The trend of burn mortality in Iran — A study of fire, heat and hot substance-related fatal injuries from 1990 to 2015
Introduction
Burn injuries are a universal health problem and an important cause of death with nearly 180,000 deaths each year. The greatest burden is in low- and middle-income countries [1] where more than 95% of all burn deaths occur [2].
Smolle et al. recently conducted a systematic review on journal publications from 2001 to 2016 for trends in burn epidemiology globally. In 13 countries, including Australia, Austria, Canada, Israel, Mexico, the Netherlands, the Oman, China, South Korea, Sweden, Germany, the United Kingdom and the United States, burn mortality has decreased. In four studies conducted in the Netherlands, Singapore, China and Finland no trend in burn mortality was observed [3] while in one study from Bulgaria, burn-related mortality has increased [4]. A population-based study by Navarrete and Rodriguez from 2000 to 2009 in Colombia, South America, indicated the crude and adjusted burn mortality rate in 5448 burn-related mortalities was 1.27 and 1.30 per 100,000, respectively [5]. In 2006, the death rate due to burns was 1.2 per 100,000 population in the United States, compared to 3.8 per 100,000 in Iran [6].
In low- and middle-income countries burns continue have a high incidence and are a main problem to the healthcare provider and society [7]. Burn injury is ranked eighth amongst the leading causes of death in Iran [8]. In a study in the north west of Iran, the six-year burn mortality rate from 2010 to 2016 was 2.9%, and was greatest in the period from 2011 to 2013 [9]. Another study indicated a mortality rate among patients with burn injury in Iran ranging from 1.4 to 9.7 per 100,000 [10]. Iran is an upper middle income country, where the mortality rate due to burn is high and causes of burn are changing over time [9]. According to the WHO, deaths from burns are preventable [11] and it supports the development and use of an international burn registry to increase the number of effective programs for burn prevention [1]. Thus, conducting accurate epidemiological studies nationwide is essential to provide accurate statistics. Trend and prevalence studies can guide national policy programmers to design plans for reducing the incidence of burn and its outcomes. The aim of this study was to determine the trend of burn mortality at national and provincial levels in Iran from 1990 to 2015.
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Study design
The National and Sub-National Burden of Disease (NASBOD) study was designed to determine the burden of 290 diseases and their 67 contributing risk factors from 1990 to 2015 in both national and provincial levels in Iran. The study classified cases into 19 age groups; these were organized in 5-year intervals, except for neonatal and children, which were 0 to 1-year and 1 to 4-years, and for individuals over 85 years old, whose age group was defined as 85+. The cause of death codes were initially
Results
Between 1990 and 2015, 80625 deaths related to burns in Iran (31 provinces) were recorded with a male: female ratio of 1.03. In 1990, 1995 and 2015, the burn-related mortality was 3053 (M/F ratio = 0.88), 4089 (M/F ratio = 0.94), and 1398 (M/F ratio = 1.14), respectively.
Discussion
We described the trend of burn-related mortality rate in Iran according to age and sex at different provincial levels from 1990 to 2015. The results indicate that the mortality rate increased from 1990 to 1995 in both genders at the national level, and then the mortality rate decreased considerably until 2015. This pattern is detectable among most of the provinces of Iran. Only among the older than 85 years age group is the trend not the same in some provinces of Iran. More efforts to reduce
Conclusion
Our study reported a decline in burn rates in Iran in recent years. This is welcome news but efforts to reduce burns and injuries are needed to accelerate this progress and reduce the burden of burns in Iran. The disparities in rates by province and the changing patterns by sex throughout the time period are an indication of the possibilities that could be achieved. Indeed, the whole country could have the same rates of the lowest province if adequate programs are in place to reduce the burden
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgments
The authors would like to thank Dr. Farshad Farzadfar, Chair of Non-Communicable Diseases Research Center (NCDRC) of Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences, who is the principal investigator of the NASBOD study. The authors would like to thank Dr. Mehrdad Azmin and the staff at NCDRC for their wholehearted cooperation. This study was funded by the Iran’s Ministry of Health and Medical Education.
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