgical treatment. Information was obtained through police reports and interviews with cases and controls. Data were analyzed by two methods bivariate analysis (crude) and by a multivariate unconditional logistic regression model.
Results: In bivariate analysis, risk factors for road traffic injuries risk were failure to wear seat belts or protective helmets, ejection from vehicle, severity of collision, number of crashes, motorcycle vs. other motor vehicle accidents, fire, rain and fog, and collision with fixed objects. In the logistic model, factors such as seat belt or helmet use with OR= 0.619 (0.376-1.018), ejection from the vehicle with OR= 2.952 (1.235-7.056), severe collision with OR= 5.413 (2.865-10.224), motorcycle vs. other motor vehicle accident with OR= 3.164 (1.05-9.537) and raining and fog vs. good weather with OR= 4.562 (1.663-12.514) were found to influence injury incidence. There was an interaction between severity of collision and weather status.
Conclusions: Better speed control, use of seat belts or helmets, not using motorcycles for road travel and equipping vehicles with fire extinguishing capsules are recommended to reduce road accident injuries.

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Background & Objectives: Pediculosis is a ubiquitous and contagious parasitic dermatosis. Throughout the world, infestation by the head louse (Pediculus humanus capitis) is more common among schoolchildren, especially in those aged 6-11 years. This descriptive/analytical study was carried out in 2003 to determine the prevalence of pediculosis capitis and risk factors involved in the epidemiology of pediculosis in primary school pupils in Amlash, Gilan province.
Methods: The children were selected by cluster random sampling of schools and classes, and then examined for head lice using hair conditioners and a fine-toothed head lice comb. We screened a total of 4244 pupils from 95 primary schools. We used a comprehensive questionnaire to evaluate the effects of school type and location, education level, parent job, regular baths, number of persons sharing the same bed, combing frequency, host sensitivity, family size, hairstyle, gender, and hair length.
Results: Statistical analysis using χ2 tests showed that school type, school location, parent job, regular baths, number of person who share the same bed, frequency of combing, gender, host sensitivity, family size, and hairstyle are significantly associated with infestation. Infestation rate showed no correlations with hair color, season, age, or education level. Results showed that pediculosis is more prevalent in rural than in urban areas. The average rate of infestation for the area was 9.2%, indicating an epidemic situation by standard criteria.
Conclusions: The high prevalence of P. capitis infestation among these children was probably due to poor environmental hygiene and scarcity of water. Hygienic controls of schoolchildren by nurses are important for elimination of Pediculus humanus capitis. This is the first community-based study describing in detail the epidemiology of head louse infestation in the Amlash district of Gilan province in Iran and confirms that Pediculosis capitis is still a problem in many environments, particularly those with low life standards and poor health care.

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Background and Objectives: A pregnancy can be considered high-risk if there are conditions that put the mother or the baby at higher-than-average risk of morbidity or mortality. Neonatal mortality rate is one of the most important indices of children's health status. The present study was conducted to evaluate the effects of high-risk states on neonatal mortality.
Methods: We performed a nested case-control study in the rural areas of Kohgiluyeh and Boyerahmad province. Within the study cohort, 97 cases and 97 controls were selected by a risk-set sampling method. Data were analyzed with univariate and multivariate conditional logistic regression models.
Results: Neonatal mortality was shown to increase significantly in high-risk pregnancies. There were no substantial differences between crude odds ratios and those adjusted for the presence of other risk factors (crude odds ratio decreased from 5.5 to an adjusted figure of 3.25 for pregnancies with one risk factor and from 5.21 to adjusted level of 4.80 for pregnancies with more than one risk factor).
Conclusions: High-risk pregnancies need great attention in family health and prenatal care programs, especially in remote rural areas. Within our rural health network there are potential cohorts for use in nested case-control studies, especially in the evaluation of neonatal mortality risk factors.

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Background & Objectives: Hypertension is one of the most prevalent and important risk factor of cardio-vascular diseases. The aim of this research was to determine relative factors on hypertension in Kohrang.
 Methods: This survey was a population – based case - control study. The study population consisted of 415 patient with hypertension (cases) and 415 controls without any history of cardiovascular and or cerebrovascular diseases & hypertension. A systematic random sampling was used. The chi-square test and conditional logistic regression model was used and the data were analyzed by STATA.
Results: Family history of hypertension, age over 60, no physical activity, bmi≥30 were calculated as risk factors with odds ratio: 2.33 (95% CI 1.58-3.47), 2.01(95% CI 1.24-2.67), 1.8 (95% CI 1.2-2.7), 1.66 (95% CI 1.32-2.07) respectively (p<0.05). Fish consumption, unsaturated fat consumption and literacy were considered as protective factors with an odds ratio: 0.516 (95% CI 0.35-0.69), 0.514 (95% CI 0.36-0.72), 0.28 (95% CI 0.17-0.45) respectively (p<0.01).
Conclusions: The findings of this study highlight to plan appropriate health promotion programmes by health policy makers.

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Background & Objectives: Recent reports indicated an increase in cutaneous Leishmaniosis (CL) cases. We designed the study in the context of community assessment process to identify and address the major public health related issues by explore the risk map of CL and assessing the environmental risk factors in Kerman.
Methods: All the registered CL in the only referral center for CL from 2002 to 2006, localized on Kerman digital map. The level of data dissemination was townships. Based on data from the national statistics organization, we determined the population and calculated the incidence of CL of each township. Secondly, the highest endemic townships were observed deeply with a specific checklist to determine the environmental risk factors.
Results: 771 cases were included. All the high endemic areas were located in the east part of Kerman. The eastern township, Sarasiyab, with 123 (15.9%) cases was the most infected region. The highest endemic townships were Sarasiyab, Emam and Sarbaz with 54.9, 52.8 and 51.2 cases per 10,000, respectively. Some minor endemic areas such as Shahab, Abouzar and Shahzadeh Mohammad (South and central regions) were going to be disappeared while Shariati, Naseriyeh-Seyedi (North and North-East regions) were the new high-risk townships (P<0.01).
Conclusions: the east and central part of Kerman, were always the high endemic regions. Some other new high-risk areas were also detected. The most environmental factors were the bare lands between the houses, ground passages and the timeworn architecture on the buildings.

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Background & Objectives: Recognition of epidemiology of acute myocardial infraction (AMI) in every region could be a need for design the programs for prevention of AMI. In this study we assessed the epidemiology of changes in AMI from 2002-2006 in Birjand(east of Iran).
Methods: All of the patients which hospitalized by AMI diagnosis from 2002-2006 years, included in this study. We compared mean of age, gender, location of living, medications used, condition at discharge and cardiac risk factors in this period.
Results: From 1233 patients, 880 were male (71.4%). Overall, mean age of patients was 62/2±12/8 years and in five years was increased (from 61.7±13/2 in 2002 to 63.5±12/4 in 2006 & p=0.37). The most risk factors in patients were: Hypertension (HTN) (34/8%) ,cigarette smoking (32/1%) & dyslipidemia (24%). These risk factors did not show any significantly changes during 5 years. But the the prevalence of HTN (30/9% in 2002 to 38% in 2006, p=0/62) and DM (15/5% in 2002 to 21% in 2006, p=0/23) raised. Cardiac drugs use tended to increase during 5 years, however only this increase about STK & Statin was statistically significant. The hospital mortality rate was decreased in 5 years (11.3%) but it was not statistically significant (p= 0.48).
Conclusions: Regarding the accelerating the rate of AMI, designing an appropriate prograrme for prevention and modifying cardiac risk factors is recommended.

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Background and objective: Numerous studies have reported beneficial effects of smoking cessation in terms of decreased cardiovascular mortality in patients with coronary heart disease. This paper aimed to determine a valid estimate for the relative risk of mortality in subjects who quit smoking compared to those continued smoking.
Methods: All relevant prospective cohort studies of chronic heart disease published during 1975 to 2008 were considered. Studies with at least two years follow-up were eligible for analysis. The qualities of studies were assessed independently by two reviewers. In addition, to obtain a precise estimate, we used the sample size and the follow-up duration of each study as the covariates in the Bayesian meta-analysis model. The Winbugs and Boa softwares were utilized for fitting the Bayesian meta-analysis model.
Results: The estimate of relative risk of mortality for those who quit smoking compared to those continued smoking was 0.64 (95%CI: 0.57-0.70). We also did not find any significant relationship between the estimate of risk reduction and the described covariates.
Conclusions: Using this Bayesian meta-analysis, a 36% reduction in relative risk of mortality was found for those who quit smoking compared to those continued smoking, after eliminating the effects of study sample size and follow-up duration.

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Background and objective: Disease or mortality mapping are statistical methods aimed at providing precise estimates of rates across geographical maps. The aim of this research is to improve the precision of relative risk (RR) estimates of infant mortality (IM) for different rural areas, using empirical and full Bayesian methods.
Methods: Infant mortality data were extracted from the vital horoscope (Zij-Hayati) for years 2001 and 2006 across rural areas of Iran. Maximum Likelihood, Empirical Bayes with Poisson-Gamma model and full Bayesian models were used. Mont Carlo Markov Chain method was used for latter models. Deviance information criterion (DIC) was computed to check the models fittings. R, WinBUGS and Arc GIS software were employed.
Results: Based on the full Bayesian method, the highest RR of infant mortality was 1.73 (95%CI: 1.58-1.88) in year 2001 and 1.62 (95%CI: 1.50-1.75) in 2006 which belonged to Sistan-va-Blouchestan area in comparison to the whole country. In 2001, the rural areas of Birjand (1.45), Kordistan (1.23) and Khorasan (1.21) and in 2006, Birjand (1.42), Zanjan (1.39), Kordistan (1.36), Ardebil (1.32), Zabol (1.28), West Azerbaijan (1.18) and finally Golestan (1.14) had significant RR of IM (all p<0.05). The lowest RR of infant mortality for year 2001 were belong to rural areas of Tehran University (0.56) and for year 2006 to former Iran University (0.52).
Conclusion: To estimate the mortality map parameters, the full Bayesian method is preferred compared to empirical Bayes and maximum likelihood.

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Background & Objectives: Cholera is always being considered as a public health threat in poor and developing countries. However outbreaks of cholera are not very common in central area of Iran in 2008 district health authority reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures.
Methods: We analyzed the data of total of 1219 patients with colorectal cancer who registered between 1 January 2002 to 1 October 2007. Data were analyzed using univariate and multivariate Accelerated Failure Time (AFT) parametric survival model with frailty, utilizing STATA statistical software.
Results: In the univariate analysis for age at diagnosis, gender, marital status, race and education level, the survival of patients with colon cancer were approximately between half to one fourth and for BMI, alcohol history, Inflammatory Bowel Disease (IBD), familial history of cancer and the pathologic stage of tumor, the survival of patients with colon cancer were significantly (between 0.12 to 0.56 times) shorter than those patients with rectal cancer. In the multivariate analysis, for age at diagnosis (45-65 years), there was significant difference between colon and rectum cancer. But for BMI, alcohol history, IBD and pathologic stage there were not significant differences. The adjusted survival and 1, 2, 3, 4 and 5 year survival of patients with rectal cancer were better than those with colon cancer.
Conclusions: Site-specific evaluation of colon and rectum could give a better perspective of factors affecting these cancers. It may help to design of clinical trials, better diagnosis of diseases and optimal administration of specific treatments.

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Background & objectives: Competing risk data is one of the multivarite survival data. Competing risk data can be modelled using copula function. In this study we propose a bayesian modelling approach of competing risk data using the copula function.
Methods: We used the data from colorectal cancer registyrarty in Tehran. After constructing likelihood function using Clayton copula by choosing appropriate prior distribution for parameters, we obtained the posterior distribution of parameters using the Metropolis-Hastings algorithms and Slice sampling.
Results: The results of univariate analysis showed that sex, histology of tumor, extent of wall penetration, lymph node metastasis, distant metastasis and pathological stage of tumor were significantly associated with colon cancer and sex, histology of tumor, lymph node metastasis, distant metastasis and pathological stage of tumor were were significantly related to rectal cancer. In the multivariate analysis, age at diagnosis, tumor grade and distant metastasis were significant prognostic factors for colon cancer and tumor grade and size of the tumor were significant prognostic factors of rectal cancer
Conclusions: As we showed some variables may have different impacts on colon and rectum cancers, consequently, further studies are needed to be conducted considering risk factors of these cancers separately.

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Background & Objectives: The epidemic of HIV has been become worldwide. Infected people with HIV which are most intravenous drug users (IDUs) and/or people who have unsafe sex are important source of transmission of infection to other persons in a community. Since there is little known about the knowledge and attitudes of HIV positives about HIV in Iran, therefore we decided to measure the level of knowledge and attitudes of this group in Golestan province in compare with individuals with risky behavior.
Methods: This cross-sectional study was conducted on 54 HIV+ persons and 134 people with high risk behavior individuals in 2007 year. Results: Our study showed that HIV- (High risk group) cases had higher education level (P=0.034). Rate of jobless was higher in HIV+ persons (P<0.001). HIV+ cases had lower income (P=0.037). Both groups had moderate knowledge and poor attitude on HIV/AIDS. Level of attitude in HIV+ positive persons was lower than high risk group (P=0.05).
Conclusion: It is concluded that these susceptible persons and also infected individuals with HIV regardless of their socio-economic levels need more continuous education in structured programs.

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Background and Objectives: Preterm birth (PTB) is a major clinical problem which is known to be associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with PTB in Birjand, Iran.
Methods: One hundred and thirty premature (<37 week) and 130 term newborns were enrolled in this case-control study. It was conducted in Birjand Hospitals during the year 2007. Potential risk factors such as type of delivery, maternal disease, placenta problems, previous history of abortion in mothers, maternal addiction, prenatal care were identified from medical files.
Results: Previous of premature labor (OR=4.68), cesarean section (OR=3.34), pre-eclampsia (OR=7.72), premature rupture of memberanes (OR=11.3), inadequate prenatal care (<4 one) (OR=4.15), and placenta previa (OR=8.96) were found to be risk factors for preterm birth. Polyhydramnios, previous abortion and cervical incompetent with prematurity were not shown to be risk factors for preterm birth.
Conclusion: These findings reinforce the need for control of risk factors of prematurity for better out come.

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Background & Objectives: Non-Communicable disease (NCD) is a main group of diseases which are responsible for a large proportion of the Global Burden of Disease around the world. Although disparities in the NCDs' risk factors can affect the goals of health for all, less attention has been paid so far on this topic. In this study, we investigated socio-economic inequality in the NCDs’ risk factors and evaluated the causes affecting on this inequality in Shahroud, Iran.
Methods: Conducting this survey, we used surveillance data for NCD of 1000 individuals who lived in Shahroud district during 2005. We determine a socio-economic variable which explained social and economic status of the people using Principal Component Analysis. We then evaluated each NCD risk factors at different levels of the socio-economic variable and calculated concentration index for the risk factors. The causes of the inequality were described by decomposition analysis of the concentration indices.
Results: Concentration indices for hypertension, smoking, insufficient physical activity, and unhealthy diet were -0.141, -0.191, -0.046 and -0.091, respectively. Differences of concentration curves of the risk factors from the line of equality were significant but not for diabetes, obesity and high blood cholestrol. Age, being a government employee, being unmarried, living in rural area and low economic status were the most important factors which influence on these inequalities.
Conclusion: Inequality in some NCD risk factors was significant in Shahroud district. More investigations with larger sample size and more appropriate variables to measure socioeconomic status are recommended.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Cardiovascular disease is the first cause of death and third place in disease burden in Iran. This study estimates population attributable fraction (PAF) of cardiovascular risk factors in Tehran population. PAF is one of the important parameters of measuring population affect of risk factors and evaluating potential impact of preventive strategies in community level.
Methods: In this study 5868 participants above 30 years old of Tehran lipid and glucose study (TLGS) were employed and 501 CVD events detected during 10 years follow-up. Direct estimate of adjusted PAFs using logistic regression which is one of less biased exist methods of PAF calculation were applied.
Results: Highest modifiable cardiovascular risk factor PAFs, in sequence, was smoking (14.16%), hypertension (11.73%), diabetes (7.32%), hypercholesterolemia (6.85%) and central obesity (5.91%) for men, and hypertension (19.25%), diabetes (18.82%), central obesity(9.88%) and hypercholesterolemia (7.95%), for women. Also PAF of hazardous age and premature family history of CVD, as most important nonmodifiable CVD risk factors, were 36.09%, 16.61% and 3.95%, 7.56% for men and women respectively.
Conclusion: According to the difference of risk factors PAFs ranking in men and women, it is suitable that CVD preventive interventions to be prioritized by sex separately. In this regard, besides special attention to control tobacco use in men, hypertension and diabetes in both sexes and high cholesterol in men and central obesity in women respectively, should be given in priority of preventive strategies.

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Background & Objectives: White spot, as one of the infectious viral diseases, has made severe losses in shrimp ponds all over the world. Despite extensive efforts made to deal with and control the disease, white spot continues to be a major health problem in shrimp farms across Iran. In this work, the significance of the risk factors of white spot disease epidemic occurred in shrimp ponds of Choubdeh farming site in Khuzestan province of Iran is determined.
Methods: A cross sectional study was conducted from June 1, 2010, to September 22, 2010 in 223 shrimp ponds of the site. Data was collected on 17 variables, thought to be associated with the occurrence and epidemic of white spot, with the aid of the shrimp ponds owners and fisheries and veterinary organizations. The occurrence of white spot disease in the farming site was determined by clinical symptoms and the results of conventional PCR tests. the effectiveness of the risk factors was established by odds ratio (OR).
Results: It is found that poor management of birds fighting (OR=3.72), less educated farm foreman
(OR= 3.29) and poor filtration of the intake water (OR= 3.43) are significantly affected the occurrence of the disease while little changes in the salinity of shrimp ponds (OR= 0.16) decreases the odds of the disease.
Conclusion: These findings help better develop shrimp farming across Iran, especially in Khuzestan province. 

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Background & Objectives: Burns is one the important injuries which may result vital impairment and disability. Burn injuries are still common particularly in developing countries. Assessment of the epidemiology of burns is very important to make effective preventive methods. This study was conducted in Fars province to assess and describe the epidemiology of burns including its main causes, and its demographic factors.
Methods: All epidemiological data of patients with burn admitted to the hospitals in Fars province during 2010 were analyzed in this descriptive study.
Results: Total of 328 patients with mean age 25.93±17.94 were included. It consisted of 178 male patients (54.3%) and 150 female patients (45.7%), The most common accident age was 26 years, the average percentage of burn was 36.63± 26.63%, average hospital stay in hospital was 13.40±12.72 days, 249 cases had unintentional injury (91/75%) and 79 cased had intentional (24.9%), The main reason for  intentional burns was divorce (16.76%), the most common month accident was December, the overall cumulative incidence of burn injuries was 7.28% in 100000 people (person per year) and the burn fatality rate was 29.88%
Conclusion: Epidemiology of burn injuries in Fars province indicates that effective public health programs on this issue would help to reduce the incidence of burn injuries in this region.

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Background & Objectives: Knowledge of the magnitude of attributable burden of cardiovascular diseases (CVDs) due to diabetes is necessary for health policy, priority setting and preventing CVD deaths. Our study aimed at estimating the attribute of proportion of diabetes to the burden of cardiovascular diseases in Kermanshah, West of Iran.

Methods: World Health Organization Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). Data on the Prevalence of newly diagnosed diabetes mellitus (People who have fasting plasma glucose (FPG) equal or greater than 126 mg/dl) were obtained from 3rd Iranian surveillance of risk factors of non- communicable diseases and data on corresponding measures of effect were derived from a national- specific study with age and multivariate adjusted hazard ratios.

Results: Based on multivariate- adjusted hazard ratios, by reducing the percent of women with diabetes from 8.1 percent to the zero level and the feasible minimum risk level i.e. 4 percent, 11.2% and 5.7% of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable, respectively. The corresponding value for men at the theoretical (zero level) and feasible minimum risk level (3 percent) were 5.6% and 2.9%, respectively.

Conclusion: To better planning, decision making and priority setting, PIF should be applied to updated and revised burden of CVDs in Iranian Health system.