نابرابری امید زندگی در بدو تولد: مطالعه مقایسه ای ایران و کشورهای منطقه خاورمیانه و شمال آفریقا (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
در نیم قرن اخیر، امید زندگی در بدو تولد در منطقه خاورمیانه و شمال آفریقا (منا) و از جمله ایران افزایش چشمگیری یافته است. بااین حال تفاوت های مهمی در این شاخص در کشورهای این منطقه وجود دارد. این مطالعه در تلاش است تا تفاوت امید زندگی در بدو تولد ایران با کشورهای منطقه منا را با تمرکز بر اهمیت نسبی سهم هر کدام از گروه های سنی- جنسی و علل مرگ روشن نماید. مطالعه حاضر، پژوهشی کمی است که با استفاده از تحلیل ثانویه داده های موجود انجام گرفته است. در این تحقیق، اطلاعات مرگ برای ایران و همچنین کشورهای منا بر حسب تمامی علل مرگ و نیز مرگ ومیر به تفکیک سن و جنس از برآوردهای مطالعه جهانی بار بیماری ها سال 2019 گرفته شده است. سپس، با کاربرد تکنیک جدول عمر، امید زندگی دو جنس در بدو تولد برای ایران و کشورهای منا محاسبه شده و در ادامه، با استفاده از روش تجزیه، سهم گروه های سنی و علل مرگ در تفاوت امید زندگی ایران و منا شناسائی گردیده است. نتایج نشان داد که امید زندگی برای مردان ایرانی 4/3 و برای زنان 5/3 سال بالاتر از رقم متناظر برای کشورهای منطقه منا بود. همه گروه های سنی مردان و زنان (به جز گروه سنی 19-15 سال، 24-20 سال و 29-25 سال در مردان)، مشارکت مثبتی در بالاتر بودن شاخص امید زندگی ایرانیان داشته اند. برپایه نتایج، تفاوت های مشاهده شده در مرگ ومیرهای اطفال زیر یک سال و همچنین بیماری های قلبی و عروقی بیشترین سهم را به ترتیب از نظر اهمیت نسبی گروه های سنی و اهمیت علل اصلی مرگ در تبیین فزونی امید زندگی ایران در مقایسه با کشورهای منا داشته اند. از بین علل مرگ، تنها حوادث ترافیکی است که تأثیر منفی بر امید زندگی مردان در کشور (با سهم 05/0-) ایجاد نموده است.. به طورکلی، یافته های این تحقیق بیانگر این است که ایران در مقایسه با کشورهای منطقه منا از نظر تکوین مراحل گذار اپیدمیولوژیک پیشرو بوده است. بنابراین، به نظر می رسد که از این پس، ارتقاء بیشتر شاخص امید زندگی در کشور عمدتا منوط به کنترل مرگ ومیرهای غیرواگیر و در سنین سالمندی است علاوه بر آن، کاهش میزان مرگ ومیر جوانان در اثر حوادث ترافیکی در ایران باید در برنامه ریزی های سیاستی مدنظر قرار گیرد.Disparities in Life Expectancy at Birth: A Comparative Study of Iran and MENA Region Countries
Over the past fifty years, life expectancy at birth has risen significantly in the Middle East and North Africa (MENA) region, including Iran. Nonetheless, significant disparities persist across this region's nations. This study tries to clarify the difference in life expectancy at birth in Iran and Mena region by focusing on the relative contribution of age-sex groups and the causes of death. Utilizing a quantitative approach and secondary data analysis, this research draws upon 2019 mortality data by cause and age for Iran and MENA countries from the estimates of Global Burden of Diseases Study 2019. Life expectancy at birth for both Iran and MENA countries was calculated for 2019 using the life table technique, separately for each sex. Subsequently, the decomposition method was employed to assess the contribution of age groups and causes of death in the differences of life expectancy between Iran and MENA. Results indicate that life expectancy for Iranian men was 3.4 years and for women 3.5 years greater than the MENA regional averages. Positive contribution to Iranian higher life expectancy were observed across nearly all age groups, with the exception of the 15-19, 20-24, and 25-29 age groups in men. Child mortality under one year and cardiovascular diseases emerged as the most significant factors in Iran's elevated life expectancy relative to MENA countries. Conversely, traffic accidents were the sole cause of death adversely affecting Iranian men's life expectancy, with a calculated decrement of -0.05 years. Overall, the findings suggest that Iran is at a more advanced stage of epidemiological transition compared to average MENA countries, with life expectancy gains increasingly dependent on mitigating non-communicable disease mortality and addressing aging-related issues. The study also highlights the need for policy measures to reduce youth mortality from traffic accidents. IntroductionThe increase in life expectancy from under 40 years globally two centuries ago to over 80 years in many developed nations has fundamentally enhanced the human condition (Milholland and Vijg 2020). This advancement occurred even though, before the mid-19th century, most infants did not survive to adulthood, with only a fortunate few living to an advanced age. Nonetheless, studies on the global burden of diseases reveals significant disparities among countries (Vas et al. 2020). These disparities are also evident at the national level within the Middle East and North Africa region. Over recent decades, these countries have achieved considerable progress in health system development and population health improvement. Yet, the region continues to confront substantial political, economic, social, and health challenges.A comparison of mortality indices in Iran with global and regional standards indicates that Iran's mortality rates are comparatively favorable (Health Assessment and Evaluation Institute 2023). Analyzing the mechanisms underlying life expectancy differences at this juncture aids in assessing the health system's efficacy and Iran's potential to enhance life expectancy by pinpointing critical aspects of the mortality pattern. Therefore, this study endeavors to compare the life expectancies of Iran and the MENA region's countries, followed by an examination of the divergent life expectancy patterns, including age-sex distribution and causes of death. Methods and Data The present study is a quantitative research, employing a secondary analysis of existing data. The data utilized herein are taken from the Global Burden of Disease Study 2019's estimates. These data include all-cause mortality and cause-specific mortality for Iran and MENA countries, by age and sex for the year 2019. Additionally, the exposed population figures were obtained from the same source. Subsequent to acquiring data on deaths and the exposed population, death rates for each age group (nmx) were calculated. Thereafter, life expectancy at birth for Iran and MENA nations in 2019 was determined using life table technique separately for each sex. finally, the decomposition technique was applied to ascertain the contributions of various age groups and causes of death to the disparities in life expectancy between Iran and the MENA region. Findings The estimated life expectancy at birth for MENA countries is 72.6 years for men and 76 years for women, while for Iranian men and women, it stands at 76 years and 79.57 years, respectively. These figures indicate that Iranian men and women enjoy a life expectancy that is 3.4 and 3.5 years longer, respectively, than their MENA counterparts. Within the MENA region, Yemen exhibits the lowest life expectancy rates, with Yemeni men and women having life expectancies of 65.72 and 69.94 years, respectively, in 2019. Furthermore, life expectancy at birth for both sexes is below the regional average in Yemen, Sudan, Egypt, Iraq, Morocco, and Syria, whereas it surpasses the average in other nations. In contrast, Iran has one of the highest life expectancies at birth for both genders. Specifically, Kuwait, Turkey, Jordan, Bahrain, and Qatar surpass Iran in male life expectancy, while Tunisia, Turkey, and Kuwait exceed Iran in female life expectancy. Decomposition analysis of life expectancy at birth between Iran and MENA countries by age reveals that all age groups, except for males aged 15-19, 20-24, and 25-29 years, have positively influenced Iranian life expectancy, contributing to its overall increase. Notably, mortality in children under one year has played the most significant role in the higher life expectancy in Iran compared to MENA countries, accounting for approximately 0.5 years of the difference (3.4 years for men and 3.5 years for women) in both genders. For males, mortality in the 15-19 and 20-24 age groups has slightly negative impact on Iran's life expectancy.Cardiovascular diseases are the leading contributors to the increased life expectancy of Iranian men and women, responsible for 1.43 and 1.36 additional years, respectively, compared to MENA countries. This equates to cardiovascular diseases accounting for 42% and 38% of the enhanced life expectancy in Iranian men and women. Digestive system diseases follow, contributing 0.36 years for men and 0.33 years for women to the life expectancy gains in Iran over MENA countries. Deaths from neoplasms, chronic respiratory diseases, diabetes, kidney diseases, respiratory infections, other non-communicable diseases, congenital anomalies, other unintentional injuries (excluding traffic accidents), and intentional injuries have also positively influenced life expectancy in Iran for both sexes in 2019. Among these causes, only traffic accidents have negatively affected the country's life expectancy in men, with a calculated impact of -0.05 years. The study found no significant gender-based differences in the contribution of various causes of death to the life expectancy disparity between Iran and MENA countries. Conclusion and DiscussionAll age groups, except the male youth and traffic accidents, have positively influenced life expectancy in Iran. This is attributed to the fact that the standard death rate from traffic accidents in Iran is one of the highest globally—at 22 deaths per 100,000 population in 2019—which also affects many countries in the region, including Kuwait, Turkey, and Qatar. Given that men are disproportionately impacted by traffic accidents, these incidents rank as the second leading cause of disability-adjusted life years (DALYs) among Iranian men, whereas they are the sixth, eighth, and tenth leading causes of DALY in Qatar, Kuwait, and Turkey, respectively. The mortality rates among the youth and due to traffic accidents present significant opportunities to enhance life expectancy in Iran, requires special attention.The most pronounced disparity in life expectancy between Iran and the MENA region is associated with older age groups and cardiovascular diseases. This may partly result from a higher incidence of unhealthy lifestyles in MENA countries, including smoking, alcohol consumption, and lack of physical activity. Overall, the research indicates that preventable causes of death have substantially contributed to the double burden of life expectancy disparities in Iran relative to MENA nations. Although Iran's life expectancy surpasses that of other regional countries, it remains below the figures for Kuwait and Turkey, with non-communicable diseases, particularly cardiovascular conditions, being the predominant factors. Hence, the establishment of Iran's non-communicable diseases committee and the implementation of the 2015 national action plan targeting these diseases are crucial steps towards bridging this gap.
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