Provincial Disparities in the COVID-19 Burden: Hospital Data Analysis from Iran

Despite extensive evidence regarding the significant impact of the COVID-19 pandemic on population health in Iran, its effects at the sub-national level and comparisons across different geographic regions have garnered less attention. This study aimed to estimate key disease burden indicators, including incidence rate, mortality rate, case fatality rate, and disability-adjusted life years, across Iranian provinces during 2020 and 2021.

We obtained and analyzed hospital billing records of beneficiaries from the Iran Health Insurance Organization (IHIO) who were admitted for COVID-19 across Iran from the onset of the pandemic until December 2021. We identified cases using the WHO-recommended ICD-10 codes U07.1 and U07.2. In addition to reporting provincial-level rates of incidence, mortality, and case fatality rates, we also assessed disease burden by aggregating Years of Life Lost and Years Lived with Disability. Data management and analysis were conducted using Microsoft Excel Office 19 (Microsoft Corporation).

Substantial interprovincial disparities were observed. Semnan (3,331) and Yazd (3,171) recorded the highest incidence rates per 100,000 people, whereas Qom (224) and Alborz (212) reported the highest death rates. In 2020, the highest case fatality rate (18.59%) was recorded in Razavi Khorasan province, while in 2021, the peak rate (12.52%) was observed in Qom province, both rates exceeding the national average. The burden of disease peaked in Qom (4,287) and the central provinces, while the lowest burden was observed in Kohgiluyeh and Boyer-Ahmad (1,042).

This study indicates geographic, age, and sex-based disparities in the burden of COVID-19 in Iran. Therefore, future pandemic preparedness policies must account for regional differences and allocate resources equitably based on the needs of various population subgroups. Further research on health inequalities and comprehensive data on social determinants of health is essential.This provides stronger evidence for policymakers to address disparities in COVID-19 case fatality and mortality rates.