Gholami Bahareh, Bastan Mohammad-Mahdi, Gholami Samira, Nejati Azar, Khosravi Sepehr, Malekpour Mohammad-Reza, Rezaei Nazila, Shahin Sarvenaz, Golestani Ali
Tehran University of Medical Sciences, Tehran, Iran.
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
PLoS One. 2025 Jun 23;20(6):e0325085. doi: 10.1371/journal.pone.0325085. eCollection 2025.
The global burden of disease (GBD) is a helpful measure that provides estimations regarding the effect of diseases and injuries on public health. This evidence is vital for making health policies and assessing the progress toward global health targets. Specifically, the burden of disease in children and adolescents can have a massive impact on a society's health status. In this study, we aim to investigate the trends in years of life lost (YLL), years lost to disability (YLD), and disability-adjusted life years (DALYs) in children and adolescents under the age of 20 in Iran, based on GBD 2021 data.
The Global Burden of Disease (GBD) classifies all causes of death and disability into four levels. Level 1 includes three main categories: communicable, maternal, neonatal, and nutritional diseases (CMNNDs), non-communicable diseases (NCDs), and injuries. Level 2 expands these categories into 22 clusters of causes. This study provides a descriptive analysis of the trends in YLLs, YLDs, and DALYs at levels 1 and 2 of the GBD hierarchy, focusing on children and adolescents under the age of 20 in Iran and its 31 provinces from 1990 to 2021.
All metrics show an overall decline. DALYs rate from all causes decreased by 79.8%, YLDs by 6.2%, and YLLs rate by 89.3%. This reduction was consistent across all metrics of CMNNDs, NCDs, and injuries, with the exception of YLD for NCDs, which showed a rise between 1990 and 2021; from 3733.4 (2742.7 to 5013.2) to 4036.1 (2941.5 to 5436.5) per 100,000 population. Mental disorders have significantly contributed to the upward trend of NCDs. NCDs, with a rate of 5666.2 per 100,000 population, exhibited the highest DALY rate in Iran in 2021. The trend of DALYs, YLLs, and YLDs of injuries and CMNNDs in Iran has been mostly downward. Differences between provinces have declined over thirty years. Following the COVID-19 pandemic, there have been changes in the trend of several diseases, especially the rise of mental disorders, respiratory infections and tuberculosis.
Despite the overall decline in DALYs, YLLs, and YLDs for most causes of death, there has been an increase in YLDs from NCDs, underscoring the importance of addressing this issue. Reviewing YLLs to YLDs ratios for various diseases and injuries, combined with economic analyses of the cost-effectiveness of various health interventions, yields comprehensive evidence for health policy making.
全球疾病负担（GBD）是一项有用的衡量指标，可提供有关疾病和伤害对公众健康影响的估计。这些证据对于制定卫生政策和评估全球卫生目标的进展至关重要。具体而言，儿童和青少年的疾病负担会对社会的健康状况产生巨大影响。在本研究中，我们旨在基于2021年全球疾病负担数据，调查伊朗20岁以下儿童和青少年的生命损失年数（YLL）、残疾损失年数（YLD）和伤残调整生命年（DALY）的趋势。
全球疾病负担（GBD）将所有死亡和残疾原因分为四个级别。一级包括三个主要类别：传染病、孕产妇、新生儿和营养疾病（CMNND）、非传染性疾病（NCD）和伤害。二级将这些类别扩展为22个病因组。本研究对GBD层次结构一级和二级的YLL、YLD和DALY趋势进行了描述性分析，重点关注1990年至2021年伊朗及其31个省份20岁以下的儿童和青少年。
所有指标总体呈下降趋势。所有原因导致的DALY率下降了79.8%，YLD下降了6.2%，YLL率下降了89.3%。CMNND、NCD和伤害的所有指标均呈现这种下降趋势，但NCD的YLD除外，其在1990年至2021年间有所上升；从每10万人3733.4（2742.7至5013.2）增至4036.1（2941.5至5436.5）。精神障碍是导致NCD上升趋势的重要因素。2021年，NCD的发病率为每10万人5666.2，是伊朗DALY率最高的疾病。伊朗伤害和CMNND的DALY、YLL和YLD趋势大多呈下降趋势。三十年来各省之间的差异有所下降。在COVID-19大流行之后，几种疾病的趋势发生了变化，尤其是精神障碍、呼吸道感染和结核病的增加。
尽管大多数死亡原因的DALY、YLL和YLD总体呈下降趋势，但NCD导致的YLD有所增加，这凸显了解决这一问题的重要性。审查各种疾病和伤害的YLL与YLD比率，结合对各种卫生干预措施成本效益的经济分析，可为卫生政策制定提供全面的证据。
