The trend of burn mortality in Iran — A study of fire, heat and hot substance-related fatal injuries from 1990 to 2015

Highlights

• In Iran burn related age standardized mortality rate decreased considerably from 6.1 in 1990 to 1.7/100,000 in 2015.

• The annual percentage change of death was −5.42% in women and −4.22% in men.

• Men and women older than 85 years had the highest rates of burn-related mortality.

• The sex ratio has changed from less than 1 in 1990 to more than 1 in 2015.

• Ongoing efforts are necessary to further reduce the burden of burn injury in Iran.

Abstract

Introduction

Burn injuries are a major cause of preventable mortality worldwide. To implement preventive strategies, a detailed understanding of the rate and trend of fatal burn injuries is needed. The aim of this study was to determine the rate and trend of burn mortality at national and province level in Iran from 1990 to 2015.

Materials and Methods

The data were retrieved from various sources: the Death Registration System, cemetery databases, the Demographic and Health Survey and three national population and housing censuses. ICD-10 codes were converted to Global Burden of Disease (GBD) codes for comparability. After addressing the incompleteness of death data, statistical methods such as spatio-temporal modelling and Gaussian Process Regression (GPR) were applied to estimate the levels and trend of death and cause specific mortality.

Results

The number of deaths due to burning across Iran was 80,625, with a male to female ratio of 0.88, 0.94 and 1.14 in 1990, 1995 and 2015, respectively. The annual percentage change of age-standardized death rate from 1990 to 2015 was −5.42% and −4.22% in women and men, respectively. The burn-related age-standardized mortality rate decreased considerably from 5.97 in 1990 to 1.74 per 100,000 in 2015. The mortality rate due to burns was highest among those aged more than 85 years, especially in Ilam province.

Conclusion

This study showed a decline in burn mortality in Iran from 1990 to 2015. Continued efforts to reduce the burden of burns are needed to accelerate this progress and prevent injuries.

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.