Journal of Research in Health Sciences
Volume:26 Issue: 2, Spring 2026

Data on mortality from Diabetes Mellitus (DM) in the United States (US) are available from various sources, including the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) death certificate data and the Global Burden of Disease Study (GBD). This study aimed to compare DM mortality reporting between the CDC WONDER and GBD datasets.

In this retrospective cohort study, we calculated the absolute number of deaths and crude mortality rates attributed to DM as the underlying cause of death in CDC WONDER and GBD in the US from 1999 to 2021 (CMR with 95% Confidence Intervals (CI) or Uncertainty Intervals (UI)) per 100000 population. Because of methodological differences between datasets, results were also evaluated based on the inclusion and exclusion of mortality from DM with renal complications.

The reported CMR for DM increased from 34 (95% CI: 34 to 35) to 41 (95% CI: 41to 42) in CDC WONDER but decreased from 36 (95% UI: 32 to 37) to 29 (95% UI: 27 to 31) in GBD from 1999 to 2021. When deaths from DM with renal complications were excluded from CDC WONDER to mirror GBD reporting, CMRs in 1999 and 2021 from CDC WONDER were 33 (95% CI: 33 to 34) and 29 (95% CI: 28 to 29), respectively, and trends were generally similar.

Estimates of DM mortality rates and temporal trends in the US vary across commonly utilized sources of mortality data. These results have important implications for epidemiological efforts to understand and interpret DM mortality reporting.

Low birth weight (LBW) remains a serious global public health challenge, with more than 20 million babies born annually. Although maternal nutritional status during pregnancy is a major determinant of LBW, desirable perceptions and knowledge do not always lead to appropriate nutritional behavior without adequate health motivation. Accordingly, this study aimed to investigate the role of health motivation in pregnant women’s perceptions of nutritional compliance behaviors for LBW prevention. Study Design: A cross-sectional study.

This study was conducted among 220 pregnant women, selected using cluster random sampling. The required data were collected through a validated questionnaire based on the Health Belief Model construct, covering perceived susceptibility, severity, benefits, barriers, health motivation, and nutritional compliance behavior among pregnant women as an effort to prevent LBW. Eventually, path analysis was processed using AMOS 29.

Perceived susceptibility (Z=0.2866; P=0.009), perceptions of benefits (Z=0.443; P=0.001), and perceptions of barriers (Z=-2.938, P=0.003) had a significant indirect effect on the nutritional compliance behavior of pregnant women. However, perceived severity exerted no significant indirect impact on pregnant women’s nutritional compliance behavior (Z=1.787, P=0.074) through healthy motivation. The study model demonstrated excellent fit (χ²=0.295, RMSEA=0.000, CFI=1.000, TLI=1.026, RMR=0.187).

In general, health motivation is an important mediator in bridging perceptions to actual actions because it builds and strengthens the motivation of pregnant women through a more personal, communicative, and experience-based approach.

Stroke remains a global health challenge, with its burden disproportionately affecting developing nations, including Iran. Rapid access to medical care is crucial for improving outcomes. However, spatial and temporal factors often leads to delays, adversely impacting survival. This study investigated predictors of in-hospital mortality among stroke patients in Mashhad, Iran, with a novel focus on spatial directionality using circular statistical methods. Study Design: A retrospective cohort study.

The data of 1,171 stroke patients transported to Ghaem Hospital (2018–2019) were analyzed in this study. Pre-hospital delays, demographics, and clinical factors were assessed alongside spatial directionality, represented by the bearing angle between patients’ residences and the hospital. Circular logistic regression was used to model in-hospital mortality, incorporating both linear and circular predictors.

The in-hospital mortality rate was 14.3%. Independent predictors included age (OR: 1.03, 95% CI: 1.01–1.04), length of stay (OR: 1.02, 95% CI: 1.01–1.04), triage level (OR: 2.31, 95% CI: 1.20–4.45), ambulance accessibility (OR: 0.97, 95% CI: 0.96–0.99), and the sine of the bearing angle (OR: 1.37, 95% CI: 1.02–1.83). Mortality was higher along the north-south axis, potentially reflecting disparities in healthcare access and population characteristics. Gender and final diagnosis were not significant predictors.

Overall, age, length of stay, triage level, ambulance accessibility, and spatial directionality were significant predictors of in-hospital stroke mortality. The circular statistical approach provided added value by detecting directional disparities not captured through conventional methods, underscoring the need for spatially informed interventions to reduce inequities in stroke outcomes.

Illicit drug use is a serious multi-factorial public health challenge globally, especially in the Eastern Mediterranean Region (EMR). In 2019, the disability-adjusted life year rate for drug use disorders in the EMR rose by approximately 40%, whereas the global rate increased by less than 25%. Despite this growing burden, limited data exist on gender patterns of drug-related mortality and its associated socio-economic factors at the national level in Iran. This study evaluated socioeconomic factors contributing to gender disparities in illicit drug-related mortality across provinces of Iran. Study Design: A national ecological study.

A secondary analysis of data from the Iranian Forensic Medicine Organization’s national registry was conducted from March 2022 to March 2024. Descriptive statistics were calculated for socioeconomic indicators (happiness, life satisfaction, literacy rate, unemployment, economic participation, and gross domestic product) across provinces of Iran to assess gender disparities in illicit drug-related mortality. Bivariate and multivariate regression analyses were performed to examine the relationship between these indicators and the sex ratio of illicit drug-related deaths.

The sex ratio of illicit drug-related deaths was 7.20, indicating a considerable gender disparity. According to the final model, greater female economic participation (β=-0.517, P=0.018) and higher GDP (β=-1.196, P=0.002) were significantly correlated with a lower gender gap in illicit drug-related mortality across provinces in Iran.

At the provincial level, there were noticeable correlations between a narrower gender gap in illicit drug-related mortality and both greater female economic participation and higher GDP in Iran.

Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system with increasing prevalence in Iran. Identifying modifiable environmental and lifestyle risk factors is essential for disease prevention and public health strategies. Therefore, this study aimed to evaluate environmental, lifestyle, and medical factors associated with multiple sclerosis in Kermanshah, Iran

This case-control study was conducted on 300 MS patients and 300 matched healthy controls. Data on demographics, substance use, sun exposure, medical and psychiatric history, family history, and major life stressors were collected using questionnaires. Univariate and multivariable logistic regression analyses were utilized to estimate crude and adjusted odds ratios and 95% confidence intervals.

MS patients were more likely to be female, with lower educational attainment compared to controls. In addition, reduced sun exposure in adolescence and adulthood was strongly associated with MS (P<0.05). Moreover, passive smoking during adolescence and maternal smoking during pregnancy were related to higher odds of MS (aOR 1.54, 95% CI: 1.05–2.72 and aOR 3.70, 95% CI: 1.19–11.52, respectively). A history of depression (aOR 3.17, 95% CI: 1.95– 5.13) and migraine (aOR 1.94, 95% CI: 1.14–3.30) were also significantly associated with MS. Additionally, a family history of MS in first-degree relatives was more frequent among cases (aOR 2.31, 95% CI: 1.36–3.94). All models were adjusted for gender, ethnicity, and education level.

The findings indicated that MS in Kermanshah is shaped by reduced sunlight exposure, passive and maternal smoking, psychiatric comorbidities, and family history, highlighting several modifiable environmental determinants that may guide targeted prevention efforts and inform public health strategies in high-prevalence regions.

Drug abuse is a public health problem that leaves morbidity, disability and premature mortality in the society. This study investigated the epidemiological features, socioeconomic disparities, and geographic distribution of drug abuse-related deaths across Iran in 2020. Study Design: An ecological study.

Data on drug abuse deaths were obtained from the Iranian Legal Medicine Organization (LMO). The Theil index, between-group variance (BGV), concentration index, and concentration curve (CC) were used to assess mortality inequality. Finally, spatial inequality was analyzed using Anselin’s Local Moran’s.

In 2020, the drug abuse mortality rate was 49.91 per million people in Iran. Opium (24.89%), methamphetamine (21.23%), and heroin (16.58%) were the most common substances involved in this respect. High-high clusters, including Hamadan, Markazi, Lorestan, and Ilam, had high drug abuse death rates and were surrounded by similar provinces. The concentration index of 0.10 indicated higher drug-related deaths in provinces with a higher human development index (HDI). Moreover, the Theil index and BGV revealed considerable regional inequality in drug abuse mortality rates.

Overall, drug-related deaths in Iran predominantly affected males, particularly in the 30–39 age group. Victims had low educational attainment and were self-employed. Provinces with lower HDIs, such as Kermanshah, Hamedan, and Lorestan, had the highest mortality rates. Thus, these regions need targeted prevention and treatment. Addressing the links between substance use and suicidal behavior requires integrated mental health and addiction treatment services. In addition, policymakers should prioritize educational, preventive, and treatment programs in high-risk areas.

Poisson and negative binomial (NB) regression models are commonly used to investigate the association between air pollution and hospital admissions for cardiovascular and respiratory diseases. This study utilized the new Poisson-generalized Lindley (NPGL) regression model to evaluate the relationship between air pollutants and daily hospital admissions for these diseases among elderly individuals. Study Design: An ecological cross-sectional study.

The data related to daily air pollutant concentrations, meteorological parameters, and the number of hospitalizations for cardiovascular and respiratory patients were gathered from the Environmental Protection Organization, the General Directorate of Meteorology, Farshchian Heart Hospital, and Shahid Beheshti Hospital in Hamadan. Then, the relationship between air pollution and daily hospital admissions was assessed using Poisson, NB, and NPGL models.

The findings indicated that the accuracy of the regression coefficients estimated in the NPGL model was higher than that in the NB and Poisson models for most pollutants. Specifically, the relative risk for carbon monoxide (CO) was calculated at 1.307 (95% confidence interval: 1.270–1.345). Cardiovascular hospitalization increased by 30.7% for each unit increase in CO concentration. A significant and direct association was found between exposure to all pollutants, except for PM2.5, and hospitalization for respiratory diseases (P<0.05).

Overall, there was a significant relationship between air pollution and hospital admissions for cardiovascular diseases (CVDs) and respiratory diseases among the elderly, particularly regarding CO. This study indicates the need for policymakers to implement health programs to mitigate the effects of air pollution on vulnerable elderly populations.

Visceral leishmaniasis (VL) is a fatal parasitic disease endemic to tropical regions and associated with severe complications and high mortality. Persistent challenges such as delayed diagnosis and limited treatment options highlight the urgent need for robust predictive epidemiological models. Study Design: This study was a secondary analysis conducted using cross-sectional data.

Sex-specific VL epidemiological data from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) database and analyzed globally and across 98 endemic countries and regions. An enhanced illness-death model (IDM), incorporating remission, was applied to estimate the age-standardized prevalence rate (ASPR) of VL by 2040.

Globally, the global ASPR of VL decreased by 94.68% between 1990 and 2021. It is projected to decrease by an additional 72.55% by 2040, declining from 0.108 in 2021 to 0.030 (95% CI: 0.020, 0.043) per 100,000 population. In 2040, ASPR is expected to remain higher in males than in females (0.041 vs. 0.019). Tropical Latin America is projected to have the highest regional ASPR at 0.583 (95% CI: 0.565, 0.602). Western Sub-Saharan Africa is the only region expected to experience an increase, rising by 417.12%. Of 83 nations, 27 are expected to exhibit increasing trends, with Djibouti demonstrating the highest projected ASPR at 20.32 (95% CI: 5.25, 78.67), a 2050.59% increase from 2021 to 2040.

Despite global declines in VL prevalence, significant increases are expected in Western Sub-Saharan Africa and countries such as Djibouti, highlighting the need for targeted interventions. Strengthening healthcare systems, improving vector control, and addressing sexspecific risks are crucial to maintain global progress.