Kurdistan Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2014 Jan;17(1):62-70.
Development of national evidence-based public health strategies requires a deep understanding of the role of major risk factors (RFs) and the burden of disease (BOD). In this article, we explain the framework for studying the national and sub-national Environmental Burden of Disease (EBD) in Iran as a part of the National and Sub-national Burden of Disease (NASBOD) study.
The distribution of exposures to environmental RFs and their attributable effect size over 1990-2013 will be estimated through comprehensive reviews of either published or unpublished sources. Statistical modeling will be used to impute missing data in the distribution of RFs exposures for each district-year. National and sub-national BOD attributable to these RFs will be estimated in the following metrics: Prevalence, death, years of life lost due to premature death (YLL), years of life lost due to disability (YLD), and disability-adjusted life years lost (DALYs). The BOD attributable to the current distribution of exposures will be compared with a counterfactual exposure distribution scenario-here, the theoretical-minimum-risk exposure distribution. Inequalities in the distribution of exposure to RFs will be analyzed and manifested nationwide using geographic information systems.
The EBD study aims to provide an official report to Iranian Ministry of Health and Medical Education, to publish a series of articles on the exposure trends of the selected environmental RFs, to estimate the BOD attributable to these RFs, and to assess inequalities and its determinants in the distribution of exposure to RFs. Iran's territory is large with diverse population, socioeconomic, and geographic areas. Results of this comparative risk assessment study may pave the way for health policy makers to plan more comprehensive and cost-effective evidence-based strategies.
制定国家循证公共卫生策略需要深入了解主要风险因素（RFs）和疾病负担（BOD）的作用。在本文中，我们解释了作为国家和次国家疾病负担（NASBOD）研究的一部分，在伊朗研究国家和次国家环境疾病负担（EBD）的框架。
通过综合审查已发表或未发表的来源，估计 1990-2013 年环境 RFs 暴露及其归因效应大小的分布。统计建模将用于推断每个区-年 RFs 暴露分布中的缺失数据。将根据以下指标估计归因于这些 RFs 的国家和次国家 BOD：患病率、死亡率、因过早死亡导致的寿命损失年（YLL）、因残疾导致的寿命损失年（YLD）和丧失的残疾调整生命年（DALYs）。将当前暴露分布归因的 BOD 与反事实暴露分布情景（此处为理论最小风险暴露分布）进行比较。将使用地理信息系统分析和全国范围内表现出 RFs 暴露分布的不平等。
EBD 研究旨在向伊朗卫生部和医疗教育部提供一份正式报告，发表一系列关于选定环境 RFs 暴露趋势的文章，估计归因于这些 RFs 的 BOD，并评估暴露于 RFs 分布的不平等及其决定因素。伊朗的领土很大，人口、社会经济和地理区域多样。这项比较风险评估研究的结果可能为卫生政策制定者规划更全面和更具成本效益的循证策略铺平道路。
