Socioeconomic inequalities in noncommunicable disease mortality in Islamic Republic of Iran

BACKGROUND: 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. AIM: To assess the socioeconomic inequalities in mortality caused by major noncommunicable diseases across provinces and districts in Islamic Republic of Iran. METHODS: 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. RESULTS: 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. CONCLUSION: 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.