Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran; Department of Environmental Health Engineering, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran; The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
Water Res. 2019 Jun 15;157:94-105. doi: 10.1016/j.watres.2019.03.087. Epub 2019 Mar 28.
National and subnational burden of disease attributable to elevated fluoride levels in drinking water apportioned by sex, age group, province, and community type in Iran, 2017 were quantified based on disability-adjusted life years (DALYs). The attributable burden of disease was estimated using four input data: (1) effect size of elevated drinking water fluoride levels for dental and skeletal fluorosis, (2) population distribution of drinking water fluoride levels, (3) the threshold levels of fluoride in drinking water for contribution in dental and skeletal fluorosis, and (4) age-sex distribution of population. The attributable burden of disease was only related to dental fluorosis, because the fluoride levels were lower than the threshold value for skeletal fluorosis (4.0 mg/L) in all of the cases. The national attributable prevalence (per 100,000 people), DALYs, and DALY rate in 2017 were calculated to be 60 (95% uncertainty interval 48-69), 3443 (1034-6940), and 4.31 (1.29-8.68), respectively. The national attributable burden of disease was not significantly different by sex, but was affected by age and community type in a manner that the highest DALY rate was related to the age group 10-14 y (6.06 [1.82-12.21]) and over 66% of the national attributable DALYs occurred in rural communities. The attributable burden of disease occurred only in 10 out of 31 provinces and about 94% of the attributable DALYs were concentrated in four provinces Fars (1967 [592-3964]), Bushehr (414 [124-836]), West Azarbaijan (400 [120-808]), and Hormozgan (377 [113-761]). Implementation of fluoride-safe drinking water supply schemes in the four leading provinces can prevent most of the national health losses and partly compensate the increasing trend of disease burden from oral conditions at the national level.
基于伤残调整生命年（DALY），本研究量化了 2017 年伊朗因饮用水氟含量升高导致的可归因于疾病负担（按性别、年龄组、省份和社区类型划分）。通过使用以下四种输入数据来估算可归因于疾病的负担：（1）饮用水氟含量升高对氟斑牙和氟骨症的影响大小；（2）饮用水氟含量的人口分布；（3）饮用水中氟化物引起氟斑牙和氟骨症的阈值水平；（4）人口的年龄性别分布。可归因于疾病的负担仅与氟斑牙有关，因为在所有情况下，氟化物水平均低于氟骨症的阈值（4.0mg/L）。2017 年，全国归因于疾病的发病率（每 10 万人）、DALY 和 DALY 率分别计算为 60（95%置信区间 48-69）、3443（1034-6940）和 4.31（1.29-8.68）。全国归因于疾病的负担在性别上没有显著差异，但受年龄和社区类型的影响，DALY 率最高的年龄组为 10-14 岁（6.06[1.82-12.21]），66%以上的全国归因于疾病的 DALY 发生在农村社区。疾病的归因负担仅发生在 31 个省份中的 10 个，约 94%的归因 DALY 集中在 4 个省份，法尔斯省（1967[592-3964]）、布什尔省（414[124-836]）、西阿扎拜疆省（400[120-808]）和霍尔木兹甘省（377[113-761]）。在这四个主要省份实施氟化物安全饮用水供应计划，可以防止大部分的国家卫生损失，并在一定程度上补偿全国范围内口腔疾病负担的上升趋势。
