Socioeconomic inequalities in noncommunicable disease mortality in Islamic Republic of Iran

Limited evidence on the socioeconomic inequalities in mortality due to noncommunicable disease hampers the development and implementation of policies to improve health equity in Islamic Republic of Iran.

To assess the socioeconomic inequalities in mortality caused by major noncommunicable diseases across provinces and districts in Islamic Republic of Iran.

We obtained data for all deaths attributed to noncommunicable disease (1 105 000) for the period 2016-2018 across 429 districts in 31 provinces of Islamic Republic of Iran. We also obtained aggregated household income and expenditure data from the statistical centre. We analysed the data with R version 4.5.1, using the index of disparity to measure inequality and regression-based relative index of inequality to measure socioeconomic inequalities in noncommunicable disease mortality.

The average noncommunicable disease mortality ranged from 36.02 per 100 000 population in Kohgiluyeh and Boyer-Ahmad to 73.06 per 100 000 in Golestan. The index of disparity was >40% in Chaharmahal and Bakhtiari, Sistan and Baluchestan, and Kohgiluyeh and Boyer-Ahmad, and <20% in Semnan and Qazvin. Cardiovascular disease mortality showed the highest difference between adjacent socioeconomic groups, decreasing from 144.1 to 118.5 per 100 000 population between the first and second groups.

Noncommunicable disease mortality varied across provinces and socioeconomic groups, particularly for cardiovascular disease mortality. To reduce inequalities in mortality due to noncommunicable disease within and between the provinces, there is a need to strengthen health inequality monitoring using evidence on the causes of death, risk factors and the social determinants of health.